Population ageing in Sweden: the effect of change in educational composition on the future number of older people suffering severe ill-health

Determinants of home care utilization among the Swedish old: nationwide register-based study

Since the 1990s, Sweden has implemented aging-in-place policies increasing the share of older adults dependent on home care instead of residing in care homes. At the same time previous research has highlighted that individuals receive home care at a higher age than before. Consequently, services are provided for a shorter time before death, increasing reliance on family and kin as caregivers. Previous studies addressing how homecare is distributed rely primarily on small surveys and are often limited to specific regions. This study aims to ascertain how home care services are distributed regarding individual-level factors such as health status, living arrangements, availability of family, education, and socioeconomic position. To provide estimates that can be generalized to Sweden as a whole, we use register data for the entire Swedish population aged 65 + in 2016. The study's main findings are that home care recipients and the amount of care received are among the oldest old with severe co morbidities. Receiving home care is slightly more common among women, but only in the highest age groups. Childlessness and socioeconomic factors play a small role in who receives home care or not. Instead, the primary home care recipients are those older adults living alone who lack direct support from family members residing in the same household.

Disability-adjusted life years associated with population ageing in China, 1990-2017

BACKGROUND

The Chinese population has aged significantly in the last few decades. Comprehensive health losses including both fatal and non-fatal health outcomes associated with ageing in China have not been detailed.

METHODS

Based on freely accessible disability adjusted life years (DALYs) estimated by the Global Burden of Diseases (GBD) 2017, we adopted a robust decomposition method that ascribes changes in DALYs in any given country across two time points to changes resulting from three sources: population size, age structure, and age-specific DALYs rate per 100,000 population. Using the method, we calculated DALYs associated with population ageing in China from 1990 to 2017 and examined the counteraction between the effects of DALYs rate change and population ageing. This method extends previous work through attributing the change in DALYs to the three sources.

RESULTS

Population ageing was associated with 92.8 million DALYs between 1990 and 2017 in China, of which 65.8% (61.1 million) were years of life lost (YLLs). Males had comparatively more DALYs associated with population ageing than females in the study period. The five leading causes of DALYs associated with population ageing between 1990 and 2017 were stroke (23.6 million), chronic obstructive pulmonary disease (COPD) (18.3 million), ischemic heart disease (13.0 million), tracheal, bronchus, and lung cancer (6.1 million) and liver cancer (5.0 million). Between 1990 and 2017, changes in DALYs associated with age-specific DALY rate reductions far exceeded those related to population ageing (- 196.2 million versus 92.8 million); 57.5% (- 112.8 million) of DALYs were caused by decreases in rates attributed to 84 modifiable risk factors.

CONCLUSION

Population ageing was associated with growing health loss in China from 1990 to 2017. Despite the recent progress in alleviating health loss associated with population ageing, the government should encourage scientific research on effective and affordable prevention and control strategies and should consider investment in resources to implement strategies nationwide to address the future challenge of population ageing.

Trends in older people’s drinking habits, Sweden 2004–2017

Aims:

To examine if and how the drinking habits of older people aged 60–79 years in Sweden have changed during 2004–2017, with a specific focus on age groups and gender.

Data and measures:

A Swedish, nationally representative, repeated cross-sectional telephone survey covering the years 2004–2017 (n = 225,134) was used. Four aspects of alcohol consumption were investigated: proportion of alcohol consumers, frequency of drinking, amount per drinking occasion, and prevalence of heavy episodic drinking.

Results:

Three of the four measures investigated showed increases in alcohol consumption in the older age groups, particularly among women. Proportion of alcohol consumers, frequency of drinking and prevalence of heavy episodic drinking during the past month increased in most older age groups among both women and men, while the average amount per drinking occasion remained stable. Thus, total consumption in older age groups has increased over time, since the proportion of drinkers and the frequency of drinking has increased. Increases were particularly marked among women and in the age groups 70–74 and 75–79 years. In age groups below 60 years, these measures showed either declines or stability.

