Trends and inequality in the new active ageing and well-being index of the oldest old: a case study of Sweden

The policy discourse on active ageing and well-being at the European level tends to have a strong focus on the experiences of the ‘young old’. In this study the focus instead is on the oldest old (75 years and older). The theoretical framework is inspired by the Active Ageing Index and the Nordic welfare research tradition. Active ageing and well-being indicators and domains of high relevance for the oldest old are used and a new Active Ageing-Well Being Index (AA-WB Index) is developed. Our aim is to go beyond averages and analyse changes over time and inequality in the AA-WB Index. The prime data is derived from two waves, 2004 and 2014, of the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), a nationally representative sample of older people. The results show an overall improvement in most domains of the AA-WB index, especially in the indicator participation in cultural and leisure activities. The findings also show clear and consistent gender and educational inequalities. In addition, the different domains correlate, implying that inequality within a domain is aggravated by the inequality in another domain. The study highlights that measurements on active ageing and well-being should place a greater importance on the living conditions of the oldest old with a special focus on inequality

How to measure retirement age? : a comparison of survey and register data

Due to an increasing heterogeneity in retirement transitions, the measurement of retirement age constitutes a major challenge for researchers and policymakers. In order to better understand the concept of retirement age, we compare a series of measures for retirement age assessed on the basis of survey and register data. We use data from Sweden, where flexible retirement schemes are implemented and register data are available. We link survey data from the Swedish Level of Living Survey with register data from the Swedish Longitudinal Integration Database for Health Insurance and Labour Market Studies. We create four measures of retirement age based on these datasets, applying approaches that have been used in previous literature. We analyse the means and distributions of these measures and evaluate the correlations between them. Finally, we regress common predictors of retirement age such as gender or education on the four measures of retirement age to examine potential differences in size, direction and statistical significance of the associations. We find that the survey measure of retirement age resembles the following two ways of defining retirement age in the register data: first, the age at which people receive more than half their income from old-age or disability pension and second, the age at which they were not gainfully employed for at least two years. This insight gives us a better understanding of when in the retirement transition process individuals identify with retirement. Moreover, it provides decision support for researchers working with register data to determine which measure to use

Prolongation of working life and its effect on mortality and health in older adults : propensity score matching

Many countries are raising the age of pension eligibility because of increases in life expectancy. Given the social gradient in life expectancy and health, it is important to understand the potential late-life health effects of prolonging working life and whether any effects differ by socioeconomic position. We examined the effect of prolonging working life beyond age 65 on mortality and a series of indicators of late-life physical health (the ability to climb stairs without difficulty, self-rated health, ADL limitations, and musculoskeletal pain) in a representative sample of the Swedish population. In addition to average effects, we also examined heterogeneous effects, for instance by occupational social class. To do this, we use propensity score matching, a method suitable for addressing causality in observational data. The data came from two linked Swedish longitudinal surveys based on nationally representative samples with repeated follow-ups; The Swedish Level of Living Survey and the Swedish Panel Study of Living conditions of the Oldest Old, and from national income and mortality registries. The analytical sample for the mortality outcome included 1852 people, and for late-life physical health outcomes 1461 people. We found no significant average treatment effect on the treated (ATT) of working to age 66 or above on the outcomes, measured an average of 12 years after retirement: mortality (ATT -0.039), the ability to climb stairs (ATT -0.023), self-rated health (ATT -0.009), ADL limitations (ATT -0.023), or musculoskeletal pain (ATT -0.009) in late life. Analyses of whether the results varied by occupational social class or the propensity to prolong working life were inconclusive but suggest a positive effect of prolonging working life on health outcomes. Accordingly, more detailed knowledge about the precise mechanisms underlying these results are needed. In conclusion, working to age 66 or above did not have effect on mortality or late-life physical health

Physical functioning as a predictor of retirement: Has its importance changed over a thirty-year period in Sweden?

Open access funding provided by Karolinska Institute. This work was supported by the Social Inequalities in Ageing (SIA) project, funded by NordForsk, [74637] and the Swedish Research Council for Health, Working Life and Welfare (FORTE) (2019-01100). The financial sponsors played no role in the design, execution, data analysis and interpretation, nor in the writing of the study.Peer reviewe

Do cognitively stimulating activities affect the association between retirement timing and cognitive functioning in old age?

