Has COVID-19 Been the Great Leveler? The Changing Use of Intergenerational Digital Communications Amongst Older People in England During the Pandemic

This research examines patterns of intergenerational digital contact before and during the COVID-19 pandemic in England, using data from the English Longitudinal Study of Ageing (ELSA) Wave nine and the first Wave of the ELSA COVID-19 Sub-study. Multivariate binary logistic regressions were applied to assess the determinants of frequent intergenerational digital communication. The findings indicate that when the pandemic began, many older persons shifted towards more frequent intergenerational digital contact, but a small minority shifted away. As a result, the pre-existing gender gap amongst older people in the use of digital communication technology narrowed, as did the disparity associated with family relationship closeness. However, pre-pandemic gaps in the intergenerational digital connection between internet users and non-users widened during the pandemic. Overall, the results suggest that the pandemic resulted in more frequent digitally-mediated social interactions within the family, which may strengthen ties between older and younger family members.

Sleep Problems and New Occurrence of Chronic Conditions during the COVID-19 Pandemic in the UK

The COVID-19 pandemic has negatively impacted upon sleep health. Relatively little is known about how this may influence the population's health subsequently. This prospective longitudinal study aims to examine the consequences of sleep problems for physical and mental health during the COVID-19 pandemic in the UK, using data from the Understanding Society: COVID-19 Study, a large-scale population-based survey with 12,804 adults aged 16 and above. A measure of sleep problems was derived from Pittsburgh Sleep Quality Index (PSQI) questions, reflecting seven dimensions of sleep quality. Binary logistic regressions were applied to investigate the relationship between sleep problem and the incidence of cardiovascular disease (CVD), hypertension, diabetes, obesity, arthritis and an emotional, nervous or psychiatric problem over the 15 months follow-up period. The analysis confirms that sleep problems are prevalent and vary between sub-groups among adults. Notably, sleep problems are then significantly associated with a higher risk of cardiovascular disease, hypertension, diabetes, obesity, arthritis and emotional, nervous or psychiatric problems, independent of demographic, socioeconomic, familial and health confounders. Our findings suggest promoting good sleep hygiene should be prioritised during the pandemic, and more generally as part of wider programmes aimed at promoting good physical and mental health.

At the junctures of healthcare: a qualitative study of primary and specialist service use by Polish migrants in England

Background:

Polish people are the biggest migrant group in the UK and the scholarship shows that they are attentive to their healthcare needs and seek to fulfil them by using various services both within and outside the British public healthcare system. This article explores the role of junctures within healthcare systems in the connections migrants realize between healthcare systems and sectors. The article argues that in a transnational context, migrants enact these junctures by joining different levels of care within the same sector, between sectors and across national borders. In particular, the article explores how Polish migrants’ healthcare seeking practices within and beyond national borders are enacted given the features, availability and relationship between primary and specialist care for how they are articulated between private and public sectors.

Methods:

This article is based on the second phase of a mixed-methods study on how Polish people in the UK manage their health transnationally. The participants were purposefully sampled from survey respondents (first phase) who identified as having a long-term health condition or caring in a non-professional capacity for someone who is chronically ill. Thirty-two semi-structured audio-call interviews were conducted with Polish migrants living in England between June and August 2020. Transcripts were analysed by applying thematic coding.

Results:

Key findings include a mix of dissatisfaction and satisfaction with primary care and general satisfaction with specialist care. Coping strategies consisting in reaching specialist private healthcare provided a way to access specialist care at all or additionally, or to partially complement primary care. When Polish private specialists are preferred, this is due to participants’ availability of time and financial resources, and to the specialists’ capacity to fulfil needs unmet within the public healthcare sector in the UK.

Conclusion

Polish migrants join with their practices systems which are not integrated, and their access is limited by the constraints implied in accessing paid services in Poland. This shapes transnational healthcare practices as relating mostly to routine and ad-hoc access to healthcare. These practices impact not only the wellbeing of migrants and the development of the private market but also the public health provision of services.

Diagnostic testing: therapeutic mobilities, social fields, and medical encounters in the transnational healthcare practices of Polish migrants in the UK

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Diagnostic testing is seldom explored in studies of migrants’ healthcare practices.

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Tests’ availability and doctors’ willingness to discuss results are crucial for migrants’ evaluation of the care received.

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Test results are moved between private and public sectors and national borders.

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Movements of patients and tests establishes relationships with doctors and have therapeutic effects.

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Future studies should consider testing as a fundamental component of migrants’ health.

While diagnostic tests are a fundamental component of contemporary medical practice they are seldom considered in studies of transnational healthcare. This article investigates the little-studied role played by diagnostic testing in the healthcare-seeking practices of migrants. It is concerned with the experiences of Polish migrants living in the UK and who access a variety of health services in their host and origin countries across the public and private sectors. We analyse data from semi-structured phone interviews conducted in 2020 with 32 adult Poles living in the UK who identified as having themselves, or non-professionally caring for someone with, a long-term health condition. The article contributes to the literature on migrants’ transnational healthcare practices by showing the centrality of diagnostic technology in their health management and sense-making through the creation, modification, and maintenance of ‘transnational social fields’ (Levitt and Schiller 2004). By emphasizing the role of tests in the patient-doctor relationship the article exposes the therapeutic outcomes of the mobilities of patients and tests as they intersect with physicians in multiple medical encounters.

