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ABSTRACT: Socioeconomic adversity is among the foremost fundamental causes of human suffering, and this is no less true in old age. Recent reports on socioeconomic inequalities in mortality rate in old age suggest that a low socioeconomic position continues to increase the risk of death even among the oldest old. We aimed to examine the evidence for socioeconomic mortality rate inequalities in old age, including information about associations with various indicators of socioeconomic position and for various geographic locations within the World Health Organization Region for Europe. The articles included in this review leave no doubt that inequalities in mortality rate by socioeconomic position persist into the oldest ages for both men and women in all countries for which information is available, although the relative risk measures observed were rarely higher than 2.00. Still, the available evidence base is heavily biased geographically, inasmuch as it is based largely on national studies from Nordic and Western European countries and local studies from urban areas in Southern Europe. This bias will hamper the design of European-wide policies to reduce inequalities in mortality rate. We call for a continuous update of the empiric evidence on socioeconomic inequalities in mortality rate.
Epidemiologic Reviews 02/2013; · 7.58 Impact Factor
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ABSTRACT: Objectives. To investigate whether number of children and, among parents, having a daughter is associated with older people's likelihood of at least weekly face-to-face social contact and later receipt of help if needed. Method. Multivariate analysis of data from Waves 1 and 2 of the English Longitudinal Study of Ageing (ELSA). RESULTS: Older parents in England had higher chances of at least weekly face-to-face social contact than their childless counterparts but larger family size had only a slight additional effect. For parents, having at least one daughter was more important than number of children. Larger family size was positively associated with receipt of help from a child by parents with activities of daily living (ADL) or instrumental activities of daily living (IADL) limitations. Childless women were more likely than mothers to receive help from friends but even so had lower odds of receiving help from any informal source. Contact with a child in 2002 predicted receipt of help 2 years later. Discussion. These results show some advantages for older parents compared with childless individuals in terms of social contact and receipt of help and, among parents, an additional effect of having a daughter. Changes in family size distributions have implications for the support of older people and for planners of formal services.
The Journals of Gerontology Series B Psychological Sciences and Social Sciences 10/2012; 67(6):742-54. · 2.62 Impact Factor
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ABSTRACT: Previous research has shown that home ownership is associated with a reduced risk of admission to institutional care. The extent to which this reflects associations between wealth and health, between wealth and ability to buy in care or increased motivation to avoid admission related to policies on charging is unclear. Taking account of the value of the home, as well as housing tenure, may provide some clarification as to the relative importance of these factors.
To analyse the probability of admission to residential and nursing home care according to housing tenure and house value.
Cox regression was used to examine the association between home ownership, house value and risk of care home admissions over 6 years of follow-up among a cohort of 51 619 people aged 65 years or older drawn from the Northern Ireland Longitudinal Study, a representative sample of ≈28% of the population of Northern Ireland. Results 4% of the cohort (2138) was admitted during follow-up. Homeowners were less likely than those who rented to be admitted to care homes (HR 0.77, 95% CI 0.70 to 0.85, after adjusting for age, sex, health, living arrangement and urban/rural differences). There was a strong association between house value/tenure and health with those in the highest valued houses having the lowest odds of less than good health or limiting long-term illness. However, there was no difference in probability of admission according to house value; HRs of 0.78 (95% CI 0.67 to 0.90) and 0.81 (95% CI 0.70 to 0.95), respectively, for the lowest and highest value houses compared with renters.
The requirement for people in the UK with capital resources to contribute to their care is a significant disincentive to institutional admission. This may place an additional burden on carers.
Journal of epidemiology and community health 02/2012; 66(2):166-9. · 3.04 Impact Factor
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ABSTRACT: We investigated associations between later-life health and fertility history for women and men, using the British Household Panel Survey. We modelled health and its rate of change jointly with sample retention over an 11-year period. For women, childlessness is associated with limitation of activity for health reasons and faster acquisition of the limitation. High parity (four or more children) is associated with poorer health for both women and men. For the parous, this association is also found when age at first birth is controlled. Early parenthood is associated with poorer health. For parents of two or more children, a birth interval of less than 18 months is associated with having a health limitation and an accelerated rate of acquiring it. We conclude that biosocial pathways link parenthood careers and the later-life health of both women and men, and that implications of closely spaced births for parents merit further attention.
