Marital disruptions and loss of support in later life: a longitudinal study of the United Kingdom

The impact of demographic change in the balance between formal and informal old-age care in Spain. Results from a mixed microsimulation–agent-based model

Changes in population and family structures are altering the provision of care for dependent older people. In Southern European countries like Spain, such care is still largely provided by family, typically spouses and adult daughters. However, an increasing proportion of women have entered the labour force, thereby affecting their availability. To study the demand and supply balance of informal care and to quantify the need for formal care when there is a deficit, we have developed a mixed microsimulation–agent-based model (ABM). Based on nuptiality, fertility and mortality levels of cohorts born at ten-year intervals between 1908 and 1968, the model starts with a microsimulation of the lifecycle of individuals and their close relatives until death. The ABM then determines the amount of time available or needed to care for family members, starting from age 50. Estimates are derived from Spanish survey data on employment, disability and time of care received. Surprisingly, results show that the family care deficit was greater in the older cohorts due to higher mortality and thus a greater impact of widowhood. However, for future elderly persons, we foresee that persistent below-replacement fertility and, paradoxically, the prolongation of the lifespan of couples will increase the demand for formal care as there will be more couples with both members incapacitated but without children to take care of them.

Always alone? Network transitions among detached older Europeans and their effects

The present study investigated the changes that occurred within the interpersonal environments of a sample of socially isolated older Europeans after four years. Based upon data from the Survey of Health, Ageing and Retirement in Europe (SHARE), the inquiry looked at 834 older people who were socially detached at baseline, at follow-up or at both time-points. The analysis traced changes in relation to the social network types that they acquired or left. The findings indicate that respondents more frequently moved from no-network status at baseline to close family-based social network types at follow-up than to other network types. In comparison, the loss of a network at follow-up was seen to originate from close networks and from other network types alike. Multivariate analysis revealed that those who moved from socially detached status to close-family networks had fewer depressive symptoms compared to those who moved to other network types. However, the move from a close-family network to the no-network status was about as depressing as was being chronically isolated. The effects of network transitions were more varied in relation to the life satisfaction outcome. In sum, the findings suggest that a transition out of social isolation in late life is possible and it may be beneficial as well.

Network type, transition patterns and well-being among older Europeans

Using SHARE data, this study was based on an earlier analysis that derived social network types among adults aged 65 and over in Europe. The current effort investigated the transitions that occurred across these network types after 4 years (N = 13,767). Four general network transition patterns were identified according to network type (close-family networks and other networks) and whether a network transition occurred. The associations between network type, network transitions and well-being (depression and life satisfaction) were examined. We regressed depressive symptoms and a life satisfaction measure on the network transition patterns, controlling for socio-demographic background, health and country. The results revealed that a majority of older Europeans experienced a range of network transition, while close-family-based networks tended to prevail over time. Moreover, respondents who remained in or transitioned to close-family networks had fewer depressive symptoms and better life satisfaction than those in other network types. The study, thus, underscores the varied effects of network types and network changes on emotional well-being in late life. It also demonstrates that beneficial changes can be made in one's social network in old age, especially with regard to greater family closeness.

Marital status, close social network and loneliness of older adults in the Czech Republic

The wellbeing of older adults is closely related to their social relationships. There is a well-documented association of widowhood with social isolation and loneliness, but less is known about the consequences of divorce. This paper focuses on the effects of divorce and widowhood on the characteristics of social networks and loneliness in the Czech Republic. Data from the Czech component of the Survey of Health, Ageing and Retirement in Europe, 2015, are used. The results show that married older adults have the lowest levels of loneliness and, together with widowed men, the largest network of confidants. However, the size of the network is not associated with loneliness (net of socio-demographic variables). The only characteristic of the close social network that has an influence on loneliness is the presence of a partner in the network. This variable explains part of the advantage of spouses. Divorce is found to have a smaller impact on loneliness than widowhood, but the size of the difference depends on the gender and timing of the event. Widowed men seem to be most vulnerable while persons who divorce at age 50 or later experience the lowest level of loneliness among the unmarried groups. The favourable effect of late divorce can be interpreted in relation to the specific nature of partnership decisions in later life.

The Association of Mastery With Loneliness

Abstract. The focus of this paper is on the association of sense of mastery with feelings of loneliness, reviewing research conducted during the period 2000–2017. The basic findings show that across different age groups and different situations, mastery is negatively correlated with loneliness. The presumed contributions of mastery to loneliness are summarized by several explanatory models: Mastery can be conceived as contributing to low loneliness through the initiation of active coping to change the situation, through behavior that changes loneliness, and through changes in perceptions. Future research should include intervention studies, longitudinal designs, and mediating variables to assess the processes by which a high sense of mastery can lower feelings of loneliness.