The impact of grandchild care provision on grandparents’ depressive symptoms across Europe using multi-level analysis: do the grandchild caring patterns and the country’s economy matter?

Little research has examined the cross-national differences in the impact of grandchild care provision on the grandparents’ depression, by taking into account of both macro- and micro-level factors. This study used a unique grandchild caring pattern variable in order to examine the effect of the changes in the intensity of grandchild caring on the grandparents’ depressive symptoms in European countries, and whether the grandparents’ country level economy influenced such effect. Longitudinal data derived from the Survey of Health, Ageing, and Retirement in Europe 2010–2018 covered 13 countries and 24,656 grandparents aged 50–90. Multi-level linear regression analyses with REML estimation were used. This study found that providing grandchild care had a protective effect against grandparents’ depressive symptoms in both lower and higher income countries. Moreover, providing more intensive grandchild care reduced the grandparents’ depressive symptoms to a greater extent in lower income countries than higher income countries. In addition, grandmothers benefited more from grandchild caring than grandfathers, and the gender gap in the effects of grandchild care provision on one’s depressive symptoms was wider in lower income countries than higher income countries in Europe. Future research can further investigate the mechanisms behind such results. The research findings can be used to develop targeted interventions aimed at grandparents providing childcare of different intensity.

The impact of changing social support on older persons' onset of loneliness during the COVID-19 pandemic in the UK

BACKGROUND AND OBJECTIVES

Social distancing measures aimed at controlling the spread of COVID-19 are likely to have increased social isolation amongst those over 70 instructed to shield at home. This study examines the incidence of loneliness by gender over the first ten months of the COVID-19 pandemic among persons aged 70 and above in the UK, and the impact of changing social networks and perceived social support on the new occurrence of loneliness.

RESEARCH DESIGN AND METHODS

Participants (N=1,235) aged 70 and over with no reports of loneliness before the pandemic who participated in seven rounds of the Understanding Society: COVID-19 Study (April 2020-January 2021) and the main Understanding Society study conducted during 2019. Cox regression analysed the time to a new occurrence of loneliness.

RESULTS

Among older people who hardly ever/never felt lonely before the pandemic, 33.7% reported some degree of loneliness between April 2020-January 2021. Living in a single-person household, having received more social support before the pandemic, changes in support receipt during the pandemic and a deteriorating relationship with one's partner during the pandemic increased the risk of experiencing loneliness. Older women were more likely than older men to report loneliness, even when living with a partner.

DISCUSSION AND IMPLICATIONS

During the three COVID-related lockdowns in the UK, changes in older people's social networks and support resulted in a significant onset of loneliness. Findings highlight the risks of shielding older persons from COVID-19 in terms of their mental well-being and the importance of strengthening intergenerational support.

Prospective longitudinal study of 'Sleepless in Lockdown': unpacking differences in sleep loss during the coronavirus pandemic in the UK

OBJECTIVES

COVID-19 is having a disproportionate impact on Black, Asian and minority ethnic (BAME) groups and women. Concern over direct and indirect effects may also impact on sleep. We explore the levels and social determinants of self-reported sleep loss among the UK population during the pandemic, focusing on ethnic and gender disparities.

SETTING

This prospective longitudinal study analysed data from seven waves of the Understanding Society: COVID-19 Study collected from April 2020 to January 2021 linked to prepandemic data from the 2019 mainstage interviews, providing baseline information about the respondents prior to the pandemic.

PARTICIPANTS

The analytical sample included 8163 respondents aged 16 and above who took part in all seven waves with full information on sleep loss, defined as experiencing 'rather more' or 'much more' than usual sleep loss due to worry, providing 57 141 observations.

PRIMARY OUTCOME MEASURES

Self-reported sleep loss. Mixed-effects regression models were fitted to consider within-individual and between-individual differences.

RESULTS

Women were more likely to report sleep loss than men (OR 2.1, 95% CI 1.9 to 2.4) over the 10-month period. Being female, having young children, perceived financial difficulties and COVID-19 symptoms were all predictive of sleep loss. Once these covariates were controlled for, the bivariate relationship between ethnicity and sleep loss (1.4, 95% CI 1.6 to 2.4) was reversed (0.7, 95% CI 0.5 to 0.8). Moreover, the strength of the association between gender and ethnicity and the risk of sleep loss varied over time, being weaker among women in July (0.6, 95% CI 0.5 to 0.7), September (0.7, 95% CI 0.6 to 0.8), November (0.8, 95% CI 0.7 to 1.0) and January 2021 (0.8, 95% CI 0.7 to 0.9) compared with April 2020, but positively stronger among BAME individuals in May (1.4, 95% CI 1.0 to 2.1), weaker only in September (0.7, 95% CI 0.5 to 1.0).

CONCLUSIONS

The pandemic has widened sleep deprivation disparities, with women with young children, COVID-19 infection and BAME individuals experiencing sleep loss, which may adversely affect their mental and physical health.