Population Studies 06/2011; 65(2):201-15. · 1.08 Impact Factor
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ABSTRACT: In developed countries with old age structures most deaths occur at older ages and older people account for the majority of those in poor health, which suggests a particular need to investigate health inequalities in the older population.
We empirically compared the materialist, psychosocial and lifestyle/behavioural theoretical mechanisms of explanation for socio-economic variation in health using data from two waves of the English Longitudinal Study of Ageing (ELSA), a nationally representative multi-purpose sample of the population aged 50 and over living in England. Three dimensions of health were examined: somatic health, depression and well-being.
The materialist and lifestyle/behavioural paths had the most prominent mediating role in the association between socio-economic position and health in the older population, whereas the psychosocial pathway was less influential and exerted most of its influence on depression and well-being, with part of its effect being due to the availability of material resources.
From a policy perspective there is therefore an indication that population interventions to reduce health differentials and thus improve the overall health of the older population should focus on material circumstances and population based interventions to promote healthy lifestyles.
BMC Public Health 05/2011; 11:390. · 2.00 Impact Factor
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ABSTRACT: Our primary aim is to develop and validate a population health metric for survey-based health assessment that combines information from both self-reported and observer-measured health indicators. A secondary objective is to use this index to examine gender and socioeconomic differentials in the health status of older people. We use data from the second wave of the English Longitudinal Study of Ageing (ELSA) conducted in 2004 (N = 8,870). Information from three observer-measured and three self-reported health indicators was combined, using a latent variable modeling approach. A model that decomposed the manifest health indicators to valid health, systematic error, and random error was found to fit the data best. The latent health dimension represented somatic health, and was tested against three external criteria: height, waist-hip ratio, and smoking status. We present the Latent Index of Somatic Health (LISH), as well as a procedure for deriving the LISH in surveys employing both self- and observer-measured health indicators. Observer-measured and self-reported indicators were found to be equally biased in indexing population somatic health, with the exception of self-reports of functional limitations, which was the most reliable somatic health indicator. As expected, results showed that women had worse health than men and that socioeconomic advantage is associated with better somatic health.
Demography 05/2011; 48(2):699-724. · 1.93 Impact Factor
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ABSTRACT: Ageing is associated with increased risk of poor health and functional decline. Uncertainties about the health-related benefits of nutrition and physical activity for older people have precluded their widespread implementation. We investigated the effectiveness and cost-effectiveness of a national nutritional supplementation program and/or a physical activity intervention among older people in Chile.
We conducted a cluster randomized factorial trial among low to middle socioeconomic status adults aged 65-67.9 years living in Santiago, Chile. We randomized 28 clusters (health centers) into the study and recruited 2,799 individuals in 2005 (~100 per cluster). The interventions were a daily micronutrient-rich nutritional supplement, or two 1-hour physical activity classes per week, or both interventions, or neither, for 24 months. The primary outcomes, assessed blind to allocation, were incidence of pneumonia over 24 months, and physical function assessed by walking capacity 24 months after enrollment. Adherence was good for the nutritional supplement (~75%), and moderate for the physical activity intervention (~43%). Over 24 months the incidence rate of pneumonia did not differ between intervention and control clusters (32.5 versus 32.6 per 1,000 person years respectively; risk ratio = 1.00; 95% confidence interval 0.61-1.63; p = 0.99). In intention-to-treat analysis, after 24 months there was a significant difference in walking capacity between the intervention and control clusters (mean difference 33.8 meters; 95% confidence interval 13.9-53.8; p = 0.001). The overall cost of the physical activity intervention over 24 months was US$164/participant; equivalent to US$4.84/extra meter walked. The number of falls and fractures was balanced across physical activity intervention arms and no serious adverse events were reported for either intervention.
Chile's nutritional supplementation program for older people is not effective in reducing the incidence of pneumonia. This trial suggests that the provision of locally accessible physical activity classes in a transition economy population can be a cost-effective means of enhancing physical function in later life.