Conclusions:

There has been a steady increase in alcohol consumption across all the older age groups studied, which implies that the changing drinking habits are not isolated only to certain birth cohorts. Instead there seems to be a continuous shift in older people’s drinking habits which can be expected to continue. However, these increases are from very low levels, and older people’s drinking is still at modest levels. Public health implications must be studied further.

Social position and geriatric syndromes among Swedish older people: a population-based study

Background

Older people with a low social position are at higher risk of poor health outcomes compared to those with a higher social position. Whether lower social position also increases the risk of geriatric syndromes (GSs) remains to be determined. This study investigates the association of social position with GSs among older community-dwellers.

Methods

Three consecutive population-based health surveys in 2006, 2010 and 2014 among older community-dwellers (age 65–84 years) in Stockholm County were combined (n = 17,612) and linked with Swedish administrative registry information. Social position was assessed using registry information (i.e. education, country of origin and civil status) and by self-reports (i.e. type of housing and financial stress). GSs were assessed by self-reports of the following conditions: insomnia, urinary incontinence, functional decline, falls, depressive disorder, hearing or vision problems. Binomial logistic regression analyses were used to estimate the association between social position and GSs after adjusting for age, sex, health status, health behavior and social stress.

Results

The prevalence of GSs was 70.0%, but varied across GSs and ranged from 1.9% for depression to 39.1% for insomnia. Living in rented accommodation, being born outside the Nordic countries, being widowed or divorced were associated with GS presence. Financial stress was most strongly associated with GSs (adjusted odds ratio, 2.59; 95% CI, 2.13–3.15).

Conclusion

GSs are highly prevalent among older Swedish community-dwellers with wide variations across syndromes and strong association with all measures of social position, most strikingly that of experiencing financial stress.

Sick leave among people in paid work after age 65: A Swedish population-based study covering 1995, 2000, 2005 and 2010

Aims: Extending working life into older age groups is discussed in many countries. However, there is no knowledge about how this affects rates of sick leave. The aim of this work was to investigate rates of sick leave among people in paid work after retirement age and if such rates have changed over time. Methods: Swedish nationwide register data on people aged >65 years and living in Sweden in 1995, 2000, 2005 and 2010 were analysed. All people with a sufficiently high work income to be eligible for public sick leave benefits were included. The proportions in paid work and compensated rates of sick leave for people aged 66–70 and ≥71 were analysed by sex, educational level, country of birth, living area, and employment type and sector. Results: The percentage of people in paid work at ages 66–70 years increased from <10% in 1995 to 24% in 2010 and among those aged ≥71 years from 2.7% in 1995 to 3.5% in 2010. The rates of sick leave among working people aged 66–70 years were 3.3% in 1995 and 2.4% in 2010 and for people aged ≥71 years the rates of sick leave were 2.2% in 1995 and 0.2% in 2010. Women had higher rates of sick leave than men in 2005 and 2010, but lower in 1995 and 2000. In 2010, the rates of sick leave were similar between employees and the self-employed, and higher among employees in the public sector than among employees in the private sector. Conclusions: Rates of sick leave among workers aged >65 years were lower in 2010 than in 1995, despite much higher rates of labour market participation in 2010.

Increased alcohol use over the past 20 years among the oldest old in Sweden

Aims

Increased alcohol consumption among old people, reported in many countries, will likely present a major challenge to public health and policy in the future. In Sweden, current knowledge about old people's alcohol consumption is incomplete because of limited historical data and a dearth of nationally representative studies. We describe the frequency of alcohol consumption among the oldest old in Sweden over a 20-year period by sex, age, education, living situation, mobility and Activities of Daily Living.

Methods

We used repeated cross-sectional survey data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), conducted in 1992, 2002 and 2011. The samples were nationally representative of the Swedish population aged 77+, with response rates of 95.4%, 84.4% and 86.2% (total n=2007). Self-reported consumption frequency was measured with the question “How often do you drink alcoholic beverages, such as wine, beer or spirits?”

Results

Frequency of alcohol consumption increased among the oldest old from 1992 to 2011. The proportion reporting no or less-than-monthly alcohol consumption decreased, whereas the proportion reporting weekly consumption increased. This was true for men, women and most age and educational groups. The period change in consumption frequency was not explained by changes in demographic factors, living situation or functional capacity during the study period.