The Impact of Living Arrangements and Intergenerational Support on the Health Status of Older People in China

Research to-date has examined the impact of intergenerational support in terms of isolated types of support, or at one point in time, failing to provide strong evidence of the complex effect of support on older persons’ wellbeing. Using the Harmonised China Health and Retirement Longitudinal Study (2011, 2013 and 2015), this paper investigates the impact of older people’s living arrangements and intergenerational support provision/ receipt on their physical and psychological wellbeing, focusing on rural/ urban differences. The results show that receiving economic support from one’s adult children was a stronger predictor for higher life satisfaction among older rural residents compared to those in urban areas, while grandchild care provision was an important determinant for poor life satisfaction only for older urban residents. Receiving informal care from one’s adult children was associated with a poor (I)ADL functional status and with depressive symptoms among older rural people. Meanwhile, having weekly in-person and distant contact reduced the risk of depression among older people in both rural and urban areas. The paper shows that it is important to improve the level of public economic transfers and public social care towards vulnerable older people in rural areas, and more emphasis should be placed on improving the psychological well-being of urban older residents, such as with the early diagnosis of depression.

Dynamics of unmet need for social care in England

Meeting individuals’ social care needs is a core element of UK social policy. However, the conceptualisation and operationalisation of ‘unmet need’ remain a challenge. This paper advances our understanding by incorporating a temporal dimension in the conceptual framework on unmet need to investigate the dynamics of met and unmet need for social care over time. Using data from Waves 6,7 and 8 of the English Longitudinal Study of Ageing, this paper examines five possible trajectories among individuals with a social care need at baseline: 1) no longer having such a need; 2) having continued needs met; 3) delayed needs met; 4) newly arisen unmet needs; and 5) persistent unmet needs. The results indicate that amongst those with need at baseline unmet need has decreased over time, indicating that some needs may be fulfilled with a delay. However, a significant proportion of older people experienced persistent unmet needs, particularly those who were younger, living alone, with educational qualifications, and with fewer difficulties with Activities of Daily Living at baseline. Understanding the dynamics of unmet need can support policymakers in ensuring that those facing an elevated risk of persistent unmet need over time do not fall through the social care safety net.

Changing living arrangements and stress during Covid-19 lockdown: Evidence from four birth cohorts in the UK

Background

The outbreak of Covid-19 in the UK has seen many families unexpectedly brought back together. The circumstances and stories of individual families have been picked up in the press focussing on the difficulties of people adjusting to their changed living arrangements. Yet, there have been few empirical analyses on how such changes might influence people's health and wellbeing. Therefore, this study explored the changing patterns of perceived stress by living arrangements change during the first wave of the Covid-19 pandemic in 2020.

Methods

The data used relates to 12,532 cohort members in the special Covid-19 surveys conducted with the participants of the 1958, 1970, 2000-01 British birth cohorts and Next Steps (born in 1989-90) in May 2020. Probit regression models were used to assess the chance of reporting increased stress amongst those who had experienced changes in living arrangements during the pandemic compared to those who had not.

Results

The results provide strong evidence that those individuals whose living arrangements changed during the Covid-19 pandemic have a higher likelihood of reported increased stress than those whose living arrangements remained unchanged. This was most clearly seen for older cohorts. Increased interpersonal conflict plays a role in mediating the association, especially for the younger cohort.

Conclusions

The findings confirm that during the first lockdown, changing living arrangements were negatively associated with individuals' mental wellbeing. As prolonged periods of stress can lead to serious health problems and policymakers need to be mindful that services may need to take these new, albeit for many temporary, forms of living arrangements into account.

Chinese women's health and wellbeing in middle life: Unpacking the influence of menopause, lifestyle activities and social participation

OBJECTIVES

To examine Chinese middle-aged women's health and wellbeing and the associated biosocial correlates.

STUDY DESIGN

This study used a cross-sectional design, including selected retrospectively collected information on the final menstrual period, drawn from the 2013 wave of the China Health and Retirement Longitudinal Study (CHARLS). Women aged 45 to 59 were selected.

MAIN OUTCOME MEASURES

Factor analysis of 16 menopausal symptom ratings yielded four different and independent measures of pre-/peri-menopausal and early postmenopausal women's health. These were: negative mood (feel frustrated, sad, lonely, worried, bored, angry, tired and stressed), positive emotions (feel enthusiastic, content and happy), musculoskeletal pain (shoulder/neck pain, knee and other joint pain, and back pain), and sleep and memory problems (trouble sleeping and poor memory).

RESULTS

Menopausal status was positively associated with sleep and memory problems, whilst the number of years since the final menstrual period was positively associated with musculoskeletal pain. In contrast, lifestyle activities and social participation were linked to positive emotions. The association between selected biosocial factors and negative mood was not significant after controlling for other demographic and social background factors.

CONCLUSIONS

Musculoskeletal health as well as sleep and memory problems are positively associated with menopausal biological factors amongst Chinese mid-life women. Maintaining active social engagement contributes to positive wellbeing among middle-aged women.

Menopausal transition and change in employment: Evidence from the National Child Development Study

OBJECTIVES

This study aims to investigate the impact of the menopausal transition and severe symptoms on changes in employment.

STUDY DESIGN

This longitudinal prospective study analysed data from a population-based cohort study, the UK National Child Development Study Wave 8 and Wave 9, when the cohort was aged 50 and 55 respectively. The analytical sample comprised 3109 employed women at age 50.

MEASURES

The outcome variable was the employment change from age 50 to age 55, with three categories: i) continued employed without reduced working time; ii) continued employed with reduced working hours; and iii) exit employment. The employment dynamics of women were compared using multinomial logistic regression modelling. Key independent variables included menopausal transition status and severe menopausal symptoms experienced.

