Health inequalities in the older population: the role of personal capital, social resources and socio-economic circumstances

For Whom Does Education Convey Health Benefits? A Two-Generation and Life Course Approach

Scholars of social determinants of health have long been interested in how parent's and own education influence health. However, the differing effects of parent's and own education on health-that is, for what socioeconomic group education conveys health benefits-are relatively less studied. Using multilevel marginal structural models, we estimate the heterogeneous effects of parent's and own education over the life course on two health measures. Our analysis considers both parent's and respondent's pre-education covariates, such as childhood health and socioeconomic conditions. We find that the protective effects of college completion against negative health outcomes are remarkably similar regardless of parent's (measured by father's or mother's) education. Meanwhile, parent's education has a larger effect when the average educational level is low in the population. Our results also reveal distinct life course patterns between health measures. We conclude by discussing the implications of our study for understanding the education-health relationship.

Diverging death risks: Mortality as a corollary of economic, social, cultural and person capital

Introduction

Diverging death risks are associated with a wide range of social factors, including not only education and income but also other economic and non-economic resources. The aim of this study was to assess the association of mortality risks with four types of resources: economic, social, cultural and person capital.

Methods

We used data of 2,952 participants from the Disparities in the Netherlands survey and annual mortality data from Statistics Netherlands for the period 2014 to 2021. Economic capital was measured through education, income, occupation, home equity, and liquid assets. Social capital was measured by the strength of social ties, the size of the core discussion network, and access to people in resourceful positions; cultural capital by lifestyle, digital skills, and mastery of English, and person capital by self-rated health, impediments to climbing stairs, self-confidence, self-image, people's appearance, and body mass index. To accommodate the fact that each capital was derived from several indicators, we used Partial Least Squares (PLS) Cox Regression.

Results

In multiple regression, higher economic, cultural, and person capital were associated with lower mortality (hazard ratio, 0.77; 95% confidence interval [CI, 0.65 to 0.90], 0.77 [0.64-0.93] and 0.80; [0.70-0.92]), adjusted for all capital measures and sex.

Conclusion

The finding that more economic, cultural and person capital is associated with lower mortality provides empirical support for an approach that uses a broad spectrum of capital measures - hitherto rarely included simultaneously in epidemiological research - in order to understand diverging death risks. By integrating sociological concepts, cohort data, and epidemiological research methods, our study highlights the need for further research on the interplay between different forms of resources in shaping health inequalities. In designing public health interventions, we advocate the adoption of a multidimensional capital-based framework for tackling social disparities in mortality.

Role of family factors in provision and perception of social support for older people in Iran: a cross-sectional survey

BACKGROUND

Iran has experienced a very fast fertility transition. The process of demographic transition, coupled with modernization, has had considerable consequences for the structure and function of families. There is rising concern in Iran about a potential decline in family care and support for older people as a result of these changes. The main aim of this study was to provide a benchmark by examining current associations between family factors and older people's social support, both perceived and received.

METHODS

A cross-sectional survey of a random sample of 644 people aged 60 + years resident in Tehran was conducted using stratified cluster random sampling method in 2015. Outcome variables were perceived social support, as measured by Social Provision Scale, and received instrumental social support. Multilevel mixed-effects models were used to examine the hypotheses.

RESULTS

The analyses showed that most of the family factors measured, including family size (p = 0.01), living arrangements (p = 0.05), and amount of contact with family members (p = 0.001) were associated with older people's receipt of instrumental social support. Living arrangements and quality of relationships with family members were associated with older people's perceptions of social support (p < 0.001). Also, a significant gender interaction was found in associations between family size and SPS (p = 0.03). Having a large size family was positively associated with higher SPS for women (Coef. = 3.9, p = 0.009) but not for men (Coef. = -0.4, p = 0.7).

CONCLUSION

findings of this study support the premise that most of family factors play an important role in provision and perception of social support for Iranian older people. Further policies should mostly be selective of those at higher risk of low support such as widowed, childless, those living alone, having poor relationship with their relatives and those with worse health status. The results of this study may be utilized to target older populations who are at higher risk of low support with innovative programs that focus on building social networks and enhancing social support.

Factors associated with self-perceived health status in Portugal: Results from the National Health Survey 2014

Background

Self-perceived health is an important indicator of illness and mortality. This study aims at identifying a wide range of factors that can influence self-perceived health status among a representative sample in Portugal.

Methods

We used the 2014 National Health Survey (n = 17,057), whereby participants were required to assess their health status from "Very good," "Good," "Fair," "Poor" to "Very poor." We grouped the answers "Very good" and "Good," and "Poor" and "Very poor," respectively. Multinomial logistic regression was used to compare participants' characteristics across groups by computing odds ratio and corresponding 95% confidence intervals. Models included Socioeconomic/demographic characteristics, objective health status, healthcare use, functional disability, barriers to healthcare services utilization, lifestyle variables, mental health status, social support, and satisfaction with life as potential factors that can affect self-perceived health. Models were adjusted for sex, age, educational level, degree of urbanization, and presence of chronic diseases.

Results

About 45% of participants reported good/very good, 39% reported fair, while ~16% reported poor/very poor health perception. Poor/very poor health was more reported by women when compared to men (19.1 vs. 11.4%, respectively, p < 0.001). A higher prevalence of poor/very poor health status was reported by participants living in thinly populated areas or among older populations. Lower educational levels, lower income, as well as unemployment, were found to increase the risk of reporting poor/very poor health status. Utilizing healthcare services more frequently, experiencing barriers to access healthcare services, having depressive symptoms or activity limitations, or lacking social support were found to be significantly associated with poor/very poor self-perceived health.

Conclusion

Subjects living in Portugal tend to report less good/very good health status and more poor/very poor health when compared to the rest of Europe. This study stresses the importance of socioeconomic factors, chronic illness, barriers to access healthcare services, social isolation, and mental health status in influencing self-perceived health and highlights the urgent need for social-informed policies, strategies, and interventions to reduce health inequalities in Portugal.

Socioeconomic inequalities in the wellbeing of informal caregivers across Europe

OBJECTIVES

Due to increasing care needs and decreasing care potentials, research around informal caregiving gains attention. Relatively new - but of utmost importance - is the role of socioeconomic inequalities in care and wellbeing. Although caregiving can be rewarding, a growing body of research shows that informal caregiving often has negative consequences for individuals' wellbeing. Theoretically, we expect these negative outcomes to be more pronounced among caregivers with lower socioeconomic resources. The current study examines socioeconomic inequalities in the consequences of caregiving inside the household for life satisfaction.

METHODS

We draw on longitudinal data from the Survey of Health, Ageing, and Retirement in Europe (SHARE waves 2, 4, 5, and 6). We estimated pooled ordinary least squares and fixed-effects regression models to examine the consequences of informal care provision within the household for individuals' life satisfaction, and whether household wealth moderates this relationship, controlling for individuals' sociodemographic and health characteristics.