In response to the rising financial pressure on old-age pension systems in industrialised economies, many European countries plan to increase the eligibility age for retirement pensions. We used data from Sweden to examine whether (and if so, how) retirement after age 65 – the eligibility age for basic pension – compared to retiring earlier affects older adults’ (between ages 70 and 85) cognitive functioning. Using a propensity score matching (PSM) approach, we addressed the selection bias potentially introduced by non-random selection into either early or late retirement. We also examined average and heterogeneous treatment effects (HTEs). HTEs were evaluated for different levels of cognitive stimulation from occupational activities before retirement and from leisure activities after retirement. We drew from a rich longitudinal data-set linking two nationally representative Swedish surveys with a register data-set and found that, on average, individuals who retire after age 65 do not have a higher level of cognitive functioning than those who retire earlier. Similarly, we did not observe HTEs from occupational activities. With respect to leisure activities, we found no systematic effects on cognitive functioning among those working beyond age 65. We conclude that, in general, retirement age does not seem to affect cognitive functioning in old age. Yet, the rising retirement age may put substantial pressure on individuals who suffer from poor health at the end of their occupational career, potentially exacerbating social- and health-related inequalities among older people

A Genetic Basis of Susceptibility to Acute Pyelonephritis

For unknown reasons, urinary tract infections (UTIs) are clustered in certain individuals. Here we propose a novel, genetically determined cause of susceptibility to acute pyelonephritis, which is the most severe form of UTI. The IL-8 receptor, CXCR1, was identified as a candidate gene when mIL-8Rh mutant mice developed acute pyelonephritis (APN) with severe tissue damage.We have obtained CXCR1 sequences from two, highly selected APN prone patient groups, and detected three unique mutations and two known polymorphisms with a genotype frequency of 23% and 25% compared to 7% in controls (p<0.001 and p<0.0001, respectively). When reflux was excluded, 54% of the patients had CXCR1 sequence variants. The UTI prone children expressed less CXCR1 protein than the pediatric controls (p<0.0001) and two sequence variants were shown to impair transcription.The results identify a genetic innate immune deficiency, with a strong link to APN and renal scarring

SWEOLD - Undersökningen om äldre personers levnadsvillkor 2002

SWEOLD is a nationally representative survey of the older population in Sweden. The sample consists of individuals previously included in the selection of Swedish Level of Living Survey (LNU), who have passed the LNU age ceiling of 75 years. The first survey was carried out in 1992. Further waves were conducted in 2002, 2004, 2010 and 2014. In 2004 and 2014, the survey included people who were aged 70 and older. A new survey wave will begin in 2021. SWEOLD data is linked to the LNU, that has been conducted regularly since 1968. This longitudinal database thus provides the opportunity to follow individuals over a 50-year period. In addition to the panel sample, SWEOLD also comprises an additional representative sample of older women and men. As each wave of LNU and SWEOLD is nationally representative, the data can also be used for cross-sectional analyses. The questionnaire covers a wide variety of areas of concern to elderly people, such as mobility and activities of daily living (ADL and IADL), as well as health, housing, economy, family, political resources and leisure activities. Various tests are included to measure the physical and cognitive ability of these individuals. Indirect interviews are used when a respondent is unable to participate in the interview directly due to physical or cognitive disabilities. Next of kin or professional caregivers are used as proxies. The second SWEOLD study was carried out in 2002. The sample consisted of persons born in 1925 and earlier, who had been in the sample of any of the previous Swedish Level of Living Surveys (LNU). The sample consisted of 736 persons and the response rate was 84.4% (n=621). Face-to-face interviews were carried out with 87% of the respondents, and 13% were proxy interviews with a close relative or care staff.SWEOLD är en riksrepresentativ undersökning av Sveriges äldre befolkning. Urvalet består av personer som tidigare ingått i urvalet i någon av levnadsnivåundersökningarna (LNU) men som har passerat den övre åldersgränsen på 75 år. Den första datainsamlingen genomfördes 1992 och följdes upp 2002, 2004, 2011 och 2014. År 2004 och 2014 omfattade undersökningen personer som var 70 år och äldre. En ny datainsamling inleds under 2021. SWEOLD är länkad till LNU som har genomförts regelbundet sedan 1968. Denna longitudinella databas erbjuder således möjlighet att följa personer över en 50-årsperiod. Utöver panelurvalet är SWEOLD också kompletterat med ett extra representativt urval av äldre kvinnor och män. I och med att LNU och SWEOLD är nationellt representativt vid varje intervjuomgång kan datamaterialen även användas för tvärsnittsanalyser. SWEOLD innehåller information om de äldres faktiska levnadsförhållanden inom en rad områden som är centrala för äldre människors liv, t.ex. hälsa, vård och omsorg, ekonomi, boende, sysselsättning och vardagliga aktiviteter. En rad enkla tester ingår för att mäta fysisk och kognitiv förmåga. Indirekta intervjuer används i de fall den äldre på grund av fysisk eller kognitiv oförmåga inte kan delta själv. De indirekta intervjuerna genomförs i första hand med en nära anhörig eller vårdpersonal med kunskaper om den äldre personen. Den andra SWEOLD-undersökningen genomfördes 2002. Urvalet bestod av personer födda år 1925 och tidigare, och som ingått i urvalet i någon av de tidigare levnadsnivåundersökningarna (LNU). Urvalet bestod av 736 personer och svarsfrekvensen var 84,4% (n=621). Personliga besöksintervjuer genomfördes med 87% av respondenterna och 13% var så kallade indirekta intervjuer med någon nära anhörig eller vårdpersonal

