Cohort-specific disability trajectories among older women and men in Europe 2004-2017

Functional limitations in 2004-22 among Europeans aged 55-69 years: time trends according to labor market group and impacts of the COVID-19 pandemic

In terms of work ability, impacts of the Coronavirus disease 2019 (COVID-19) pandemic on functional ability warrant investigation. The aim is to explore trends in functional limitations in 2004-22 focusing on the impacts of the pandemic among older working-aged Europeans in different labor market groups and at different levels of COVID-19 stringency policies. Data come from the Survey of Health, Ageing and Retirement in Europe (SHARE) collected in 2004-22. Individuals aged 55-69 years from 27 countries were included (N = 245 060). Outcome was functional limitations (Global Activity Limitation Index). Generalized estimating equations were used to analyze time trends and COVID-19 impacts within labor market groups and at different levels of COVID-19 stringency policies. In 2004-22, the likelihood of functional limitations increased slightly among men but remained the same among women. Functional limitations were more likely in countries with low and moderate as compared to high COVID-19 stringency (which represents mostly Southern Europe) in both women and men. During the ∼1st year of the pandemic, likelihood of functional limitations decreased especially in countries with moderate COVID-19 stringency. Decreases were observed in all labor market groups. During the ∼2nd year of the pandemic, the likelihood of functional limitations increased in time but not statistically significantly in most groups. Policymakers should be aware of trends in functional limitations and the impacts of policy decisions while pursuing to prolong work careers. Further investigation is required to verify our findings and to explore underlying reasons behind the decreases in functional limitations after the pandemic.

Association between frailty and subsequent disability trajectories among older adults: a growth curve longitudinal analysis from the Survey of Health, Ageing and Retirement in Europe (2004-19)

Frailty is associated with adverse health outcomes in ageing populations, yet its long-term effect on the development of disability is not well defined. The study examines to what extent frailty affects disability trajectories over 15 years in older adults aged 50+. Using seven waves of data from the Survey of Health, Ageing and Retirement in Europe (SHARE), the study estimates the effect of baseline frailty on subsequent disability trajectories by multilevel growth curve models. The sample included 94 360 individuals from 28 European countries. Baseline frailty was assessed at baseline, using the sex-specific SHARE-Frailty-Instrument (SHARE-FI), including weight loss, exhaustion, muscle weakness, slowness, and low physical activity. Disability outcomes were the sum score of limitations in activities of daily living (ADL) and Instrumental ADL (IADL). Analyses were stratified by sex. Over 15 years, baseline frailty score was positively associated with disability trajectories in men [βADL = 0.074, 95% confidence interval (CI) = 0.064; P = .083; βIADL = 0.094, 95% CI = 0.080; P = 0.107] and women (βADL = 0.097, 95% CI = 0.089; P = .105; βIADL = 0.108, 95% CI = 0.097; P = .118). Frail participants showed higher ADL and IADL disability levels, independent of baseline disability, compared with prefrail and robust participants across all age groups. Overall, participants displayed higher levels of IADL disability than ADL disability. Study findings indicate the importance of early frailty assessment using the SHARE-FI in individuals 50 and older as it provides valuable insight into future disability outcomes.

Trends over time in the deficit of (instrumental) activities of daily living in the Austrian population aged 65 years and older : Results from the Austrian Health Interview Survey series

BACKGROUND

Difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL) in older adults are associated with diminished quality of life and increased demand for long-term care. The present study examined the prevalence of disability among individuals aged 65 years and older in Austria, using data from the Austrian Health Interview Surveys (ATHIS).

METHODS

The ATHIS 2014 and 2019 surveys were used (N = 5853) for the analysis. Binary logistic regression was performed to measure the association between disability in at least one ADL or IADL limitation and independent variables adjusted for sociodemographic, health-related behavior and survey year.