RESULTS

53.5 % of employed women at age 50 reported at least one severe menopausal symptom. Women experiencing severe menopausal symptoms had a higher chance of employment exit or reducing their working hours. The odds ratios contrasting severely symptomatic women with those with no severe symptoms were 1.43 (95 % CI = 1.11-1.84) between exiting employment vs continued employment without reducing working hours, and 1.23 (95 % CI = 1.02-1.48) between reducing working hours vs continued employment without reducing working hours. The strength of the association between women's severe menopausal symptoms and the risk of employment exit or reducing working hours varied according to their HRT usage and their partner's economic activity.

CONCLUSIONS

Menopausal symptoms can pose obstacles to some middle-aged women in terms of remaining in employment or maintaining their number of working hours.

Social Participation and Health Outcomes Among Caregivers and Noncaregivers in Great Britain

This study investigates the relationship between social participation and health outcomes between caregivers and noncaregivers in Great Britain. Previous studies indicate that the impact of informal caregiving on the carer's health is complex, and the intensity of care provision has an adverse impact on the caregivers' health, while social participation could have a protective role in this respect. Using qualitative and quantitative data from Wave 8 of the 1958 National Child Development Study, the analysis shows that social participation has a positive effect on the carers' mental health and subjective well-being. Individuals who did not engage in social participation reported lower levels of mental health and control, autonomy, self-realization and pleasure (CASP) scores than those engaged in social participation. The qualitative results showed the barriers to social participation of caregivers to be time, energy, and finance. We discuss ways in which the government could address such barriers to improve the level of social participation among caregivers.

Stakeholder identities in Britain's neoliberal ethical community: Polish narratives of earned citizenship in the context of the UK's EU referendum

This article examines the narrative strategies through which Polish migrants in the UK challenge the formal rights of political membership and attempt to redefine the boundaries of 'citizenship' along notions of deservedness. The analysed qualitative data originate from an online survey conducted in the months before the 2016 EU referendum, and the narratives emerge from the open-text answers to two survey questions concerning attitudes towards the referendum and the exclusion of resident EU nationals from the electoral process. The analysis identifies and describes three narrative strategies in reaction to the public discourses surrounding the EU referendum - namely discursive complicity, intergroup hostility and defensive assertiveness - which attempt to redefine the conditions of membership in Britain's 'ethical community' in respect to welfare practices. Examining these processes simultaneously 'from below' and 'from outside' the national political community, the paper argues, can reveal more of the transformation taking place in conceptions of citizenship at the sociological level, and the article aims to identify the contours of a 'neoliberal communitarian citizenship' as internalized by mobile EU citizens.

The role of social networks in using home care by older people across Continental Europe

The diversification of caregiving arrangements in European societies has drawn attention to the factors that condition the use of care by older people. Social and family relations appear as a key factor, mainly to be related to the availability and accessibility to potential informal caregivers. Recent studies evidenced that geographical proximity and a larger social network increase the probability of receiving informal support in old age. However, the ways in which interpersonal relationships are associated with the use of formal care, as well as the cross-country variability of this association, have been barely explored. Using a sample of 37,708 individuals aged 65 and over from Wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE), this study examines to what extent the characteristics of older people's social networks predict the use of three types of home care; formal, informal, or combined, exploring the cross-European convergences and divergences. Binomial logistic regressions are conducted to compare four macro-regions in continental Europe (northern countries: Denmark and Sweden; western countries: Austria, Belgium, France, Germany, Switzerland, and Luxembourg; southern countries: Italy, Spain, Greece, and Portugal; and eastern countries: Poland, Czech Republic, Slovenia, Estonia, and Croatia). The structure, availability, and accessibility to the members of the social network are the major predictors of the receipt of informal care everywhere. Regional divergences are observed regarding to formal care, alone or combined with informal caregivers.

The Return of Citizenship? An Empirical Assessment of Legal Integration in Times of Radical Sociolegal Transformation

Intra-EU migrants have traditionally faced few pressures or incentives to formalize their “permanent” residence or to naturalize in their EU host countries. Focusing on the United Kingdom and combining an analysis of secondary administrative data and primary online survey data ( N = 1,413), this article examines practices and attitudes toward such legal integration in the context of the 2016 EU Referendum among five major EU nationality groups. The analysis reveals that British citizenship is the main legal mechanism of integration among intra-EU migrants in the United Kingdom and that while there is continuity in this respect with pre-Brexit processes, Brexit also has a strong but differential effect as a driver of legal integration. The article identifies some of the main decision-influencing factors shaping legal integration, making a significant contribution to understanding the complexities of integrative processes in times of radical structural change.

Knowledge about risk factors for falls and practice about fall prevention in older adults among physiotherapists in Nigeria

BACKGROUND AND OBJECTIVE

Falling is a major health concern that has contributed significantly to older people's injury and loss of life worldwide, warranting the development of fall-prevention strategies, the success of which has been attributed to the levels of knowledge and practice about fall prevention among physiotherapists and other health professionals. The objective of this study was to determine the self-reported levels of knowledge on risk factors of fall and practices about fall prevention in older adults among physiotherapists in Nigeria.

METHODS

Physiotherapists (N = 237) recruited from the six geopolitical zones of Nigeria completed a three-part structured questionnaire that asked questions about risk factors for fall and common practices for fall prevention using a 5-point-rated Likert scale. Data were analysed using descriptive analysis, chi-square, and Kruskal-Wallis tests.