SWEOLD - Undersökningen om äldre personers levnadsvillkor 2014

SWEOLD is a nationally representative survey of the older population in Sweden. The sample consists of individuals previously included in the selection of Swedish Level of Living Survey (LNU), who have passed the LNU age ceiling of 75 years. The first survey was carried out in 1992. Further waves were conducted in 2002, 2004, 2010 and 2014. In 2004 and 2014, the survey included people who were aged 70 and older. A new survey wave will begin in 2021. SWEOLD data is linked to the LNU, that has been conducted regularly since 1968. This longitudinal database thus provides the opportunity to follow individuals over a 50-year period. In addition to the panel sample, SWEOLD also comprises an additional representative sample of older women and men. As each wave of LNU and SWEOLD is nationally representative, the data can also be used for cross-sectional analyses. The questionnaire covers a wide variety of areas of concern to elderly people, such as mobility and activities of daily living (ADL and IADL), as well as health, housing, economy, family, political resources and leisure activities. Various tests are included to measure the physical and cognitive ability of these individuals. Indirect interviews are used when a respondent is unable to participate in the interview directly due to physical or cognitive disabilities. Next of kin or professional caregivers are used as proxies. The fifth SWEOLD study was conducted in 2014. The sample consisted of persons born in 1944 and earlier who had been in the sample of any of the previous Swedish Level of Living Surveys (LNU), and those in the additional sample for SWEOLD 2011 who were still alive. In total, the sample consisted of 1,539 persons and the response rate was 84.3% (n=1,297). Similar to SWEOLD 2004, the interviews were carried out per telephone. In some cases, a postal questionnaire was used. Direct interviews were conducted with 87.3% of the respondents and 10.7% were proxy interviews with a close relative or care staff. ‘Mixed’ interviews were used with 2.0% of the respondents, where the respondent took part in the interview with the support from a relative or other close person.SWEOLD är en riksrepresentativ undersökning av Sveriges äldre befolkning. Urvalet består av personer som tidigare ingått i urvalet i någon av levnadsnivåundersökningarna (LNU) men som har passerat den övre åldersgränsen på 75 år. Den första datainsamlingen genomfördes 1992 och följdes upp 2002, 2004, 2011 och 2014. År 2004 och 2014 omfattade undersökningen personer som var 70 år och äldre. En ny datainsamling inleds under 2021. SWEOLD är länkad till LNU som har genomförts regelbundet sedan 1968. Denna longitudinella databas erbjuder således möjlighet att följa personer över en 50-årsperiod. Utöver panelurvalet är SWEOLD också kompletterat med ett extra representativt urval av äldre kvinnor och män. I och med att LNU och SWEOLD är nationellt representativt vid varje intervjuomgång kan datamaterialen även användas för tvärsnittsanalyser. SWEOLD innehåller information om de äldres faktiska levnadsförhållanden inom en rad områden som är centrala för äldre människors liv, t.ex. hälsa, vård och omsorg, ekonomi, boende, sysselsättning och vardagliga aktiviteter. En rad enkla tester ingår för att mäta fysisk och kognitiv förmåga. Indirekta intervjuer används i de fall den äldre på grund av fysisk eller kognitiv oförmåga inte kan delta själv. De indirekta intervjuerna genomförs i första hand med en nära anhörig eller vårdpersonal med kunskaper om den äldre personen. Den femte SWEOLD-undersökningen genomfördes år 2014. Urvalet bestod av personer födda år 1944 och tidigare och som ingått i urvalet i någon av de tidigare levnadsnivåundersökningarna (LNU), samt de personer i extraurvalet för SWEOLD 2011 som fortfarande var i livet. Totalt sett bestod urvalet av 1539 personer och svarsfrekvensen var 84,3% (n=1297). I likhet med SWEOLD 2004 genomfördes intervjuerna per telefon. I vissa fall skickades frågeformuläret ut i form av en postenkät. Direkta intervjuer genomfördes med 87,3% av respondenterna och 10,7% var indirekta intervjuer med någon nära anhörig eller vårdpersonal. För 2,0% av respondenterna genomfördes så kallade mixade intervjuer, där respondenten själv medverkade men hade stöd av en anhörig eller annan närstående under intervjun