Conclusions

Alcohol use increased among the oldest old in Sweden during the 20-year study period. More liberal attitudes toward alcohol could contribute to the increased use. The increase in weekly alcohol consumers suggests an increase in the number of older risk consumers.

The impact of education and health heterogeneity on Generational Support Ratios: a cross-national comparison between Mexico and Korea

Policy makers are concerned about the socio-economic consequences of population ageing. Policies often rely on estimations of support ratios based solely on the population age structure. We estimate Generational Support Ratios (GSRs) considering health heterogeneity of the population age 60+ and education heterogeneity of their offspring. We explore the effect of a public policy that changes the education of a targeted sub-group of women when they are young on their health once they become older, taking into account changes in demographic processes (i.e.marriage, fertility, offspring's education). We used the model presented by Kyeet al.for the Korean context and examine the Mexican context. Our paper has three objectives. First, by applying this framework to the Mexican context we aim to find that improvements in women's education may mitigate the negative consequences of population ageing directly and indirectly through subsequent demographic behaviours that altogether affect GSRs. Second, by making a cross-national comparison between Korea and Mexico, we aim to quantify how policies of educational expansion have different impacts in contexts in which the population age 60+ have universal access to health care compared to contexts in which access to health care is selective. Third, by comparing cross-nationally we aim to show how differences in family processes across countries alter the pathways through which improvements in education affect GSRs.

Trends and variation in mild disability and functional limitations among older adults in Norway, 1986-2008

An increase in the number of older adults may raise the demand for health and care services, whereas decreasing prevalence of disability and functional limitations among them might counteract this demographic effect. However, the trends in health are inconsistent between studies and countries. In this article, we estimated the trends in mild disability and functional limitations among older Norwegians and analyzed whether they differ between socio-demographic groups. Data were obtained from repeated cross-sectional surveys conducted in 1987, 1991, 1995, 2002, 2005, and 2008, in total 4,036 non-institutionalized persons aged 67 years or older. We analyzed trends using multivariate logistic regression. On average, the age-adjusted trend in functional limitations was −3.3% per year, and in disability 3.4% per year. The risk for functional limitations or disability was elevated for women compared to men, for married compared to non-married, and was inversely associated with educational level The trends were significantly weaker with increasing age for disabilities, whereas none of the trends differed significantly between subgroups of sexes, educational level or marital status. Both functional limitations free and disability-free life expectancy appeared to have increased more than total life expectancy at age 67 during this period. The analysis suggests downward trends in the prevalence of mild disability and functional limitations among older Norwegians between 1987 and 2008 and a compression of lifetime in such health states. The reduced numbers of older people with disability and functional limitations may have restrained the demand for health and care services caused by the increase in the number of older adults.

The effect of change in educational composition on population ageing

Official Swedish demographic projections have systematically underestimated the number of older people. One explanation behind the underestimation may be found in the fact that the demographic projections are not taking into account socio-economic mortality differentials. We performed alternative demographic scenarios based on assumptions of unchanged and continuing declining mortality, with and without taking into account socio-economic gradients in mortality. According to a scenario based on assumption on declining mortality rates per age group, sex and educational level, the number of older persons (65+) in Sweden will increase by 62% during the period 2000-2035. This can be compared to an increase by 54% in a scenario that does not take into account future structural differences in educational levels and the latest trends in socio-economic inequality in life expectancy (the method used by statistical offices). The socio-economic structure of the older population is significantly changing over the years. We project that by year 2035, only 20% of women 80 years and older will have a low educational level, compared to about 75-80% today. The change in socio-economic structure is similar for the older men. Standard demographic projections that do not take into account socio-economic mortality differentials, risk underestimating the number of older people and hiding dramatic changes in population composition. Taking into account socio-economic mortality differentials results in alternative projections giving us new information regarding the future size and socio-economic composition of the older population. We recommend use of this information in health care and long-term care human resources planning or when assessing financial sustainability of health care, long-term care and pension systems in the future.