Current Controlled Trials ISRCTN 48153354.
PLoS Medicine 04/2011; 8(4):e1001023. · 16.27 Impact Factor
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ABSTRACT: As shared family context may be an important influence on mental health, and gender differences in mental health, in later life we investigated how gender, family-related variables and gender roles were associated with mental health in older married couples.
Using data on a sample of 2,511 married couples born between 1923 and 1953 (drawn from the British Household Panel Survey) we analysed differences in the mental health of husbands and wives by fertility history, length of marriage, presence of co-resident children, reported social support, hours of household work, attitudes to gender roles and health of husband and wife. Mental health in 2001 was measured using the General Health Questionnaire (GHQ-12). Multilevel modelling was used to assess effects in husbands and wives and variations between husbands and wives.
Results showed that although the mental health of married couples was correlated, wives had poorer mental health than their husbands. The gender difference was smaller in couples who lived with a child aged 16 or more (and had no younger co-resident children) and in couples in which both spouses had experienced early parenthood. The influence of individual and family characteristics on mental health also differed between husbands and wives. For husbands, early fatherhood and co-residence with a child or children aged 16 or more increased the odds of poor mental health. For wives, having had a child when aged 35 or more appeared protective while having traditional gender role attitudes increased the odds of poorer mental health.
The role of family characteristics in the shared marital context has complex associations with mental health, some of which seem gender specific. Although wives express more mental distress, husbands in general show poorer mental health related to family characteristics.
Social Psychiatry 03/2010; 46(4):331-41. · 2.05 Impact Factor
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ABSTRACT: The relationship between women's reproductive histories and later all-cause mortality has been investigated in several studies, with mixed results. Some studies have also considered cause-specific mortality and some have included men, but none has done both. We analyse associations between parity and age of first birth for women and men across 11 cause-of-death groupings using Norwegian register data for complete cohorts born 1935-1968 whose mortality was observed 1980-2003 (i.e. at ages 45-68). Age, period, educational level, marital status, region of residence and population size of municipality were included as co-variates. In total, there were 63,000 deaths. Results showed that relative to parents of two children, childless men and women and those with one child had higher mortality risks for nearly all cause of death groupings. High parity (4+ children) was associated with raised male mortality from accidents and violence and higher mortality from cancer of the cervix among women. For other cause and gender groupings there was either little difference between those with two children and those of higher parities or an overall negative association between parity and mortality. Among men with the lowest level of education, however, high parity was positively associated with mortality from circulatory diseases. For all causes except female breast cancer, there was an inverse association between age at first birth and mortality risk. Similarities observed across cause groups and for women and men suggest that much of the fertility-mortality relationship is a result of selection or effects of reproductive behaviour on lifestyle. The latter may include both beneficial effects and harmful stress responses. However, physiological mechanisms are most probably important for some causes of death for women. Research on associations between parenting histories, health related behaviours, social support exchanges and reported or measured stress is needed to clarify mechanisms underlying the associations reported here.