RESULTS

Care provision inside the household was negatively associated with older adults' life satisfaction. The longitudinal analyses accordingly show that the uptake of care led to declines in life satisfaction. Differentiating by socioeconomic background, we find that caregivers with higher socioeconomic resources in terms of wealth generally experienced higher life satisfaction. Our longitudinal analyses on wellbeing declines reveal, however, that these mechanisms did not significantly differ by socioeconomic status of the caregiver.

DISCUSSION

Our findings suggest the need for increased investments in support services for informal caregivers to mitigate caregiving burdens, irrespective of socioeconomic status, and enhance later life wellbeing.

Gender Interaction in Association of Perceived Social Support and Health-Related Quality of Life Among Iranian Older People: A Cross-sectional Survey

Background: The purpose of this study was to examine the relationship between perceived social support (PSS) and dimensions of health-related quality of life (HRQoL) and to examine possible gender interaction in the mentioned associations. Methods: A community-based cross-sectional study conducted among 644 participants over the age of 60 years old in Tehran. The data were collected through face-to-face interviews conducted in their own homes, by using a structured multi-sectional questionnaire. The version 1 of the SF-12 scale was used to measure the HRQoL, consisting of two summary measures; PCS (Physical Component Score) and MCS (Mental Component Score). The Persian version of the Social Provisions Scale (SPS) was used to measure PSS. Four multilevel mixed-effects logistic regression models were used to examine the associations. Results: Older people with poor SPS score were 1.8 times more likely to be in the worst quartile of the MCS distribution (CI=1.11-2.93, P =0.021), and twice as likely to be in the worst quartile of the PCS distribution (CI=1.18-3.54, P =0.011). We found strong evidence to support the hypothesis of gender interaction in the association between economic status and PCS [Men: OR 0.28, CI (0.11-0.71); Women: OR 1.00, CI (0.53-1.88); P of Interaction 0.021], and a borderline evidence for gender interaction in the association between physical activity and PCS [Men: OR 5.32, CI (2.14-13.20); Women: OR 1.80, CI (0.82-3.93); P of Interaction 0.051]. Conclusions: Social support could be regarded as one of the main social determinants affecting HRQoL among older people. Men with poor economic status and poor physical activity, compared to women, are more likely to suffer from poor quality of life, thus men should be prioritized in financial support and life style and physical activity interventions.

Social exclusion and mental health among older adults: cross-sectional evidence from a population-based survey in India

BACKGROUND

Social exclusion has far-reaching consequences that extend beyond regular activities and access to resources and knowledge; social exclusion is a major social determinant of health. However, there is a lack of evidence on social exclusion and health outcomes among India's older adults. Thus, the current study investigates the association of social exclusion with depressive symptoms among Indian older adults.

METHODS

This study used information on 30,366 older adults from Longitudinal Ageing Study in India (LASI) wave-1, 2017-2018. Social exclusion scores were calculated, and two broad domains of social exclusion, i.e., exclusion from civic activity & social relations and exclusion from services, were considered in the study. The depressive symptom was calculated using the CES-D score. Using logistic regression models, the average marginal effects of selected covariates and domains of social exclusion on depressive symptoms were estimated to assess the links between social exclusion and depressive symptoms.

RESULTS

With the increase in the social exclusion score in the selected domains, the prevalence of depressive symptoms among older also increased. Elderly persons who do not vote or live alone in the domain of being excluded from civic & social activities and older adults excluded from services were observed to have a higher prevalence of depressive symptoms. Adjusting for sociodemographic factors, the average marginal effects suggested that older with four scores of civic activity & social relation exclusion, two scores of service exclusion and four scores of overall social exclusion were estimated to have a higher prevalence of depressive symptoms, respectively.

CONCLUSIONS

This study's findings shed light on social exclusion and its relationship to depressive symptoms among older Indians. Older health care services should be expanded in breadth while also addressing social exclusion, resulting in considerable improvements in older individuals' mental health.

Impact of Social Cognition on the Self-Rated Health of the Elderly and Its Mechanisms: Evidence From China’s Comprehensive Social Survey

Whether and how the differentiated social cognition of the elderly affects their self-rated health has not been deeply discussed. Based on social cognition theory and Chinese situation, this study constructs the social cognitive dimension of Chinese elderly including social attitude, class identity and perception of social relations. Using the data from Chinese General Social Survey in 2017, this study screens out 1,728 elderly people aged 60 and over, and discusses the impact mechanism of social cognition on self-rated health of Chinese elderly people aged 60 and over by the construction of structural equation model and mediation effect test method. The results show that social attitude, class identity and perceptions of social relationships have significantly positive effects on the self-rated health levels of elderly individuals. Among them, the path coefficient of social attitude to self-rated health was 0.049, the path coefficient of class identity to self-rated health was 0.171, and the path coefficient of social relationship perception to self-rated health was 0.248; both class identity and perception of social relationship have significant mediating effects on elderly self-rated health through social engagement. This study shows that social cognition rarely studied in existing literature has significant effects on the self-rated health of older adults, providing fruitful insights for enhancing the self-rated health level of elderly individuals.

Dynamic identities and self-perception of aging: The case of Turkish cosmetic surgery patients

Drawing on the idea that aging is a physical and a psychosocial process, this study aimed to understand self-perceived aging by focusing on the cultural and experiential perspective presented by Turkish women. The social and interactive aspects were reflected in their self-perceptions of aging, which did not necessarily entail physical degradation or health problems. This study focused on patients who underwent anti-aging operations, and cosmetic surgery was revealed to be a convenient and quick way to eliminate the physical signs of aging. By analyzing 31 in-depth interviews with patients of ages ranging from 21 to 75, three interpretations of aging were identified and discussed. Past-oriented women wanted to return to "good old times," present-oriented women wanted to balance their inner and outer selves, and future-oriented women desired a total transformation in their lives. This study contributes to our understanding of self-perceived aging and presents findings from patients who did not necessarily conceptualize their selves as moving forward in time. Successful aging may be possible by means of past, present, or future selves, and "success" in aging is socio-culturally interpreted by these women in addition to more objective definitions of well-being and medical norms.

Financial hardship and suicide ideation: Age and gender difference in a Korean panel study

BACKGROUNDS

Socioeconomic factors influence suicide risk but a systematic understanding of the role of financial hardship is unclear. We examined whether financial hardship had cumulative or contemporaneous impacts on suicide ideation and any gender and age differences in a large Korean sample.

METHODS

Data of 67,728 observations from 14,321 individuals were extracted from seven waves of Korean Welfare Panel Study. The association of financial hardship at baseline and its change over two years with suicide ideation was investigated using generalized estimation equation to account for repeated measurements within an individual, adjusting for other socioeconomic factors.

RESULTS

Financial hardship was associated with suicide ideation but the magnitude of association varied across age and gender groups. Specifically, the impact of financial hardship was persistent over two years presenting a cumulative effect among men aged 50-64 years and ≥65 years; e.g., adjusted OR (adjusted odds ratio) = 3.87, 95 % CI = 2.71-5.54 for emergent hardship group vs adjusted OR = 4.22, 95 %CI = 3.00-5.93 for persistent group in those aged ≥65 years. Financial hardship increased the risk of suicide ideation incrementally with age, although the pattern was less clear among women.