Pathways into living alone in mid-life: diversity and policy implications

This paper adopts a life course approach to investigate the pathways into living alone in mid-life in Britain and how these vary by gender and socio-economic status. The rise in the proportion of people living alone over the past three decades has been well documented. However, much of the focus of the existing literature has been on either people living solo in young adulthood or in later life. Mid-life has received surprising little scholarly attention, despite the fact that living arrangements in mid-life are changing rapidly, and that household composition and socio-economic circumstances in the period immediately prior to retirement are strongly associated with living arrangements and associated sources of support in later life. This paper therefore aims to fill this gap. We begin with a review of previous research on living alone and present a conceptual framework of the pathways into living alone in mid-life. Data from the United Kingdom Household Longitudinal Survey (UKHLS) are used to analyse the partnership and parenthood histories and socio-economic characteristics of those currently living alone in mid-life. The findings indicate that the dissolution of a marriage with children is the dominant pathway into mid-life solo-living, but that there is also a substantial group of never partnered men living alone. These never partnered men are split between those with low and high socio-economic status. Distinguishing between different groups of individuals living alone in mid-life is important for policy as these groups of men and women will have different social and financial resources as they enter later life. Mid-life men living alone who have not had children, have no educational qualifications, are not economically active and who live in rented housing are likely to be most at risk of needing a social and economic 'safety net' in old age.

A growing care gap? The supply of unpaid care for older people by their adult children in England to 2032

A key feature of population ageing in Europe and other more economically developed countries is the projected unprecedented rise in need for long-term care in the next two decades. There is, however, considerable uncertainty over the future supply of unpaid care for older people by their adult children. The future of family care is particularly important in countries planning to reform their long-term care systems, as is the case in England. This article makes new projections of the supply of intense unpaid care for parents aged 65 and over in England to 2032, and compares these projections with existing projections of demand for unpaid care by older people with disabilities from their children. The results show that the supply of unpaid care to older people with disabilities by their adult children in England is unlikely to keep pace with demand in future. By 2032, there is projected to be a shortfall of 160,000 care-givers in England. Demand for unpaid care will begin to exceed supply by 2017 and the unpaid ‘care gap’ will grow rapidly from then onwards. The article concludes by examining how far this unpaid ‘care gap’ is likely to be met by other sources of unpaid care or by developments in new technology and examines the implications of the findings for long-term care policy.

The comparison of quality of life among people with mild dementia in nursing home and home care—a preliminary report

Background

Living arrangements play an important role in determining the quality of life (QoL) of people with dementia. Although informal care (home-based) is favored, the transition to formal (institutional) care often becomes necessary, especially in the later stages of dementia. Nevertheless, there is currently no definitive evidence showing that informal or formal care provides a higher QoL for those with dementia.

Objective

To compare the QoL of people with dementia in the nursing home and home care, and identify factors that differentiate their QoL.

Design and methods

This was a cross-sectional survey. A total of 49 people with dementia ≥60 years old were recruited from government nursing homes and hospitals (home care). Consenting participants were assessed on cognitive severity, QoL, activities of daily living (ADLs), depression, and social isolation/connectedness by the Short Mini Mental State Examination (SMMSE), the WHO-8 (the EUROHIS-QOL), Short Assessment of Quality of Life (AQoL-8), Barthel Index (BI), Cornell Scale for Depression (CSDD), and Friendship Scale (FS).

Results

There were significant differences in QoL, HRQoLs, ADLs, and social connectedness among people with dementia in home care ( n = 19) and those in nursing homes ( n = 30) ( p < 0.01). No significant differences were found by socio-demographic factors, cognitive severity, or depression between the study cohorts.

Conclusions

Older adults with dementia who were living at home experienced higher QoL, ADLs, and social connectedness compared with those living in institutional care. Support should be provided enabling home care and empowering caregivers to provide better care for people with dementia.

Personal and neighborhood resources, future time perspective, and social relations in middle and older adulthood

OBJECTIVES

Aging-related changes in motivation and the availability of resources have been hypothesized to result in social network changes in later life. However, few studies have examined associations of both motivation and resources with different aspects of social network composition in the same analytical context. The present study examined associations of key motivational (future time perspective [FTP]) and resource variables (partner status, physical health, and perceived neighborhood cohesion) with social network size and positive and negative social exchanges.

METHOD

A population-based sample of midlife (aged 55-59 years, n = 169) young-old (aged 60-74 years, n = 306) and old-old (aged 75+ years, n = 77) adults completed a questionnaire.

RESULTS

Those who were partnered reported larger networks with family, whereas never-married individuals reported larger networks with neighbors. Perceived neighborhood cohesion was related to larger networks with family, neighbors, and friends. Open-ended FTP was associated with larger networks of friends and more frequent positive social exchanges.

DISCUSSION

Our results point to FTP and resources having different implications for social engagement across network domains.

Sex Differences in Medication and Primary Healthcare Use before and after Spousal Bereavement at Older Ages in Denmark: Nationwide Register Study of over 6000 Bereavements

Background. The study aimed to examine sex differences in healthcare use before and after widowhood to investigate whether reduced healthcare use among widowers compared with widows may partially explain excess mortality and more adverse health outcomes among men than women after spousal loss. Methods. All individuals alive and aged at least 60 years in 1996 and who became widowed in the period from 1996 to 2003 were selected from the 5% sample of the total Danish population and all Danish twins. The healthcare use was assessed as the average daily all-cause and major system-specific medication use and the average annual number of visits to general physicians (GPs). Results. The average daily use of all-cause and major system-specific medications, as well as the number of GP visits increased over the period from 1 year before and up to 5 years after a spouse's death, but there were no sex-specific patterns in the trajectories of medication use and number of GP visits after conjugal loss. Conclusion. We found little support for the hypothesis that reduced healthcare use contributes to the explanation of more adverse health outcomes after conjugal loss in men compared with women in Denmark.