RESULTS

Among physiotherapists in Nigeria, 89% rated their level of knowledge about preventing falls among older adults as high, and 64% of them rated their level of practice on this topic as high. Among the individual items that measured knowledge, 40% of the participants reported a moderate level of knowledge about multiple medications as a risk factor for falls. Fifty percent of the participants reported a low level of practice of referral to other health care professionals, whereas 40% and 41% reported a moderate level of practice on documenting risk factors and treatment plans, respectively. There was no association between age, gender, or years of practice with levels of knowledge or practice.

CONCLUSION

This study suggests that physiotherapists in Nigeria have adequate knowledge and practice for fall prevention in older adults. However, there are potential gaps in knowledge of risk factors, documentation, and referrals to other professions that may be addressed through developing context-specific fall-prevention clinical guidelines for practice in Nigeria.

Children's migration and lifestyle-related chronic disease among older parents 'left behind' in india

Lifestyle-related chronic diseases such as cardiovascular diseases and diabetes are now the leading causes of death and disability in India. Interestingly, those Indian states with the highest prevalence of lifestyle-related chronic disease among older adults are also found to have the highest rates of international or internal out-migration. This paper investigates the association between having migrant (adult) children and older parents’ lifestyle-related chronic disease in India. Bi-variate and multivariate analysis are conducted using data from a representative sample of 9507 adults aged 60 and older in seven Indian states from the UNFPA project ‘Building Knowledge Base on Ageing in India’. The results show that for any of the diagnosed conditions of hypertension, diabetes and heart disease, the prevalence among older people with a migrant son is higher than among those without. More specifically, the odds ratio of reporting a lifestyle-related chronic disease is higher among older adults with at least one adult son living in another district, State or outside India than those with their children living closer. This study contributes empirical evidence to the academic and policy debate about the consequences of globalization and urbanization for older people's health status generally, and particularly their risk for reporting chronic diseases that relate to changes in their lifestyle.

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The prevalence of chronic disease is high among ‘left behind’ older parents in India.

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Children's out-migration and (or) migration within different states and (or) different districts are risk factors.

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Selected chronic diseases include diagnosed hypertension, diabetes and heart disease.

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More research is required on the health consequences of globalization and urbanization.

General Health Questionnaire-12 reliability, factor structure, and external validity among older adults in India

AIMS

The purpose of this study is to analyze the internal consistency, factor structure, and external validity of the 12-item General Health Questionnaire (GHQ-12) among older adults in India.

SETTINGS AND DESIGN

This study analyzes data collected as part of the UNFPA "Building Knowledge Base on Ageing in India (BKPAI)" project. The BKPAI Survey was conducted in 2011 in seven major demographically advanced states of India - Himachal Pradesh, Punjab, West Bengal, Odisha, Maharashtra, Kerala, and Tamil Nadu.

MATERIALS AND METHODS

A community-based representative sample of 9692 respondents aged 60 and above from seven Indian states was employed. The GHQ-12 questionnaire was administered.

STATISTICAL ANALYSIS

The Cronbach's alpha was calculated to analyze internal consistency. Factor analysis was applied to explore the factor structure of GHQ-12, and then correlation coefficients were calculated to examine the external validity of the measurement.

RESULTS

The Cronbach's alpha of the GHQ-12 is 0.9. Factor analysis reveals two significant components which accounted for 59% of the variance. The correlation between the overall score of GHQ-12 and the subjective well-being inventory (SUBI) is 0.58.

CONCLUSIONS

The GHQ-12 shows adequate reliability among the older population in India.

Changes in living arrangements and mortality among older people in China

Living arrangements in later life are dynamic, with changes associated with life events such as widowhood or moves into an institution. Previous research has found particular changes in living arrangements to be associated with an elevated risk of mortality. However, research in this area within the context of China is limited, despite China being home to the world's largest population of older people. This study investigates the impact of changes in living arrangements on older persons' survival using the Chinese Longitudinal Healthy Longevity Survey from 2002 to 2011. The original sample was 16,064 in 2002, and this study includes 6191 individuals who survived in 2005 and had complete information of track record in later waves. Changes in living arrangements are examined between 2002 and 2005. Cox-proportional hazards models are then used to investigate the association between the dynamics of living arrangements and respondents' survival status from 2005 to 2011 . Results show that men and women who lived in an institution in both 2002 and 2005, or who moved into an institution from living with family faced a greater risk of dying compared to those continuing to live with family. By contrast, continuing to live with family or alone, or moving between living with family and living alone, were not associated with an increased mortality risk, although there were some differences by gender. The institutional care sector in China is still in its infancy, with provision based on ability to pay market fees rather than need associated with age-related function impairment. The findings show that living in, or moving into, an institution is associated with a high mortality risk therefore requires further investigation in the context of a rapidly changing Chinese society.

Elder abuse as a risk factor for psychological distress among older adults in India: a cross-sectional study

OBJECTIVES

This study examines the association between elder abuse and psychological distress among older adults in India and explores whether this association varies by the level of psychosocial and material resources.

DESIGN

The study uses a cross-sectional survey design.

SETTING

The data are drawn from a representative sample of 9589 adults aged 60 and above in seven Indian states-Himachal Pradesh, Punjab, West Bengal, Odisha, Maharashtra, Kerala and Tamil Nadu-in 2011.

STATISTICAL ANALYSES

Secondary analysis, using bivariate and multivariate logistic regression models, is conducted using the United Nations Population Fund project Building Knowledge Base on Ageing in India survey. Elder abuse (physical and/or emotional) emanating from family members in the previous month before the survey is examined. Multivariate models are run on the total analytical sample and for men and women separately.