LIMITATIONS

Financial hardship was identified as having changing nature, though it was assumed to occur over two years.

CONCLUSION

In general, financial hardship plays a role in amplifying suicide ideation in a contemporaneous way but also in a cumulative way, predominantly among late-middle-aged and elderly men. Monitoring and intervention for financial hardship would be a promising strategy for suicide prevention.

The association between home ownership and the health of older men: Cross-sectional analysis of the Australian Concord Health and Ageing in Men Project

OBJECTIVE

To investigate the association between home ownership and health in older men.

METHODS

Cross-sectional analysis of 909 community-dwelling Australian men (mean age: 81.3 ± 4.6) from the Concord Health and Ageing in Men Project (CHAMP, 2012-2013). We considered self-rated health, frailty status, multimorbidity, and anxiety and depressive symptoms which identify different dimensions of health.

RESULTS

Most participants were owner-occupiers (89.7%). In age- and country of birth-adjusted analyses, not being an owner-occupier was associated with an increased likelihood of depressive symptoms [prevalence ratio: 1.82, 95% confidence intervals 1.17 to 2.84]. There were no associations between home ownership and other health conditions.

CONCLUSION

Lack of home ownership was associated with a higher prevalence of depressive symptoms, largely explained by poorer social support. Thus, targeting mental health programs at older divorced or separated men who do not own their own home could be an appropriate community-based intervention.

Effects of healthcare access and financial status on self-rated health among adults living alone in South Korea

Assessments of the overall health status of people living alone are important for developing health promotion programs and delivering appropriate health services. In the context of universal social health insurance system of South Korea, the relationship between failure to access health-care and self-rated health among adults living alone has given little attention. In addition, the influence of objective financial status on self-rated health in adults living alone has not explored so far. The sample of the present study comprised 4,852 adults who participated in the cross-sectional 2015 Korea National Health and Nutrition Examination Survey. The main finding was that the unmet health-care needs resulting from the inability to access health-care services during the previous 12 months was independently associated with fair or poor self-rated health, especially for women living alone. Having an income below the subsistence level was significantly associated with fair or poor self-rated health among women living alone. The findings of this study demonstrate the need for policies enabling appropriate delivery of health-care services, especially for women living alone. It is necessary to provide community-based monitoring programs related to general health for women living alone with a household income below the minimum cost-of-living.

Living arrangements and quality of life among older adults in China: does social cohesion matter?

Objectives: This study investigated how living arrangements are related to the well-being of Chinese older adults and the role of social cohesion in this relationship. Methods: This study used the China data from the WHO's Study on Global AGEing and Adult Health. The analytic sample featured 5,600 Chinese adults aged 60 or older. The study conceptualized two sets of models: social cohesion as mediators and as moderators in the relationship of living arrangements and quality of life. Results: Results from structural equation modelling analyses show that Chinese older adults who lived with adult children had lower quality of life scores compared with those who did not live with adult children; the negative relationship was partially mediated through decreased social cohesion. The study also found social cohesion may buffer the negative influence of not living with a spouse compared with those who did. Conclusion: This study sheds light on the mediating and moderating effects of social cohesion on the relationship between living arrangement and quality of life among older adults in China. The findings indicate the necessity of promoting social connectedness and neighborhood cohesion for older Chinese, especially those who live with their adult children.

Associations between social connections, their interactions, and obesity differ by gender: A population-based, cross-sectional analysis of the Canadian Longitudinal Study on Aging

Objectives

To quantify the link between four different types of social ties and objective measures of abdominal and general obesity, and to explore their inter-relationships in association with obesity using a gender-sensitive analysis.

Methods

A cross-sectional analysis of 28,238 adults (45–85 years) from the baseline Canadian Longitudinal Study on Aging Comprehensive cohort (2012–15). Social ties (marital status, living arrangement, social network size, and social participation) and measured anthropometry (body mass index, waist circumference) were analyzed using linear and logistic regression models with interaction terms conditioned on known confounders.

Results

We found that being single, widowed or divorced/separated was associated with worse anthropometric outcomes in women, including higher odds of both abdominal and general obesity, and that associations were enhanced when combined with limited social participation, lone-living and greater social network size. Few clear associations were observed in men. Limited social participation (no social activities at least once/month) among women was associated with larger waist circumference (+4.19 cm [95% CI: 1.86, 6.52]) and higher odds of both abdominal and general obesity. By contrast, associations appeared to be reversed in men: lone-living and smaller social networks were associated with lower odds of obesity, compared to co-living and larger social networks. We also found that more regular social participation can potentially mitigate the adverse associations between non-partnership (single, divorced) and obesity in women. Overall, the combined influence of two types of social tie deficits on excess weight measures was more pronounced in women than men.

Conclusions

Results highlight the importance of considering how the role of social ties for obesity prevention may differ for women and men. Frequent social participation and number of social contacts may matter for assessing whether divorced, single or lone-living older women are at risk of obesity while living arrangement and social contacts may matter for obesity in men.

Socioeconomic inequalities in mental distress and life satisfaction among older Chinese men and women: The role of family functioning

Despite growing concern over socioeconomic inequality in health, few studies have focused on health inequality among older adults. The present study examined the independent and joint effects of socioeconomic status (SES) and family functioning on mental health and subjective well-being and explored the gender differences in such relations. Representative survey data on older adults (N = 1,432) were drawn from the third wave of the Hong Kong Panel Study of Social Dynamics conducted in 2015. Descriptive analyses and ordinary least-squares regressions were conducted for data analysis. The results demonstrate that receipt of means-tested welfare payments was associated with more severe mental distress and lower life satisfaction; living in private (as opposed to public or subsidised) housing was associated with better mental health; whereas holding investments and larger residence size were related to higher life satisfaction. Moreover, greater family functioning predicted better mental health and greater subjective well-being and mitigated the detrimental effects of low SES. Gender differences were observed concerning the effects of different predictors. The findings could inform the development of health-promotion services sensitive to gender and socioeconomic differences and facilitate integration of individual- and family-level services for older adults.

Work–family lifecourses and later-life health in the United Kingdom

Socio-economic inequalities in physical and mental health persist at older ages and previous studies have shown that partnership and parenthood histories are also associated with differentials in later-life health. These domains of adult life interact, and both may be influenced by earlier life circumstances, indicating a need for a holistic approach to understanding lifecourse influences on health at older ages. In this paper, we identify classes of lifecourse types for a United Kingdom (UK) cohort born 1933–1945 and investigate differences between the latent classes identified in physical and mental health, and changes in health over a five-year follow-up period. Data were drawn from Waves 1–5 (2009–2013) of the nationally representative UK Household Longitudinal Study. Multi-level models were used to analyse associations with summary indicators of physical and mental health measured using the SF-12, and changes in health, controlling for childhood circumstances and taking account of support from family and friends in later life. Lifecourses characterised by lower socio-economic position, early parenthood and large family size were associated with worse physical and mental health in later life, with respondents who had combined a high socio-economic position and two children being the most advantaged. The study indicates that socio-economic disparities in later-life health vary depending on the way in which individuals combine work and family life.