Social Science [?] Medicine 02/2010; 70(11):1847-57. · 2.70 Impact Factor
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ABSTRACT: Abstract Background Health benefits of marriage have long been recognised and extensively studied but previous research has yielded inconsistent results for older people, particularly older women. At older ages accumulated benefits or disadvantages of past marital experience, as well as current marital status, may be relevant, but fewer studies have considered effects of marital history. Possible effects of parity, and the extent to which these may contribute to marital status differentials in health, have also been rarely considered. Methods We use data from the Office for National Statistics Longitudinal Study, a large record linkage study of 1% of the population of England & Wales, to analyse associations between marital history 1971-1991 and subsequent self-reported limiting long-term illness and mortality in a cohort of some 75,000 men and women aged 60-79 in 1991. We investigate whether prior marital status and time in current marital status influenced risks of mortality or long term illness using Poisson regression to analyse mortality differentials 1991-2001 and logistic regression to analyse differences in proportions reporting limiting long-term illness in 1991 and 2001. Co-variates included indicators of socio-economic status at two or three points of the adult life course and, for women, number of children borne (parity). Results Relative to men in long-term first marriages, never-married men, widowers with varying durations of widowerhood, men divorced for between 10 and twenty years, and men in long-term remarriages had raised mortality 1991-2001. Men in long-term remarriages and those divorced or widowed since 1971 had higher odds of long-term illness in 1991; in 2001 the long-term remarried were the only group with significantly raised odds of long-term illness. Among women, the long-term remarried also had higher odds of reporting long-term illness in 1991 and in 2001 and those remarried and previously divorced had raised odds of long-term illness and raised mortality 1991-2001; this latter effect was not significant in models including parity. All widows had raised mortality 1991-2001 but associations between widowhood of varying durations and long-term illness in 1991 or 2001 were not significant once socio-economic status was controlled. Some groups of divorced women had higher mortality risks 1991-2001 and raised odds of long-term illness in 1991. Results for never-married women showed a divergence between associations with mortality and with long-term illness. In models controlling for socio-economic status, mortality risk was raised but the association with 1991 long-term illness was not significant and in 2001 never-married women had lower odds of reporting long-term illness than women in long-term first marriages. Formally taking account of selective survival in the 20 years prior to entry to the study population had minor effects on results. Conclusions Results were consistent with previous studies in showing that the relationship between marital experience and later life health and mortality is considerably modified by socio-economic factors, and additionally showed that taking women's parity into account further moderated associations. Considering marital history rather than simply current marital status provided some insights into differentials between, for example, remarried people according to prior marital status and time remarried, but these groups were relatively small and there were some disadvantages of the approach in terms of loss of statistical power. Consideration of past histories is likely to be more important for later born cohorts whose partnership experiences have been less stable and more heterogeneous.
BMC Public Health. 01/2010;
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ABSTRACT: The ONS Longitudinal Study (LS) includes information from the 1971, 1981, 1991 and 2011 censuses. This article explains definitional differences over time, and their implications for household and family classifications.List of tables, 65.
Population trends 01/2010;
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ABSTRACT: Previous studies have shown that self-reported health indicators are predictive of subsequent mortality, but that this association varies between populations and population sub-groups. For example, self-reported health is less predictive of mortality at older ages, has a stronger association with mortality for men than for women and is more predictive of mortality for those of lower than those of higher socio-economic status, particularly among middle aged working adults. This article explores this association using individual level, rather than ecological, data to see whether there are differences between the constituent countries of the UK in the relationship between self-reported health and subsequent mortality, and to investigate socio-economic inequalities in mortality more generally. Data are used from the three Census based longitudinal studies now available for England and Wales, Scotland and Northern Ireland.List of tables, 13.
Population trends 01/2010;
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ABSTRACT: Populations throughout Europe and the developed world are ageing, with growing proportions over age 60, associated with increases
in life expectancy and falling birth rates. Between 1960 and 2004, the proportion of people aged 65 and over in the UK increased
by a third from 11.7 to 15.6%, and the proportion of the population aged 85 and over nearly tripled (Soule et al., 2005).
In the same time period, there have been major changes in living arrangement patterns of older people throughout Europe and
the developed world. Older people are much less likely to live with relatives in multi-generational households than previously
and are much more likely to live alone (Elman and Uhlenberg, 1995; Glaser et al., 2004; Iacovou, 2000). For example, in Italy
the proportion of women aged 65 and over living alone was 22% in 1971, and had risen to 36% by 2000 (Tomassini et al., 2004).
In the last decade, there has been a stalling of the trend towards increased solitary living among older people in Europe,
but this has been driven by demographic changes, notably increases in the proportion of older people who are married, rather
than by changes in the residence patterns of the unmarried (Grundy, 1996; Tomassini et al., 2004). The overall pattern, however,
is of greater residential independence among older people with larger proportions living alone or just with a spouse.