SWEOLD - Undersökningen om äldre personers levnadsvillkor 2002

SWEOLD is a nationally representative survey of the older population in Sweden. The sample consists of individuals previously included in the selection of Swedish Level of Living Survey (LNU), who have passed the LNU age ceiling of 75 years. The first survey was carried out in 1992. Further waves were conducted in 2002, 2004, 2010 and 2014. In 2004 and 2014, the survey included people who were aged 70 and older. A new survey wave will begin in 2021. SWEOLD data is linked to the LNU, that has been conducted regularly since 1968. This longitudinal database thus provides the opportunity to follow individuals over a 50-year period. In addition to the panel sample, SWEOLD also comprises an additional representative sample of older women and men. As each wave of LNU and SWEOLD is nationally representative, the data can also be used for cross-sectional analyses. The questionnaire covers a wide variety of areas of concern to elderly people, such as mobility and activities of daily living (ADL and IADL), as well as health, housing, economy, family, political resources and leisure activities. Various tests are included to measure the physical and cognitive ability of these individuals. Indirect interviews are used when a respondent is unable to participate in the interview directly due to physical or cognitive disabilities. Next of kin or professional caregivers are used as proxies. The second SWEOLD study was carried out in 2002. The sample consisted of persons born in 1925 and earlier, who had been in the sample of any of the previous Swedish Level of Living Surveys (LNU). The sample consisted of 736 persons and the response rate was 84.4% (n=621). Face-to-face interviews were carried out with 87% of the respondents, and 13% were proxy interviews with a close relative or care staff.SWEOLD är en riksrepresentativ undersökning av Sveriges äldre befolkning. Urvalet består av personer som tidigare ingått i urvalet i någon av levnadsnivåundersökningarna (LNU) men som har passerat den övre åldersgränsen på 75 år. Den första datainsamlingen genomfördes 1992 och följdes upp 2002, 2004, 2011 och 2014. År 2004 och 2014 omfattade undersökningen personer som var 70 år och äldre. En ny datainsamling inleds under 2021. SWEOLD är länkad till LNU som har genomförts regelbundet sedan 1968. Denna longitudinella databas erbjuder således möjlighet att följa personer över en 50-årsperiod. Utöver panelurvalet är SWEOLD också kompletterat med ett extra representativt urval av äldre kvinnor och män. I och med att LNU och SWEOLD är nationellt representativt vid varje intervjuomgång kan datamaterialen även användas för tvärsnittsanalyser. SWEOLD innehåller information om de äldres faktiska levnadsförhållanden inom en rad områden som är centrala för äldre människors liv, t.ex. hälsa, vård och omsorg, ekonomi, boende, sysselsättning och vardagliga aktiviteter. En rad enkla tester ingår för att mäta fysisk och kognitiv förmåga. Indirekta intervjuer används i de fall den äldre på grund av fysisk eller kognitiv oförmåga inte kan delta själv. De indirekta intervjuerna genomförs i första hand med en nära anhörig eller vårdpersonal med kunskaper om den äldre personen. Den andra SWEOLD-undersökningen genomfördes 2002. Urvalet bestod av personer födda år 1925 och tidigare, och som ingått i urvalet i någon av de tidigare levnadsnivåundersökningarna (LNU). Urvalet bestod av 736 personer och svarsfrekvensen var 84,4% (n=621). Personliga besöksintervjuer genomfördes med 87% av respondenterna och 13% var så kallade indirekta intervjuer med någon nära anhörig eller vårdpersonal