Gender and Socioeconomic Inequalities in Health at Older Ages Across Different European Welfare Clusters: Evidence from SHARE Data, 2004-2015

This study takes a comparative approach to assess whether the association between socioeconomic status (SES) and health in later life differs by gender in a sample of individuals aged 50 and above living in nine European countries (Austria, Belgium, Denmark, France, Germany, Italy, Spain, Sweden, and Switzerland). We apply linear hybrid (between-within) regression models using panel data (50,459 observations from 13,955 respondents) from five waves of the Survey of Health, Ageing and Retirement in Europe (SHARE) between the years 2004-2015. SES measures included education, income, and wealth. A 40- item Frailty Index (FI) of accumulated deficits, an important indicator of health in older populations, was used as dependent variable. Considering between-effects estimates, our results show that the positive impact of education and wealth on health is stronger for women living in countries where the welfare arrangements are less decommodifying and defamilializing. No such interaction is found for income and for fixed-effects estimates. This study could advance the understanding of gender inequalities in health. Also, such findings can guide future policies devoted at reducing gender and socioeconomic inequalities in health in later life.

Precarity and the assumption of rising insecurity in later life: a critique

In recent years, several authors have drawn attention to signs of growing inequalities in the ageing populations of the developed economies. Such formulations have employed the concept of precariousness to suggest that a ‘new’ precarity has emerged in old age. Questioning this position and drawing on data reported over the last two decades on income and health inequalities between and within retired and working-age households, the present paper argues that evidence of this ‘precarity’ is speculative at most and relates more to imagined futures than to empirically observed trends in the present. The ageing of ageing societies – that is the growing agedness of the older population – might imply an increase in precarity or vulnerability at older ages, but this is not a result of changes in the underlying economic and social relations of society. Instead, we would contend that it is the corporeal consequences of living longer. By conflating the various meanings of ‘precarity’ there is a corresponding danger that the very real changes brought about by population ageing will be underplayed, which may be to the detriment of the most vulnerable. The idea of a new precarity in later life may thus not serve the ends to which it is intended.

Perceptions of Neighborhood Environment, Sense of Community, and Self-Rated Health: an Age-Friendly City Project in Hong Kong

To examine the relationships between perceptions of neighborhood environment, sense of community, and self-rated heath, we recruited 1798 people aged 60 years and older living in Hong Kong. With reference to the checklist of the essential features of age-friendly cities developed by the World Health Organization, perceptions of neighborhood environment were assessed using a questionnaire covering physical and social environmental domains, which mapped onto "outdoor spaces and buildings," "transportation," "housing," "social participation," "respect and social inclusion," "civic participation and employment," "communication and information," and "community support and health services." Sense of community was measured by the Brief Sense of Community Scale. Self-rated health was assessed by a single question. The relationships between these measures were analyzed using partial correlations, multivariate regression models, and path analyses. The mean age of the participants was 71.7 years; of which 54.3% were women. In multivariate regression models, perceived neighborhood environments were positively associated with sense of community and self-rated health. Among the domains of perceived neighborhood environment, "transportation" and "respect and social inclusion" were the physical and the social environmental domains most strongly associated with sense of community, respectively. In addition, sense of community accounted for part of the relationship between perceived neighborhood environments and self-rated health. The results of this study support the importance of perceived neighborhood environments for the sense that older person has of one's community, and self-rated health of older people which may be enhanced through the improvement of neighborhood environments.

Economic Adversity Transitions From Childhood to Older Adulthood Are Differentially Associated With Later-Life Physical Performance Measures in Men and Women in Middle and High-Income Sites

Objective: This study examines the relationship between economic adversity transitions from childhood to older adulthood and older adulthood physical performance among 1,998 community-dwelling older adults from five demographically diverse sites from middle and high-income countries. Method: The principal exposure variable was economic adversity transition. No adversity encompassed not experiencing poverty in both childhood and older adulthood, improved described having only experienced poverty in childhood, worsened captured having experienced poverty in older adulthood, and severe is having experienced poverty in both childhood and older adulthood. The short physical performance battery (SPPB) was used for outcome measures. Analyses of the continuous SPPB score used linear regression, while analysis of a binary outcome (SPPB < 8 vs. ≥8) used Poisson regression models with robust error variance, both adjusting for sex, education, and site location. Result: In sex-stratified models, the SPPB < 8 prevalence rate ratio (PRR) was higher for the severe (PRR: 2.80, 95% confidence interval [CI] = [1.70, 4.61]), worsened (PRR: 2.40, 95% CI = [1.41, 4.09]), and improved (PRR: 1.82, 95% CI = [1.11, 3.01]) groups, compared with those with no adversity in childhood or as adults, but only for females. Discussion: Findings from this study indicate that persistent economic adversity has a negative effect on older adult physical performance, especially among women.

Understanding the Wellbeing of the Oldest-Old in China: A Study of Socio-Economic and Geographical Variations Based on CLHLS Data

Empirical studies of the socio-economic determinants of the wellbeing of the oldest-old in China including the role of geography and spatial factors are rare. This paper applies binary logistic regression analysis to data on the oldest-old aged 80 years old and higher from the 2011 Chinese Longitudinal Healthy Longevity Study (CLHLS). Socioeconomic determinants of the self-reported quality of life (QoL) and self-reported health (SRH) of the oldest-old population are explored, with special attention paid to the role of residence and region. The results indicate that, after controlling for individual demographic and health behavior variables, both economic status and social welfare have a significant effect on self-reported QoL and SRH. There are also significant differences in self-reported QoL among cities, towns and rural areas, with the oldest-old respondents living in Central rural, Western town and Western rural areas being significantly less likely to report good QoL, compared to the oldest-old living in Eastern cities. Significant differences in SRH exist among Eastern China, Western China and Northeastern China, with the oldest-old from Western towns being significantly less likely to report good health, and the oldest-old from Northeastern cities being significantly more likely to report good health than those from Eastern cities. The results of this study indicate that socioeconomic factors that explain self-reported QoL and SRH of the older population are in general factors that explain the self-reported QoL and SRH of the oldest-old cohorts. The interaction effect of residence and region matters more than each of the individual factors, in providing us with more detailed information on the role of geography in explaining QoL and health of the oldest-old. At a time when the oldest-old cohorts in China are at the beginning of their projected growth, these findings are vital for providing policy makers with more information on the urgency of making more geographically targeted policy to improve more effectively the self-reported QoL and SRH of the oldest-old population.

Health-Related Quality of Life according to the Socioeconomic Status of Living Areas in Iranian Children and Adolescents: Weight Disorders Survey

BACKGROUND

Health-related quality of life (HRQoL) has become a major concern in the field of children's health research. We assessed HRQoL among Iranian children and adolescents according to the socioeconomic status (SES) of their living region.