RESULTS

The overall prevalence of psychological distress among persons aged 60 and over living in the seven Indian States is 40.6%. Among those older persons who experienced some form of physical or emotional abuse or violence in the last month, the prevalence of psychological distress is much higher than that in the general older population, at 61.6% (p<0.001). The results show that the experience of abuse is negatively associated with the mental health of older adults, and this relationship persists even after controlling for demographic and socioeconomic factors (OR=1.60, 95% CI 1.22 to 2.09). The findings also suggest that household wealth has an inverse relationship with mental health, with the association between experiencing elder abuse and reporting poor mental health being strongest among older people in wealthy households.

CONCLUSIONS

Elder abuse in India is currently a neglected phenomenon, and greater recognition of the link between abuse and mental health is critical to improve the well-being of vulnerable older adults, some of whom may be 'hidden' within well-off households.

Children's migration and chronic illness among older parents 'left behind' in China

The relationship between adult children's migration and the health of their older parents 'left behind' is an emerging research area and existing studies reflect mixed findings. This study aims to investigate the association between having migrant (adult) children and older parents' chronic illness in China, using chronic stomach or other digestive diseases as a proxy. Secondary analysis of the national baseline survey of the 2011 China Health and Retirement Longitudinal Study (CHARLS) was conducted. Analyses were conducted in a total of sample of 6495 individuals aged 60 years and above from 28 out of 31 provinces in China, who had at least one child at the baseline survey. Binary logistic regression was used. The prevalence of any of the diagnosed conditions of chronic stomach or other digestive diseases was higher among older people with a migrant son than among those without (27 percent vs 21 percent, p < 0.001). More specifically, the odds ratio of reporting a disease was higher among older adults with at least one adult son living in another county or province than among those with all their sons living closer (OR = 1.29, 95% CI = 1.10-1.51). The results from this large sample of older adults support the hypothesis that migration of sons significantly increases the risk of chronic stomach and other digestive diseases among 'left behind' elderly parents in contemporary China.

Social trust, interpersonal trust and self-rated health in China: a multi-level study

Background

Trust is important for health at both the individual and societal level. Previous research using Western concepts of trust has shown that a high level of trust in society can positively affect individuals’ health; however, it has been found that the concepts and culture of trust in China are different from those in Western countries and research on the relationship between trust and health in China is scarce.

Method

The analyses use data from the national scale China General Social Survey (CGSS) on adults aged above 18 in 2005 and 2010. Two concepts of trust (“out-group” and “in-group” trust) are used to examine the relationship between trust and self-rated health in China. Multilevel logistical models are applied, examining the trust at the individual and societal level on individuals’ self-rated health.

Results

In terms of interpersonal trust, both “out-group” and “in-group” trust are positively associated with good health in 2005 and 2010. At the societal level, the relationships between the two concepts of trust and health are different. In 2005, higher “out-group” social trust (derived from trust in strangers) is positively associated with better health; however, higher “in-group” social trust (derived from trust in most people) is negatively associated with good health in 2010. The cross-level interactions show that lower educated individuals (no education or only primary level), rural residents and those on lower incomes are the most affected groups in societies with higher “out-group” social trust; whereas people with lower levels of educational attainment, a lower income, and those who think that most people can be trusted are the most affected groups in societies with higher “in-group” social trust.

Conclusion

High levels of interpersonal trust are of benefit to health. Higher “out-group” social trust is positively associated with better health; while higher “in-group” social trust is negatively associated with good health. Individuals with different levels of educational attainment are affected by trust differently.

Trajectories of informal care and health

The evidence of the impact of informal care provision on the health of carers presents a complex and contested picture, depending on the characteristics of the care studied, including its duration, which has been relatively short in previous research (up to 4 years). Drawing on data from the Office for National Statistics Longitudinal Study, a 1% sample of linked Census records for respondents in England and Wales (N=270,054), this paper contributes original insights on the impact of care provision on the carer's health ten years later. The paper explores differentials in self-reported health in 2011 between individuals according to their caring status at 2001 and 2011, and controlling for a range of demographic and socio-economic characteristics. The results show that individuals providing informal care in 2011 (regardless of carer status in 2001) exhibit lower odds of poor health in 2011 than those who did not provide care in both 2001 and 2011. Taking the intensity of care into account, 'heavy' carers in 2001 (i.e. caring for more than 20 h per week) who were not caring in 2011 show a higher likelihood of reporting poor health than non-carers, while those who were 'heavy' carers in both 2001 and 2011 are around one-third less likely to report poor health at 2011 compared to non-carers (2001 and 2011). These findings provide new insights in relation to repeat caring and its association with the carer's health status, further contributing to our understanding of the complex relationship between informal care provision and the carer's health.

The determinants of transitions into sheltered accommodation in later life in England and Wales

Background

Population ageing is a global challenge and understanding the dynamics of living arrangements in later life and their implications for the design of appropriate housing and long-term care is a critical policy issue. Existing research has focused on the study of transitions into residential care in the UK. This paper investigates transitions into sheltered accommodation among older people in England and Wales between 1993 and 2008.

Methods

The study uses longitudinal data constructed from pooled observations across waves 2–18 of the British Household Panel Survey (BHPS) data, focusing on individuals aged 65 and over who lived in private housing at baseline and who were observed for two consecutive time points. A discrete-time logistic regression model was used to examine the association of transitioning into sheltered accommodation with a range of demographic, health and socioeconomic predictors.