12/2009: pages 127-150;
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Emily Grundy
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ABSTRACT: Evolutionary theory suggests a trade-off between reproduction and somatic maintenance implying a negative relationship between parity and longevity, at least in natural fertility populations. In populations in which fertility control is usual, there are also a number of mechanisms that may link reproductive careers and later mortality, but evidence of associations between women's fertility patterns and their later life health has been judged inconclusive due to varying controls for socio-economic characteristics and marital status. Here, we build on three recent studies that followed a common framework to investigate associations between women's parity and timing of first and last birth with mortality in late middle age in three contemporary developed counties, Norway, England and Wales, and the USA. Data were drawn from whole population registers (Norway); a large census-based record linkage study (England and Wales), and a nationally representative survey linked to death records (USA). Results show that teenage childbirth was associated with higher mortality risks in late middle age in all three countries. Risks of death were significantly raised among nulliparous women in Norway and England and Wales, and also raised (although not significantly so) for childless US women. However, although higher parity was associated with a slight mortality disadvantage in England and Wales and the USA, the reverse seemed the case in Norway. These finding suggest that in populations in which fertility control is usual, contextual factors influencing the relative costs and benefits of childbearing may influence associations between fertility histories and later mortality.
American Journal of Human Biology 06/2009; 21(4):541-7. · 2.27 Impact Factor
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ABSTRACT: In an effort to promote healthy ageing and preserve health and function, the government of Chile has formulated a package of actions into the Programme for Complementary Food in Older People (Programa de Alimentación Complementaria para el Adulto Mayor - PACAM). The CENEX study was designed to evaluate the impact, cost and cost-effectiveness of the PACAM and a specially designed exercise programme on pneumonia incidence, walking capacity and body mass index in healthy older people living in low- to medium-socio-economic status areas of Santiago. The purpose of this paper is to describe in detail the methods that will be used to estimate the incremental costs and cost-effectiveness of the interventions.
The base-case analysis will adopt a societal perspective, including the direct medical and non-medical costs borne by the government and patients. The cost of the interventions will be calculated by the ingredients approach, in which the total quantities of goods and services actually employed in applying the interventions will be estimated, and multiplied by their respective unit prices. Relevant information on costs of interventions will be obtained mainly from administrative records. The costs borne by patients will be collected via exit and telephone interviews. An annual discount rate of 8% will be used, consistent with the rate recommended by the Government of Chile. All costs will be converted from Chilean Peso to US dollars with the 2007 average period exchange rate of US$1 = 522.37 Chilean Peso. To test the robustness of model results, we will vary the assumptions over a plausible range in sensitivity analyses.
The protocol described here indicates our intent to conduct an economic evaluation alongside the CENEX study. It provides a detailed and transparent statement of planned data collection methods and analyses.
ISRCTN48153354.
BMC Health Services Research 06/2009; 9:85. · 1.66 Impact Factor
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ABSTRACT: To investigate the influence of country of residence on depression and well-being among older Europeans, after establishing the between-country measurement invariance of both constructs.
We used data from a cross-sectional nationally representative population-based sample of older Europeans, the Survey of Health, Ageing, and Retirement in Europe (SHARE). The analysis sample comprised 13,498 older Europeans from nine countries. The EURO-D was used to measure depression, and a well-being outcome was derived from self-report items available in SHARE. The between-country measurement invariance of both mental health outcomes was established using modern psychometric modeling techniques.
After adjustment for demographic characteristics and the presence of chronic illness, Spain was the country scoring highest on depression and Denmark highest on well-being. Optimal mental health was associated with higher educational attainment and being married.
There is considerable between-country heterogeneity in later-life mental health in Europe. The Scandinavian countries, the Netherlands, and Austria, do best (low depression/high well-being), followed by Germany and France, whereas residents of Spain, Italy, and Greece report the worst mental health.
The Journals of Gerontology Series B Psychological Sciences and Social Sciences 06/2009; 64(5):666-76. · 2.62 Impact Factor
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ABSTRACT: to identify socio-psychological predictors of mortality during a 20-year follow-up period among people aged 65 to <85 and 85+ at baseline interview.
elderly people living at home in East London and mid-Essex, who responded to surveys of successful survival in older age in the late 1980s; their mortality was traced through the National Health Central Registry.
adjusted analyses show that, as expected, the hazard rate for mortality over a 20-year follow-up was reduced for younger respondents and increased for less functionally able respondents. The hazard ratio for males was almost one and a half times that of females. The hazard rate was also reduced with each categorical increase in life satisfaction and was consistently reduced for those who undertook crafts, social visiting and activities regularly. There was some variation by age and sex.
the results show that social participation is associated with lower risks of death, particularly among people aged 65 to <85, and that life satisfaction is also protective, particularly among females and people aged 85+, even when health status and socio-demographic circumstances are controlled. The study thus provides support for the hypothesised influence of social participation and subjective well-being on survival in older age.