METHODS

Via multistage cluster sampling from rural and urban school students aged 6 to 18 years, this nationwide study was conducted from 2011 to 2012. HRQoL was assessed using the adolescent core version of the Pediatric Quality of Life questionnaire. Through survey data analysis methods, the data were compared according to the SES of the living region, sex, and the living area.

RESULTS

Overall, 23043 students participated in the survey (participation rate=92.2%). The mean age of the participants was 12.55±3.31 years. Boys accounted for 50.8% of the study population, and 73.4% were from urban areas. At national level, the mean of the HRQoL total score was 81.7 (95% CI: 81.3 to 82.1) with a mean of 83.5 (95% CI: 83.0 to 84.1) for the boys and 79.8 (95% CI: 79.1 to 80.5) for the girls. The highest and the lowest scores, respectively, belonged to social functioning (90.0 [95% CI: 89.7 to 90.3]) and emotional functioning (78.2 [95% CI: 77.7 to 78.7]). The highest total HRQoL score belonged to the second highest SES region of the country (mean=83.1; 95% CI: 82.5 to 83.7). The association between total HRQoL and the score of all the subscales and SES in the living area was statistically significant (P<0.001).

CONCLUSION

The results of the present study showed that in the children and adolescents, SES was associated with HRQoL. Accordingly, HRQoL and the related SES differences should be considered one of the priorities in health research and health policy.

The puzzle of sex, gender and Alzheimer’s disease: Why are women more often affected than men?

Objective:

There are impressive differences in the incidence, prevalence and experience of women and men with Alzheimer’s Disease (AD). Notably, two-thirds of those with AD, the most common form of dementia, are women. Our objective was to provide a literature-based framework to understand these sex and gender differences in AD.

Methods:

We conducted a narrative review to examine sex and gender influences on AD.

Results:

We present a framework to understanding why these sex and gender differences exist in AD. This includes the influence of longevity (women live longer than men), biological differences (hormonal differences, epigenetics and frailty), differences in cognitive performance (women and men tend to perform differently on some cognitive tests), and gendered social roles and opportunities (educational and occupational opportunities, functional roles post-retirement). Our review clearly indicates the complex interaction of these sex and gender differences and variability within each.

Conclusions:

Given these important sex and gender differences in AD, we provide recommendations and steps forward describing how both sex and gender should be considered in dementia diagnosis and management and in the design and implementation of dementia research, including studies of caregiving interventions and models of dementia care.

Social engagement and survival in people aged 50 years and over living with HIV and without HIV in Uganda: a prospective cohort study

This study examined the association between social engagement and survival in people with or without HIV aged 50 years and over in Uganda. We analysed two waves of a survey from two sites in Uganda to assess predictors of mortality between waves. The first wave was conducted between 2009 and 2010 while the second wave was conducted between 2012 and 2013. A standardised questionnaire adapted from the World Health Organization study on global AGEing and adult health (SAGE) was administered through face-to-face interviews at both survey waves. Cox proportional hazards models and Nelson-Aalen cumulative hazards functions were used to investigate associations between the strength of participants' social ties, using distance and intimacy metrics, and their social engagement with mortality between waves. Of the original 510 participants, 63 (12.3%) died between waves. Being more socially engaged and able to provide in-kind or financial contributions to family or friends were protective. After adjusting for covariates neither social tie measure was predictive of mortality. There were no significant differences in social engagement and survival by HIV status. Further research is needed in African settings on the relationship between social relationships and subsequent mortality in older adults to assess if improved social relationships could moderate mortality.

Socioeconomic gradients in chronic disease risk behaviors in a population-based study of older adults in rural South Africa

OBJECTIVES

To investigate the associations between household wealth, household consumption, and chronic disease risk behaviors among older adults in rural South Africa.

METHODS

Data were from baseline assessments of 5059 adults aged ≥ 40 in the population-based "Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa" in 2015. Confounder-adjusted prevalence ratios were estimated for the associations between each of household wealth and household consumption quintiles with low moderate-to-vigorous physical activity (MVPA), current smoking, frequent alcohol intake, and overweight/obese body mass index (BMI).

RESULTS

Low MVPA and overweight/obese BMI were common (57% and 58%, respectively), and linearly increased in prevalence across household wealth quintiles. Low MVPA decreased and overweight/obese BMI increased in prevalence across household consumption quintiles. Smoking and frequent alcohol intake were rare (9% and 6%, respectively); they decreased in prevalence across wealth quintiles, but did not vary by consumption quintile.

CONCLUSIONS

Chronic disease risk behaviors are socioeconomically graded among older, rural South African adults. The high prevalence of overweight and obesity in rural South Africa is a public health concern requiring urgent attention.

Health disparities in Europe's ageing population: the role of social network

BACKGROUND

Previous research suggests that the social network may play very different roles in relation to health in countries with differing welfare regimes.

OBJECTIVE

The study aimed to assess the interplay between social network, socioeconomic position, and self-rated health (SRH) in European countries.

METHODS

The study used cross-sectional data on individuals aged 50+ from the fourth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) and includes data from 16 countries. The outcome is poor SRH. All analyses are adjusted for age and stratified by gender.

RESULTS

Low satisfaction with the social network was associated with poor SRH among women in all country groups, but predicted poor SRH among males in West/Central and Eastern Europe only. The results from the multivariable analysis showed an increased likelihood of poor SRH among those with relatively lower education, as well as among those with low satisfaction with the social network (women from all country groups and men from Western/Central and Eastern Europe). However, the results from interaction analysis show that poor SRH for those with lower relative position in educational level was greater among those with higher satisfaction with the social network among male and female participants from Northern Europe. The health of individuals who are highly satisfied with their social network is more associated with socioeconomic status in Northern Europe.

CONCLUSIONS

This study highlights the significance of social network and socioeconomic gradients in health among the elderly in Europe.

Explaining the impact of poverty on old-age frailty in Europe: material, psychosocial and behavioural factors

Background

Previous research found poverty to be associated with adverse health outcomes among older adults but the factors that translate low economic resources into poor physical health are not well understood. The goal of this analysis was to assess the impact of material, psychosocial, and behavioural factors as well as education in explaining the poverty-health link.

Methods

In total, 28 360 observations from 11 390 community-dwelling respondents (65+) in the Survey of Health, Ageing and Retirement in Europe (2004-13, 10 countries) were analysed. Multilevel growth curve models were used to assess the impact of combined income and asset poverty risk on old-age frailty (frailty index) and associated pathway variables.

Results

In total, 61.8% of the variation of poverty risk on frailty level was explained by direct and indirect effects. Results stress the role of material and particularly psychosocial factors such as perceived control and social isolation, whereas the role of health behaviour was negligible.

Conclusion

We suggest to strengthen social policy and public health efforts in order to fight poverty and its deleterious health effects from early age on as well as to broaden the scope of interventions with regard to psychosocial factors.

Effects of a community health promotion program on social factors in a vulnerable older adult population residing in social housing

BACKGROUND

Supporting older adults' health and wellbeing in the community is an important policy goal that can be supported by health promotion. Despite widespread acceptance of the biopsychosocial model of health and its relation to health, many health promotion programs fail to realize this model in program design. Further, there is limited evidence to support program design targeting social determinants of health such as social isolation or connectedness. To fill this gap, we aimed to understand older adult's experiences participating in cardiovascular health promotion program in a subsidized residential building to capture unintended 'spin-off' psychosocial effects.