Results

Demographic (age, region), socioeconomic factors (housing tenure, having a washing machine) and contact with health professionals (number of visits to the general practitioner, start in use of health visitor) were significant determinants of an older person's move into sheltered accommodation.

Conclusions

Transitions into sheltered accommodation are associated with a range of demographic and socioeconomic characteristics as well as service use but not with health. Such results indicate that this type of housing option may be accessible by individuals with relatively good health, but may be limited to those who are referred by gatekeepers. Policymakers could consider making such housing option available to everyone, as well as providing incentives for building lifecourse-sensitive housing in the future.

Ethnic inequalities in limiting health and self-reported health in later life revisited

Background

It is well established that there are ethnic inequalities in health in the UK; however, such inequalities in later life remain a relatively under-researched area. This paper explores ethnic inequalities in health among older people in the UK, controlling for social and economic disadvantages.

Methods

This paper analyses the first wave (2009–2011) of Understanding Society to examine differentials in the health of older persons aged 60 years and over. 2 health outcomes are explored: the extent to which one's health limits the ability to undertake typical activities and self-rated health. Logistic regression models are used to control for a range of other factors, including income and deprivation.

Results

After controlling for social and economic disadvantage, black and minority ethnic (BME) elders are still more likely than white British elders to report limiting health and poor self-rated health. The ‘health disadvantage’ appears most marked among BME elders of South Asian origin, with Pakistani elders exhibiting the poorest health outcomes. Length of time resident in the UK does not have a direct impact on health in models for both genders, but is marginally significant for women.

Conclusions

Older people from ethnic minorities report poorer health outcomes even after controlling for social and economic disadvantages. This result reflects the complexity of health inequalities among different ethnic groups in the UK, and the need to develop health policies which take into account differences in social and economic resources between different ethnic groups.

Ethnicity and Occupational Pension Membership in the UK

Reflecting a relatively low-value Basic State Pension, occupational pensions have historically been a key aspect of pension protection within Britain. Existing research shows that minority ethnic groups are less likely to benefit from such pensions and are more likely to face poverty in later life, as a result of the interaction of their labour market participation and pension membership patterns. However, the lack of adequate data on ethnic minorities has so far prevented the direct comparison of different ethnic groups, as well as their comparison to the White British group. Using data from the UK Household Longitudinal Study, this article explores patterns of employment and the odds ratios of membership in an employer's pension scheme among working-age individuals from minority ethnic groups and the White British population, taking into account factors not used by previous research, such as one's migration history and sector of employment (public/private). The analysis provides new empirical evidence confirming that ethnicity remains a strong determinant of one's pension protection prospects through being in paid work, being an employee and working for an employer who offers a pension scheme. However, once an individual is working for an employer offering a pension scheme, the effect of ethnicity on that person's odds of being a member of that scheme reduces, except among Pakistani and Bangladeshi individuals for whom the differentials remain. The article also provides evidence on the pension protection of Polish individuals, a relatively 'new' minority group in the UK.

Informal caring in England and Wales--Stability and transition between 2001 and 2011

Informal caring is of significant and increasing importance in the context of an ageing population, growing pressures on public finances, and increasing life expectancy at older ages. A growing body of research has examined the characteristics associated with informal care provision, as well as the impact of caring for the carer's physical and mental health, and their economic activity. However, only a relatively small body of literature has focused on the study of 'repeat' or continuous caring over time, and the factors associated with such trajectories. In 2001, for the first time, the United Kingdom census asked about provision of informal care, enabling identification of the prevalence of informal caregiving at a national level. This paper follows up informal carers from the 2001 Census in order to examine their characteristics and circumstances 10 years later using a nationally representative 1% sample of linked census data for England and Wales, the Office for National Statistics Longitudinal Study. The analysis classifies the range of possible combinations of caring and non-caring roles between 2001 and 2011, focusing on the characteristics of those who were providing care at one, or both, time points. Among other results, the analysis identified that, among those who were carers in 2001, caring again in, or continuing to care until, 2011 was associated with being female, aged between 45 and 54 years in 2011, looking after the home, and providing care for 50 hours or more per week in 2001. Such results contribute to our understanding of a particular group of informal carers and provide a more nuanced picture of informal care provision at different stages of the life course.

Women's economic activity trajectories over the life course: implications for the self-rated health of women aged 64+ in England

BACKGROUND

Previous research has highlighted the importance of accumulated life-course labour market status and the balancing of multiple roles for understanding inequalities in health in later life. This may be particularly important for women, who are increasingly required to balance work and family life in liberal welfare contexts, such as in Britain.

METHODS

This study analyses retrospective life history data for 2160 women aged 64+ years (born 1909-1943) from the English Longitudinal Study of Ageing, collected in 2006-2007 as part of an ongoing panel study. Optimal matching and cluster analyses are used to produce a taxonomy of women's life-course economic activity trajectories based on their experiences between ages 16 and 64 years. This classification is then used in logistic regression analysis to investigate associations with self-rated health in later life.

RESULTS

A set of five trajectories emerge as the dominant patterns of women's economic activity over the life course for those cohorts of English women born prior to 1943: (1) full-time workers; (2) family carers; (3) full-time returners; (4) part-time returners; (5) atypical/inactive. Regression analyses show that women who experience defined periods of full-time work both before and after focusing on family life appear to have the most favourable later life health outcomes.