Age and Ageing 10/2008; 38(1):51-5. · 3.09 Impact Factor
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ABSTRACT: In this paper, we examine associations between employment history and marital status and unpaid care provision among those aged 40-59 in England and Wales. We used data from a large nationally representative longitudinal study, the Office for National Statistics Longitudinal Study. Initially based on a sample drawn from the 1971 Census, in 2001 this study included data on 110,464 people aged 40-59 of whom 5% provided 20 or more hours per week of unpaid care. We analysed associations between caregiving of this intensity and current employment, employment history, employment characteristics, marital status, and employment after childbearing. Among men, caregiving was associated with a history of lower levels of employment. The small group of men with a history of least employment were 70% more likely to provide care than those with a history of most employment. Among women, caregiving was associated with a history of non-employment, but there were no differences between those with fully engaged and partially engaged labour market histories. Analyses of a subset of data on women who had a child between 1981 and 1991 showed that those who had returned to full-time paid work by 1991 were over 50% less likely to later become caregivers. Some associations between employment characteristics and propensity to provide 20 or more hours per week of care were also identified. Those in public sector jobs and those previously in employment with a caregiving dimension were 20-30% more likely than other working women to provide unpaid care. These results suggest a continuing gender dimension in care provision which interacts with marital status and employment in gender-specific ways. It also suggests that implementation of strategies to enable those in midlife to combine caregiving and work responsibilities, should they wish to do so, should be an urgent priority.
Health & Social Care in the Community 08/2008; 16(4):388-99. · 0.86 Impact Factor
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ABSTRACT: There is growing recognition that reproductive patterns may have long-term health implications, although most evidence is restricted to women. The authors used register data to derive fertility histories for all Norwegian men and women born in 1935-1958. Discrete-time hazard modeling was used to analyze later-life mortality by aspects of reproductive history. A total of 63,312 deaths were observed during 14.5 million person-years of follow-up in 1980-2003, when subjects were aged 45-68 years. Models included detailed information on educational qualifications and marital status. Odds of death relative to those for subjects with two children were highest for the childless (women: odds ratio (OR) = 1.50, 95% confidence interval (CI): 1.43, 1.57; men: OR = 1.35, 95% CI: 1.30, 1.40) and next highest for those with only one child (women: OR = 1.31, 95% CI: 1.26, 1.37; men: OR = 1.20, 95% CI: 1.16, 1.24). Results for the parous showed a positive association between earlier parenthood and later mortality, a reverse association with late age at last birth, and an overall negative association between higher parity and mortality. The similarity of results for women and men suggests biosocial pathways underlying associations between reproductive history and health. The lack of any high-parity disadvantage suggests that in the "family friendly" Norwegian environment, the health benefits of having several children may outweigh the costs.
American journal of epidemiology 03/2008; 167(3):271-9. · 5.59 Impact Factor
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ABSTRACT: We investigate mortality differentials by marital status among older age groups using a database of mortality rates by marital status at ages 40 and over for seven European countries with 1 billion person-years of exposure. The mortality advantage of married people, both men and women, continues to increase up to at least the age group 85-89, the oldest group we are able to consider. We find the largest absolute differences in mortality levels between marital status groups are at high ages, and that absolute differentials are: (i) greater for men than for women; (ii) similar in magnitude across countries; (iii) increase steadily with age; and (iv) are greatest at older age. We also find that the advantage enjoyed by married people increased over the 1990s in almost all cases. We note that results for groups such as older divorced women need to be interpreted with caution.
Population Studies 12/2007; 61(3):287-98. · 1.08 Impact Factor