METHODS

This study took a constructivist, ethnographic approach utilizing participant observation and semi-structured interviews with participants of the program to understand participant's lived experiences of a health promotion program. In total, we conducted eighty hours of field work and fifteen semi-structured interviews with participants of the program. Thematic analysis was used to analyze the data.

RESULTS

Four themes emerged. First, the health promotion program filled a perceived gap caused by a constrained and impersonal health care system. Secondly, the program connected older adults with resources and provided regular and secure access to health information and support. Third, for some residents, the program facilitated social relationships between older adults, leaving participants feeling more socially connected to other residents. Lastly, a paradox of loneliness emerged where older adults talked openly about feelings of loneliness, however not in relation to themselves, but rather regarding their peers.

CONCLUSIONS

Psychosocial aspects of health, such as loneliness, social connectedness, and social support may be of equal value as the physical health benefits to the older adults who participate in health promotion programs. Incorporating these elements into programming is a complex goal, and the complexity of targeting social determinants of health such as social loneliness or connectedness should not be under-estimated. Given the benefits of targeting social determinants of health, future research should be considered that measure both the objective and subjective aspects of social isolation, loneliness and connectedness in health promotion programming.

Social Inequality and Visual Impairment in Older People

Objectives

Visual impairment is the leading cause of age-related disability, but the social patterning of loss of vision in older people has received little attention. This study's objective was to assess the association between social position and onset of visual impairment, to empirically evidence health inequalities in later life.

Method

Visual impairment was measured in 2 ways: self-reporting fair vision or worse (moderate) and self-reporting poor vision or blindness (severe). Correspondingly, 2 samples were drawn from the English Longitudinal Study on Ageing (ELSA). First, 7,483 respondents who had good vision or better at Wave 1; second, 8,487 respondents who had fair vision or better at Wave 1. Survival techniques were used.

Results

Cox proportional hazards models showed wealth and subjective social status (SSS) were significant risk factors associated with the onset of visual impairment. The risk of onset of moderate visual impairment was significantly higher for the lowest and second lowest wealth quintiles, whereas the risk of onset of severe visual impairment was significantly higher for the lowest, second, and even middle wealth quintiles, compared with the highest wealth quintile. Independently, lower SSS was associated with increased risk of onset of visual impairment (both measures), particularly so for those placing themselves on the lowest rungs of the social ladder.

Discussion

The high costs of visual impairment are disproportionately felt by the worst off elderly. Both low wealth and low SSS significantly increase the risk of onset of visual impairment.

Social support and mental health status of older people: a population-based study in Iran-Tehran

OBJECTIVES

To investigate direct and stress-buffering associations between social support from family and the mental health of older people in Iran, a country which has recently undergone an exceptionally fast fertility transition and is consequently experiencing rapid population ageing.

METHOD

A cross-sectional stratified random survey of 800 people aged 60+ years resident in Tehran was conducted. In total, 644 people responded. The Social Provisions Scale and the General Health Questionnaire were used to measure perceived social support and mental health, respectively. Multilevel mixed-effects models were used to examine the hypotheses.

RESULTS

The findings supported the hypothesis of a direct association between perceived and received social support and mental health. However, we did not find strong evidence to suggest that social support buffered the effects of stress arising from limitations of physical functioning. Lack of help doing paperwork was associated with worse mental health for women but not men. Source of support did not seem to be important.

CONCLUSION

Our results indicated that in Tehran, as in Western settings, social support is important for the mental well-being of older people. Recommendations for policy and further research priorities based on the study findings were provided.

The effect of informal caregiver support on utilization of acute health services among home care clients: a prospective observational study

BACKGROUND

Emergency department visits and hospitalizations (EDVH) place a large burden on patients and the health care system. The presence of informal caregivers may be beneficial for reducing EDVH among patients with specific diagnoses. Our objective was to determine whether the presence of an informal caregiver was associated with the occurrence of an EDVH among clients 50 years of age or older.

METHODS

Using a database accessed through the Toronto Central Community Care Access Centre (CCAC), we identified 479 adults over 50 years of age who received home care in Toronto, Canada. Exposure variables were extracted from the interRAI health assessment form completed at the time of admission to the CCAC. EDVH data were linked to provincial records through the CCAC database. Data on emergency room visits were included for up to 6 months after time of admission to home care. Multiple logistic regression analysis was used to identify factors associated with the occurrence of an EDVH.

RESULTS

Approximately half of all clients had an EDVH within 180 days of admission to CCAC home care. No significant association was found between the presence of an informal caregiver and the occurrence of an EDVH. Significant factors associated with an EDVH included: Participants having a poor perception of their health (adjusted OR = 1.68, 95% CI: 1.11-2.56), severe cardiac disorders (adjusted OR = 1.54, 95% CI: 1.04-2.29), and pulmonary diseases (adjusted OR = 1.99, 95% CI: 1.16-3.47).

CONCLUSIONS

The presence of an informal caregiver was not significantly associated with the occurrence of an EDVH. Future research should examine the potential associations between length of hospital stay or quality of life and the presence of an informal caregiver. In general, our work contributes to a growing body of literature that is increasingly concerned with the health of our aging population, and more specifically, health service use by elderly patients, which may have implications for health care providers.

Changes in Socioeconomic Differences in Hospital Days With Age: Cumulative Disadvantage, Age-as-Leveler, or Both?

OBJECTIVES

Length of hospital stay is inversely associated with socioeconomic status (SES). It is less clear whether socioeconomic disparities in numbers of hospital days diverge or converge with age.

METHOD

Longitudinal linked Finnish registry data (1988-2007) from 137,653 men and women aged 50-79 years at the end of 1987 were used. Trajectories of annual total hospital days by education, household income, and occupational class were estimated using negative binomial models.

RESULTS

Men and women with higher education, household income, and occupational class had fewer hospital days in 1988 than those with lower SES. Hospital days increased between 1988 and 2007. For some age groups, higher SES was associated with a faster annual rate of increase, resulting in narrowing rate ratios of hospital days between SES groups (relative differences); the rate ratios remained stable for other groups. Absolute SES differences in numbers of hospital days appeared to diverge with age among those aged 50-69 years at baseline, but converge among those aged 70-79 years at baseline.

DISCUSSION

The hypotheses that socioeconomic disparities in health diverge or converge with age may not be mutually exclusive; we demonstrated convergence/maintenance in relative differences for all age groups, but divergence or convergence in absolute differences depending on age.