CONCLUSIONS

The findings are discussed with reference to the accumulation of social and economic resources over the life course and the balancing of multiple roles in work and family domains. In conclusion, the development of policies that facilitate women, if they wish, to successfully combine paid employment with family life could have a positive impact on their health in later life.

Individual and province inequalities in health among older people in China: evidence and policy implications

This paper uses multi-level modelling to analyse data from the nationally-representative Chinese Health and Retirement Longitudinal Study (CHARLS) in order to investigate the characteristics associated with poor health among older people, including individual and household characteristics as well as the characteristics of the provinces in which the older person lives (contextual effects). The results show that older Chinese women, rural residents, those with an education level lower than high school, without individual income sources, who are ex-smokers, and those from poor economic status households are more likely to report disability and poor self-rated health. Differentials in the health outcomes remain substantial between provinces even after controlling for a number of individual and household characteristics.

Mortality at older ages and moves in residential and sheltered housing: evidence from the UK

Background

The study examines the relationship between transitions to residential and sheltered housing and mortality. Past research has focused on housing moves over extended time periods and subsequent mortality. In this paper, annual housing transitions allow the identification of the patterning of housing moves, the duration of stay in each sector and the assessment of the relationship of preceding moves to a heightened risk of dying.

Methods

The study uses longitudinal data constructed from pooled observations from the British Household Panel Survey (waves 1993–2008). Records were pooled for all cases where the survey member is 65 years or over and living in private housing at baseline and observed at three consecutive time points, including baseline (N=23 727). Binary logistic regression (death as outcome three waves after baseline) explored the relative strength of different housing transitions, controlling for sociodemographic predictors.

Results

(1) Transition to residential housing within the previous 12 months was associated with the highest mortality risk. (2) Results support existing findings showing an interaction between marital status and mortality, whereby unmarried persons were more likely to die. (3) Higher male mortality was observed across all housing transitions.

Conclusions

An older person's move to residential housing is associated with a higher risk of mortality within 12 months of the move. Survivors living in residential housing for more than a year, show a similar probability of dying to those living in sheltered housing. Results highlight that it is the type of accommodation that affects an older person's mortality risk, and the length of time they spend there.

Informal care, health and mortality

Informal care provision is an activity in which individuals are increasingly likely to become involved across their life course, and particularly in later life, as a result of demographic changes such as increasing longevity and changes in co-residential living arrangements in later life. Academic research so far has highlighted the adverse impact of informal care provision on the financial position of the carer, however, the evidence on the impact of informal care provision on the carer's physical, mental and emotional health, and on their mortality, presents a more complex picture. This paper reviews research from the UK and beyond on the provision of informal care and its subsequent impact on health and mortality outcomes. Two key findings emerge from this review paper. Firstly, the cross-sectional analysis of data shows mixed associations between informal care provision and poor health outcomes for the carer. Such research highlights the importance of the demographic and socio-economic characteristics of the carer and the person cared for, and of the specific characteristics and nature of the care provided (e.g. duration, level). Secondly, longitudinal analysis, which typically benefits from a longer timeframe to follow up the impact of caring, shows that although informal care provision is not per se associated with adverse health and mortality outcomes, nevertheless particular types and durations of caring have shown negative outcomes.

Marital status, health and mortality

Marital status and living arrangements, along with changes in these in mid-life and older ages, have implications for an individual's health and mortality. Literature on health and mortality by marital status has consistently identified that unmarried individuals generally report poorer health and have a higher mortality risk than their married counterparts, with men being particularly affected in this respect. With evidence of increasing changes in partnership and living arrangements in older ages, with rising divorce amongst younger cohorts offsetting the lower risk of widowhood, it is important to consider the implications of such changes for health in later life. Within research which has examined changes in marital status and living arrangements in later life a key distinction has been between work using cross-sectional data and that which has used longitudinal data. In this context, two key debates have been the focus of research; firstly, research pointing to a possible selection of less healthy individuals into singlehood, separation or divorce, while the second debate relates to the extent to which an individual's transitions earlier in the life course in terms of marital status and living arrangements have a differential impact on their health and mortality compared with transitions over shorter time periods. After reviewing the relevant literature, this paper argues that in order to fully account for changes in living arrangements as a determinant of health and mortality transitions, future research will increasingly need to consider a longer perspective and take into account transitions in living arrangements throughout an individual's life course rather than simply focussing at one stage of the life course.

Financial inequality and gender in older people

Gender inequalities in the financial resources in later life result from the combined effect of women's atypical life courses, which include interrupted employment records and periods of care provision, and the fact that pension systems have generally been slow in mitigating 'diversions' from continuous and full-time working lives. Gender differentials in financial resources can often result in a greater likelihood of facing poverty for older women compared to older men, and such risk can be experienced for longer periods for women, as a result of their higher life expectancy on average. For example, across the EU-27, 16% of men compared to 23% of women aged 65 and over faced a poverty risk, and at age 65, men can expect to live another 17 years on average, while women another 21 years. Although modern pension systems are increasingly recognising the diversity of women's patterns of paid and unpaid work, for example by accounting for periods of childcare in the calculation of the state pension, research continues to show a 'penalty' for women who have spent significant periods of their life providing care to children or dependent adults in and outside the household. Reducing such penalty is particularly important as population ageing and an increasing demand for formal and informal care are likely to present challenges with critical policy implications for societies and individuals alike.