RESULTS

The prevalence of ADL or IADL limitations increased in both sexes during the 5‑year follow-up period. For ADL limitations, the prevalence rose from 12.8% to 17.9% in men (p < 0.001) and from 19.2% to 25.7% in women (p < 0.001). The IADL limitations increased from 18.9% to 35.1% in men (p < 0.001) and from 38.2% to 50.8% in women (p < 0.001). Women reported significantly higher odds for ADL (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 0.93-1.26) and IADL limitations (OR: 1.74, 95% CI: 1.53-1.98). In both sexes, participants aged 80 years and older reported higher odds for ADL (OR: 4.37, 95% CI:3.77-5.07) and IADL limitations (OR: 4.43, 95% CI: 3.86-5.09) compared to the younger group. Participants with at least one chronic disease reported higher odds for ADL (OR: 4.00, 95% CI: 3.41-4.70) and IADL limitations (OR: 4.37, 95% CI: 3.85-4.96). Primary education, single status, being born in non-EU/EFTA countries, and residing in Vienna were associated with higher odds of ADL and IADL limitations.

CONCLUSION

Gender, age, education, country of birth, residence, partnership status, number of chronic diseases, noncompliance with physical activity, and nutrition recommendations had a strong association with increased vulnerability to disability. Public health policy must address these factors for disability prevention strategies.

Cohort Differences in Physical Health and Disability in the United States and Europe

OBJECTIVES

Declines in mortality have historically been associated with improvements in physical health across generations. While life expectancy in most high-income countries continues to increase, there is evidence that younger generations, particularly in the United States, are less healthy than previous generations at the same age. We compared generational trends in physical health in the United States, England, and continental Europe to explore whether other regions have experienced a similar pattern of worsening health across cohorts.

METHODS

Using data from nationally representative studies of adults aged ≥50 years from the United States (Health and Retirement Study, n = 26,939), England (English Longitudinal Study of Ageing, n = 14,992) and 11 continental European countries (Survey of Health, Ageing and Retirement in Europe, n = 72,595), we estimated differences in the age-adjusted prevalence of self-reported chronic disease and disability and observer-measured health indicators across pseudo-birth cohorts (born <1925, 1925-1935, 1936-1945, 1946-1954, 1955-1959).

RESULTS

Age-adjusted prevalence of doctor-diagnosed chronic disease increased across successive cohorts in all regions. Trends in disability prevalence were more regionally varied. Still, in both the United States and Europe, we observed a structural break in disability trends, with declines observed in prewar cohorts slowing, stalling, or reversing for cohorts born since 1945.

DISCUSSION

In all regions, we found evidence for worsening health across cohorts, particularly for those born since 1945. While more chronic disease in younger cohorts need not necessarily translate to worse quality of life or higher rates of functional limitation, there is some suggestion that worsening chronic disease morbidity may be spilling over into worsening disability.

Generational differences in physical health and disability in the United States and Europe

Objectives

Declines in mortality have typically been associated with improvements in physical health across generations. While life expectancy in most high-income countries continues to increase, there is evidence that younger generations, particularly in the United States (US), are less healthy than previous generations at the same age. We compared generational trends in physical health in the US, England, and continental Europe to explore whether other regions have experienced a similar pattern of worsening health across cohorts.

Methods

Using data from nationally representative studies of adults aged ≥50 years from the US (Health and Retirement Study, n=26,939), England (English Longitudinal Study of Ageing, n=14,992) and 11 continental European countries (Survey of Health, Ageing and Retirement in Europe, n=72,595), we estimated differences in the age-adjusted prevalence of self-reported chronic disease and disability and observer-measured health indicators across pseudo-birth cohorts (born <1925, 1925-1935, 1936-1945, 1946-1954, 1955-1959).

Results

Age-adjusted prevalence of doctor-diagnosed chronic disease increased across cohorts in all regions. Trends in disability prevalence were more regionally varied. Still, in both the US and Europe, we observed a structural break in disability trends, with declines observed in pre-war cohorts slowing, stalling, or reversing for cohorts born since 1945.

Discussion

In all regions, we found evidence for worsening health across cohorts, particularly for those born since 1945. While more chronic disease in younger cohorts need not necessarily translate to worse quality of life or higher rates of functional limitation, there is some suggestion that worsening chronic disease morbidity may be spilling over into worsening disability.