Support From Migrant Children and Depressive Symptoms Among Chinese Older Adults in Transnational Families

International migration creates important consequences both for migrants and the family members they leave behind. Prior research has noted not only the adverse effects of children's migration on parents' mental health but also the fact that family ties and closeness can persist because of supportive exchange despite geographical distances. This study examined the associations between economic and emotional support from migrant children living abroad and depressive symptoms among Chinese elders in transnational families and whether such associations were moderated by the elders' physical health status and the presence of children remaining in China. The data were collected from a cross-sectional survey of 293 older Chinese in transnational families in Beijing, China. The results of linear regression show that more emotional support from migrant children was associated with lower depressive symptoms among these elders. The association between emotional support and depressive symptoms was stronger among the elders who did not have children remaining in China and who had functional limitations. The findings suggest that maintaining emotionally supportive relationships with their migrant children abroad may help to prevent depressive symptoms among these elders, especially among the older adults who have functional limitations and who have no children remaining in the home country.

Gender differences in psychosocial predictors of self-perceived health status in the elderly: Evidence from a Brazilian community study

This article aims to identify the psychosocial factors associated with self-perceived health status in the Brazilian elderly population and to present differences related to gender. The data were collected by questionnaire, including sociodemographic and behavioral questions, and scales for psychological dimensions. Self-perceived health status is related to level of education, physical activity, and self-efficacy in the total population. Regarding gender differences, self-rated health status among men is related to education level and self-efficacy and in women to level of education, physical activity, social support, and self-efficacy. These results can inform future health promotion interventions.

Self-rated health disparities among disadvantaged older adults in ethnically diverse urban neighborhoods in a Middle Eastern country

OBJECTIVES

This paper examines differentials in self-rated health (SRH) among older adults (aged 60+ years) across three impoverished and ethnically diverse neighborhoods in post-conflict Lebanon and assesses whether variations are explained by social and economic factors.

DESIGN

Data were drawn from the Older Adult Component (n = 740) of the Urban Health Survey, a population-based cross-sectional study conducted in 2003 in a formal community (Nabaa), an informal settlement (Hey El-Sellom), and a refugee camp for Palestinians (Burj El-Barajneh) in Beirut, Lebanon. The role of the social capital and economic security constructs in offsetting poor SRH was assessed using multivariate ordinal logistic regression analyses.

RESULTS

Older adults in Nabaa fared better in SRH compared to those in Hey El-Sellom and Burj El-Barajneh, with a prevalence of good, average, and poor SRH being respectively, 41.5%, 37.0%, and 21.5% in Nabaa, 33.3%, 23.9%, and 42.7% in Hey El-Sellom, and 25.2%, 31.3%, and 43.5% in Burj El-Barajneh. The economic security construct attenuated the odds of poorer SRH in Burj El-Barajneh as compared to Nabaa from 2.57 (95% confidence interval, CI: 1.89-3.79) to 1.42 (95% CI: 0.96-2.08), but had no impact on this association in Hey El-Sellom (odds ratio, OR: 2.12, 95% CI: 1.39-3.24). The incorporation of the social capital construct in the fully adjusted model rendered this association insignificant in Hey El-Sellom (OR: 1.49, 95% CI: 0.96-2.32), and led to further reductions in the magnitude of the association in Burj El-Barajneh camp (OR: 1.18, 95% CI: 0.80-1.76).

CONCLUSIONS

The social context in which older adults live and their financial security are key in explaining disparities in SRH in marginalized communities. Social capital and economic security, often overlooked in policy and public health interventions, need to be integrated in dimensions of well-being of older adults, especially in post-conflict settings.

Re-thinking social exclusion in later life: a case for a new framework for measurement

Social exclusion is a dynamic multi-dimensional process that is interactive in nature. The complex interplay between domains, whereby each domain can act as a determinant, indicator and/or outcome of social exclusion, hinders understanding of the process and the mechanisms through which social exclusion exists. This article highlights the need to disentangle these pathways and move beyond descriptive accounts of social exclusion, presenting a new working framework that allows direct hypothesis testing of these between-domain relationships. Whilst this working framework can be applied to any population, this article focuses on older adults. Life events that can drive social exclusion such as bereavement and changes in health are more likely to occur in later life, and occur more frequently, increasing the risk of social exclusion for this population. Rooted in the new working framework, this article presents the construction of later life social exclusion measures for use with Understanding Society – the United Kingdom Household Longitudinal Study. The validity of these measures are considered by examining the characteristics of those aged 65 years and over who score the highest, and therefore experience the greatest level of exclusion. This new working framework and developed social exclusion measures provide a platform from which to explore the complex relationships between domains of social exclusion and ultimately provide a clearer understanding of this intricate multi-dimensional process.

Social pathways to health: On the mediating role of the social network in the relation between socio-economic position and health

Good health is one of the key qualities of life, but opportunities to be and remain healthy are unequally distributed across socio-economic groups. The beneficial health effects of the social network are well known. However, research on the social network as potential mediator in the pathway from socio-economic position (SEP) to health is scarce, while there are good reasons to expect a socio-economical patterning of networks. We aim to contribute to our understanding of socio-economic inequalities in health by examining the mediating role of structural and functional characteristics of the social network in the SEP-health relationship. Data were from the second wave of the Norwegian study on the life course, aging and generation study (NorLAG) and comprised 4534 men and 4690 women aged between 40 and 81. We applied multiple mediation models to evaluate the relative importance of each network characteristic, and multiple group analysis to examine differences between middle-aged and older men and women. Our results indicated a clear socio-economical patterning of the social network for men and women. People with higher SEP had social networks that better protect against loneliness, which in turn lead to better health outcomes. The explained variance in health in older people by the social network and SEP was only half of the explained variance observed in middle-aged people, suggesting that other factors than SEP were more important for health when people age. We conclude that it is the function of the network, rather than the structure, that counts for health.

Health Equity and Aging of Bisexual Older Adults: Pathways of Risk and Resilience

OBJECTIVES

Bisexual older adults are a growing yet largely invisible, underserved, and understudied population. Utilizing the Health Equity Promotion Model, we examined hypothesized mechanisms accounting for health disparities between bisexual older adults and lesbian and gay older adults.

METHOD

Based on data from Caring and Aging with Pride, the largest national survey of LGBT older adults, this study (N = 2,463) utilized structural equation modeling to investigate direct and indirect associations between sexual identity (bisexual vs. lesbian and gay) and health via sexual identity factors (identity disclosure and internalized stigma), social resources, and socioeconomic status (SES).

RESULTS

Bisexual older adults reported significantly poorer health compared with lesbian and gay older adults. Indirect effects involving sexual identity factors, social resources, and SES explained the association between bisexual identity and poorer health. A potentially protective pathway was also identified wherein bisexuals had larger social networks after adjusting for other factors.

DISCUSSION

Bisexual older adults face distinct challenges and health risks relative to other older adults, likely because of the accumulation of socioeconomic and psychosocial disadvantages across the life course. Interventions taking into account older bisexuals' unique risk and protective factors may be helpful in reducing health inequities.