Help from spouse and from children among older people with functional limitations: comparison of England and Finland

Future increases in need of old-age care warrant research on receipt of informal care among older people in different policy and cultural contexts. Separating informal care into help provided by spouse and by children may shed more light on dynamics of informal help, important in alleviating the demands on the formal sector. Using nationally representative data from England and Finland, we performed logistic regression analyses to study receipt of help from spouse and children among community-dwelling persons aged 70+ years with functional limitations. In both countries, women and those with more functional limitations had higher odds of receiving spousal and filial help. In England – but not in Finland – those receiving formal public help had lower odds of receiving spousal help than those with no formal help. Those with low education received more filial help in England, but no association was found between formal and filial help. In Finland, the effect of education was not significant but those receiving formal help had higher odds of also receiving filial help. The results suggest that in a liberal market-led state, the role of children may be to help their parents living alone and with low financial resources. In the context of a generous welfare state, children may function more as active agents bridging the gap between their parents and formal services.

Spousal Bereavement as a Triggering Mechanism for a Loss of Residential Independence Among Canadian Seniors

Although it is well recognized that unmarried seniors are more likely to experience instability in their living arrangements than their married counterparts, few studies have tested whether spousal bereavement in and of itself operates as a triggering mechanism for a subsequent loss of residential independence. The purpose of this study was to investigate whether Canadian seniors are at greatest risk for institutionalization and coresidence with others in the period immediately following spousal bereavement and whether this risk declines as acute responses to the crisis of bereavement become tempered with time. Data come from six waves of the Canadian National Population Health Survey (1994-2004), with the sample restricted to married or cohabiting adults who, at initial interview, were 65 years of age or older and living in a couple-only household ( n = 1,082). Results from a competing risks analysis for time to first event, where first event was either moving into an institution or sharing a residence with others, confirm the time-dependent consequences of spousal bereavement. Relative to seniors whose spouse was still living 10 years later, respondents who experienced the death of a spouse or partner between 1994 and 2004 were at significantly greater risk for both institutionalization and coresidence in the period immediately following bereavement, with risk attenuating over time.

Factors which enhance or inhibit social support: a mixed-methods analysis of social networks in older women

Evidence suggests that people with strong social support have lower mortality and morbidity and better self-rated health in later life, but few studies have used longitudinal data to examine the factors that inhibit or enhance social support. This study used both quantitative data and qualitative texts to explore older women's social networks. The mixed-methods design drew participants from the 1921–26 cohort of the Australian Longitudinal Study on Women's Health (ALSWH). Regression modelling for repeated measures was used to analyse the longitudinal data. The qualitative data was content analysed by the themes identified from the quantitative analyses. The quantitative analyses revealed that larger social networks associated with better mental health, widowhood, illness or death of a family member, and no mobility problems. Women who were not Australian-born, had sight problems or who had moved house were more likely to have smaller social networks. The qualitative data provided insight into the lived experiences of this group of women. The use of a mixed methodology enabled the longitudinal quantitative results to be enriched by the women's own words. The findings highlight the importance to older women of being able to access their social network members to gain the psychological and emotional benefits.

Gender Differences in Social Network Size and Satisfaction in Adults in Their 70s

Strong social support is associated with lower mortality and morbidity and better self-rated health in later life. The aim of this study was to compare social network size and satisfaction in men ( N = 2589) and women ( n = 3152), aged 72—78 years. Women reported significantly larger networks (Difference 1.36, 95% CI 0.89, 1.83) than men. However, being separated, divorced or single had a significantly greater impact on men’s social networks (Difference 0.92, 95% CI 0.17, 1.68). Poor mental health and sensory impairments were associated with smaller networks and lower satisfaction with support for both men and women.

Couples' provision of informal care for parents and parents-in-law: far from sharing equally?

This study examines whether and how couples share the provision of informal care for their parents. Four waves of the British General Household Survey contain cross-sectional information about caring for parents and parents-in-law. Descriptive and multivariate analyses were conducted on 2214 couples that provided parent care. The findings emphasise married men's contribution to informal caring for the parental generation and at the same time demonstrate the limits of their involvement. Spouses share many parts of their care-giving but this arrangement is less common with respect to personal and physical care. The more care is required the more likely are people to participate in care for their parents-in-law. More sons-in-law than daughters-in-law provide care but, once involved, daughters-in-law provide on average more hours of care than sons-in-law. Own full-time employment reduces both men's and women's caring for their parents-in-law, and men's caring drops further if their wife is not in the labour market. The findings suggest that daughters-in-law often take direct responsibility whereas sons-in-laws' care-giving depends more on their wives' involvement. Children-in-laws' informal care-giving might decrease in the future because of women's increasing involvement in the labour market and rising levels of non-marital cohabitation in mid-life.