Cohort Trajectories by Age and Gender for Informal Caregiving in Europe Adjusted for Sociodemographic Changes, 2004 and 2015

OBJECTIVES

We present a dynamic view of gender patterns in informal caregiving across Europe in a context of sociodemographic transformations. We aim to answer the following research questions: (a) has the gender gap in informal caregiving changed; (b) if so, is this due to changes among women and/or men; and (c) has the gender care gap changed differently across care regimes?

METHODS

Multilevel growth curve models are applied to gendered trajectories of informal caregiving of a panel sample of 50+ Europeans, grouped into 5-year cohorts and followed across 5 waves of the Survey of Health, Ageing and Retirement in Europe survey, stratified by sex and adjusted for several covariates.

RESULTS

For men in cohorts born more recently, there is a decrease in the prevalence of informal care outside the household, whereas cohort trajectories for women are mostly stable. Prevalence of care inside the household has increased for later-born cohorts for all without discernible changes to the gender care gap. Gender care gaps overall widened among later-born cohorts in the Continental cluster, whereas they remained constant in Southern Europe, and narrowed in the Nordic cluster.

DISCUSSION

We discuss the cohort effects found in the context of gender differences in employment and care around retirement age, as well as possible demographic explanations for these. The shift from care outside to inside the household, where it mostly consists of spousal care, may require different policies to support carers, whose age profile and possible care burden seem to be increasing.

Will your child take care of you in your old age? Unequal caregiving received by older parents from adult children in Sweden

Intergenerational family care provided to older parents by adult children is growing and differs based on gender and socioeconomic status. Few studies consider these elements in relation to both the parent and their adult child, and little is known about the number of care tasks received even though those providing intensive levels of care are at risk of experiencing adverse consequences in their lives. This study uses data from the nationally representative 2011 Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) and includes child-specific information from parents aged 76 years and above. Analyses used ordinal logistic regression and are presented as average marginal effects and predictive margins. Results show that parents in need of care report that one-third of all adult children in the sample provide care to three out of five of them. The care is most often non-intensive, yet nearly one in ten of all children provide more intensive care of two or more tasks. When adjusting for dyad characteristics as well as geographic proximity, results show adult-child gender differences where parents receive more care from manual-working-class daughters than manual-working-class sons. Overall, manual-working-class daughters are most commonly reported as carers among adult children, and they are particularly overrepresented in providing intensive care. We conclude that gender and socioeconomic inequalities exist among care receivers' adult children, even in a strong welfare state such as Sweden. Knowledge about levels and patterns of intergenerational care have important implications for how to reduce unequal caregiving.

Functional disability and utilisation of long-term care in the older population in England: a dual trajectory analysis

This study investigates the developmental trajectories of long-term care needs and utilisation in older people aged 65 years and over in England. The data came from the English Longitudinal Survey of Ageing (ELSA, waves 6-9, 2012-2018, N = 13,425). We conducted dual trajectory analyses to cluster people's trajectories of care needs (measured by functional disability) and utilisation into distinct groups. We conducted logistic regression analyses to identify the factors associated with trajectory memberships. We identified three trajectories of long-term needs (low, medium, and high) and three trajectories of care utilisation (low, medium, and high). Both care needs and care hours increased with age, but the speed of increase varied by trajectory. Females, minority ethnic groups, people with low wealth, and those experiencing housing problems were more likely to follow the joint trajectories characterised by higher care needs and higher care intensity. People with low or medium care needs stayed in the same trajectories of care utilisation. In contrast, people in the high-needs trajectory followed divergent trajectories of care utilisation: 63% of them followed the trajectory of high care intensity and the rest (37%) followed the trajectory of medium care intensity. Lack of spouse care was the leading predictor of trajectory divergence (OR = 3.57, p < 0.001). Trajectories of care needs and utilisation are highly heterogeneous in later life, which indicates persistent inequalities over time. Single people with multiple functional limitations face an acute and enduring risk of inadequate care and unmet needs. The amount of support is as important as the availability of support.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10433-022-00723-0.