Socioeconomic inequalities in health in the context of multimorbidity: A Korean panel study

Socioeconomic inequalities in health are commonly known to decrease at late age. Yet, it remains unclear whether socioeconomic inequalities in health at late age appear in relation to multimorbidity, particularly in Korea where social support remains unsatisfactory for older people. Using three waves of Korea Health Panel, data of 19,942 observations with repeated measure were constructed to ensure a temporal sequence between three socioeconomic measures (i.e., poverty, employment status, and education) and multimorbidity with a t to t+1 year transition. A multilevel multinomial model was applied to quantify the socioeconomic impact across different age, diseases and disease groups, both separately and in combination. There were associations between socioeconomic position (SEP) and multimorbidity, and increasing trends of socioeconomic inequalities not only with greater number of morbidity but also with age. The latter result was only observed with employment status through mid-to-early old age; i.e., between the 40s (odds ratio (OR) = 2.45, 95% confidence interval (CI):1.08–5.57) and 70s (OR = 3.48, 95%CI: 1.24–9.74). The patterns of socioeconomic inequalities in multimorbidity varied for particular pairs of diseases and were stronger in the disease pairs co-occurring with mental and cardiovascular diseases but weaker in the disease pairs co-occurring with cancer. Accumulation of adversity tended to intensify with increase in number of diseases and older age, though this finding was not consistently supported. The labour market should be encouraged to actively participate in actions to promote healthy aging needs to be complemented by the provision of more generous and universal income support to the elderly in Korea.

Health and social exclusion in older age: evidence from Understanding Society, the UK household longitudinal study

BACKGROUND

Social exclusion of the elderly is a key policy focus but evidence on the processes linking health and social exclusion is hampered by the variety of ways that health is used in social exclusion research. We investigated longitudinal associations between health and social exclusion using an analytical framework that did not conflate them.

METHODS

Data employed in this study came from 4 waves of Understanding Society, the UK Household Longitudinal Study 2009-2013. The sample comprised all adults who took part in all 4 waves, were 65 years or more in Wave 3, and had complete data on our variables of interest for each analysis. We used linear regression to model the relationship between Wave 2/3 social exclusion and Wave1-2 health transitions (N=4312) and logistic regression to model the relationship between Wave2/3 social exclusion and Wave 4 health states, conditional on Wave 3 health (N=4244).

RESULTS

There was a dose-response relationship between poor health in Waves 1 and 2 and later social exclusion. Use of a car, mobile phone and the internet moderated the association between poor health and social exclusion. Given the health status in Wave 3, those who were more socially excluded had poorer outcomes on each of the three domains of health in Wave 4.

CONCLUSIONS

Use of the internet and technology protected older adults in poor health from social exclusion. Age-friendly hardware and software design might have public health benefits.

Marriage and cancer prevention: Does marital status and inviting both spouses together influence colorectal cancer screening participation?

Objectives

This study examined the influence of marital status and inviting both partners together on participation in colorectal cancer screening.

Setting

Data were from a subset of participants from the UK Flexible Sigmoidoscopy Trial (1996–1999).

Methods

Marital status was self-reported, and co-invitation of partner was obtained from the trial database. Screening intentions were assessed in 16,527 adults aged 55–64 years. Attendance was recorded in the 4130 respondents who were subsequently invited.

Results

Multivariate analyses, controlling for age and educational level, indicate that married (or cohabiting) people have more positive intentions (odds ratio [OR] 1.26; 95% confidence interval [CI] 1.14–1.38) and higher attendance rates at screening (OR = 1.23; 95% CI 1.04–1.45) than non-married people. After adjusting for the marriage effect, inviting partners together (co-invitation) significantly increased screening intentions among women (OR = 1.17; 95% CI 1.04–1.31) but not men (OR = 0.97; 95% CI 0.85–1.10). Co-invitation significantly increased attendance at screening in both genders (OR = 1.34; 95% CI 1.14–1.58).

Conclusions

In this age group, married adults are more likely to participate in colorectal cancer screening than the non-married, and inviting both members of a couple together further increases screening uptake. The positive effect of marriage was as strong for women as men.

Coexisting Disadvantages in later Life: Demographic and Socio-Economic Inequalities

In this study, we aimed to identify which of certain demographic and socio-economic groups in the oldest part of the population that have an increased probability of experiencing simultaneous disadvantages in different life domains - here termed coexisting disadvantages. To do so, we compared analyses of coexisting disadvantages, measured as two or more simultaneous disadvantages, with analyses of single disadvantages and specific combinations of disadvantages. Indicators of physical health problems, ADL limitations, psychological health problems, limited financial resources, and limited social resources were included. We used nationally representative data from 2011 on people aged 76 and older in Sweden (n = 765). Results showed that coexisting disadvantages were associated with specific demographic and socio-economic groups, particularly certain marital status groups. Moreover, the differences between the demographic and socio-economic groups were only found for those who reported coexisting disadvantages, and not for those who reported only one disadvantage, which suggests that demographic and social factors become more important as disadvantages compound. Further, we analysed pairwise combinations of disadvantages. We found that different combinations of disadvantages tended to be associated with different groups, information useful from a social planning perspective since different combinations of disadvantages may imply different needs for help and support.

The Role of Subjective Perception of Health in the Dynamics of Context and Psychological Well-Being

The purpose of this study was to establish the role played by subjective perceptions of physical health in the relationship between psychological well-being and two social contexts that are stratified by socio-economic differentials pertaining to race, socio-economic indices and infrastructural resources. An availability sample of 514 participants from Potchefstroom ( n = 384) and Mafikeng ( n = 130), North West Province, completed questionnaires on the perceptions of health and psychological well-being. Regression equations were computed to explore the viability of relationships between context and subjective perceptions of physical health, context and psychological well-being, and psychological well-being and subjective perceptions of physical health. Structural equation models showed that subjective perceptions of physical health mediate the relationship between context and psychological well-being. The implications of the findings are indicated.

The impact of differences between subjective and objective social class on life satisfaction among the Korean population in early old age: Analysis of Korean longitudinal study on aging

BACKGROUND

Several previous studies have established the relationship between the effects of socioeconomic status or subjective social strata on life satisfaction. However, no previous study has examined the relationship between social class and life satisfaction in terms of a disparity between subjective and objective social status.

OBJECTIVE

To investigate the relationship between differences in subjective and objective social class and life satisfaction.

METHODS

Data from the Korean Longitudinal Study of Aging with 8252 participants aged 45 or older was used. Life satisfaction was measured by the question, "How satisfied are you with your quality of life?" The main independent variable was differences in objective (income and education) and subjective social class, which was classified according to nine categories (ranging from high-high to low-low). This association was investigated by linear mixed model due to two waves data nested within individuals.

RESULTS

Lower social class (income, education, subjective social class) was associated with dissatisfaction. The impact of objective and subjective social class on life satisfaction varied according to the level of differences in objective and subjective social class. Namely, an individual's life satisfaction declined as objective social classes decreased at the same level of subjective social class (i.e., HH, MH, LH). In both dimensions of objective social class (education and income), an individual's life satisfaction declined as subjective social class decreased by one level (i.e., HH, HM, HL).

CONCLUSION

Our findings indicated that social supports is needed to improve the life satisfaction among the population aged 45 or more with low social class. The government should place increased focus on policies that encourage not only the life satisfaction of the Korean elderly with low objective social class, but also subjective social class.