Old-Age Exclusion: Active Ageing, Ageism and Agency (Editorial)

This editorial serves a double purpose. It introduces the articles and commentary comprising this thematic issue on old-age exclusion, and simultaneously aims to make a concise contribution to the discussion on the relation between agency of older people and old-age exclusion. While indeed it is clear that limitations of agency due to a lack of resources in old age or age discrimination lead to exclusion of older people, the relationship between reduced agency and exclusion is less clear in the case of internalized age norms. It ends with a plea for surveys studying older populations to pay more attention to older people's identities and life goals, opinions and reasons for action

Mental health nurses’ support to caregivers of older adults with severe mental illness : a qualitative study

Background: Literature has shown the serious impact of severe mental illness on the daily life of caregivers. We studied reported caregiver support practices by mental health nurses for use in the development of a nursing intervention. We aimed to explore current caregiver support practices by mental health nurses. Methods: Twenty-one participants completed semi-structured interviews, and 17 participants attended two focus groups. All interviews were audio-taped, transcribed and coded for qualitative analysis. Results: The diversity in caregiver support could best be described by three prototypes: the tolerator, the preventer and the concerner, representing three approaches of involvement with caregivers. At one end of the spectrum are mental health nurses (MHN) who are essentially only concerned with the wellbeing of the care recipient and see the caregiver as a potential impediment in reaching the client’s goals. We call these the tolerators. At the other end of the spectrum are the MHNs who see the caregiver and the care recipient as inextricably connected with each other. In these cases the MHN directs her/his intervention towards both the informal caregiver and the care recipient. We call these the concerners. In the middle position are MHNs who realize that caregivers are important agents in the achievement of the client’s goals, and therefore consider preventing them from becoming overburdened as an important goal. We call these the preventers. Conclusions: Based on the extent to which the MHNs believe that the informal caregiver plays a necessary role in the client’s support system, and the degree to which they feel responsible for the caregiver’s wellbeing, three MHN prototypes can be distinguished. These prototypes determine how the nurses’ vision directs their understanding of their role and responsibilities and the content of their behaviour. This implies that a change in behaviour needs to be preceded by a change in vision. Therefore, promoting family support cannot be achieved by one-size-fits-all-programmes

Social engagement from childhood to middle age and the effect of childhood socio-economic status on middle age social engagement: results from the National Child Development study

Social engagement has powerful effects on wellbeing, but variation in individual engagement throughout the lifecourse is wide. The trajectories may differ by gender and be affected by socio-economic status (SES). However, long-term development of social engagement is little studied and the effect of childhood SES on later-life social engagement remains obscure. We aimed to describe the social engagement development from childhood to middle age by gender and test the effect of childhood SES on middle age social engagement. Data (N=16,440, 51.3% male) are drawn from the on-going National Child Development Study, following British babies born in 1958. Social engagement was measured by social activities, voluntary work and social contacts, with follow-ups at age 11, 16, 23 and 50. SES was measured by father's occupational social class and tenure status. Structural equation modelling suggested inter-individual stability in social engagement, showing that development of social engagement started in childhood and increased social engagement in middle age through adolescence and early adulthood. Longitudinal effects were detected within and across the social engagement domains. Lower childhood SES was significantly related to a lower level of voluntary work and social activity in middle age, but to higher levels of social contacts. Although stability in social engagement is moderate over the lifecourse, variation within and across the different social engagement domains is shaped by differences in childhood SES

Social Exclusion and Mental Wellbeing in Older Romanians

In Romania, inequalities in health and wellbeing between younger and older Romanians are substantial, and an important reason for inequalities may be the higher risk of social exclusion among older adults. After the fall of Communism in 1989, the many transformations in economic structures and welfare regimes contributed to enhanced levels of social exclusion, in particular among the older generations. Social exclusion is a multidimensional problem with substantial effects on the mental wellbeing of people. The present study examines age differences in mental wellbeing and evaluates to what extent differences can be explained by age and social exclusion, while controlling for a number of potential confounders. Data are from the fourth wave (2016) of the European Quality of Life Survey. Data for Romania include 1004 people aged between 18 and 85 years old, of which 726 are included in the analyses (only complete cases). In the study sample, 259 were 55 years or older. Mental wellbeing was measured with The World Health Organization Wellbeing Index (WHO-5 scale), and social exclusion was measured in four domains: social relations, material resources, services and the neighbourhood. The results show that older Romanians have a statistically significant lower mental wellbeing than younger generations in Romania. All domains of social exclusion were associated with lower levels of mental wellbeing. These effects remained statistically significant after controlling for partner status, chronic diseases, having children, and level of education. Improving mental wellbeing of older Romanians would greatly benefit from increasing social inclusion by means of social transfers provided by the government, improving the neighbourhood and access to services, and providing facilities to enhance the social network

Policy to Reduce Late-Life Social Exclusion – From Aspirations to Action

Drawing on interdisciplinary, cross-national perspectives, this open access book contributes to the development of a coherent scientific discourse on social exclusion of older people. The book considers five domains of exclusion (services; economic; social relations; civic and socio-cultural; and community and spatial domains), with three chapters dedicated to analysing different dimensions of each exclusion domain. The book also examines the interrelationships between different forms of exclusion, and how outcomes and processes of different kinds of exclusion can be related to one another. In doing so, major cross-cutting themes, such as rights and identity, inclusive service infrastructures, and displacement of marginalised older adult groups, are considered. Finally, in a series of chapters written by international policy stakeholders and policy researchers, the book analyses key policies relevant to social exclusion and older people, including debates linked to sustainable development, EU policy and social rights, welfare and pensions systems, and planning and development. The book’s approach helps to illuminate the comprehensive multidimensionality of social exclusion, and provides insight into the relative nature of disadvantage in later life. With 77 contributors working across 28 nations, the book presents a forward-looking research agenda for social exclusion amongst older people, and will be an important resource for students, researchers and policy stakeholders working on ageing

Exclusion from Social Relations in Later Life : Micro- and Macro-Level Patterns and Correlations in a European Perspective

Older adults face particular risks of exclusion from social relationships (ESR) and are especially vulnerable to its consequences. However, research so far has been limited to specific dimensions, countries, and time points. In this paper, we examine the prevalence and micro- and macro-level predictors of ESR among older adults (60+) using two waves of data obtained four years apart across 14 European countries in the Survey of Health, Ageing and Retirement in Europe (SHARE). We consider four ESR indicators (household composition, social networks, social opportunities, and loneliness) and link them to micro-level (age, gender, socioeconomic factors, health, and family responsibilities) and national macro-level factors (social expenditures, unmet health needs, individualism, social trust, and institutional trust). Findings reveal a northwest to southeast gradient, with the lowest rates of ESR in the stronger welfare states of Northwest Europe. The high rates of ESR in the southeast are especially pronounced among women. Predictably, higher age and fewer personal resources (socioeconomic factors and health) increase the risk of all ESR dimensions for both genders. Macro-level factors show significant associations with ESR beyond the effect of micro-level factors, suggesting that national policies and cultural and structural characteristics may play a role in fostering sociability and connectivity and, thus, reduce the risk of ESR in later life

Are there educational disparities in health and functioning among the oldest old? : Evidence from the Nordic countries

With the ageing of the population and recent pressures on important welfare state arrangements, updated knowledge on the linkage between socioeconomic status and health in old age is pertinent for shedding light on emerging patterns of health inequalities in the Nordic countries. This study examined self-rated health (SRH), mobility and activities of daily living (ADL) according to level of education in the three oldest old age groups 75–84, 85–94, and 95+, in four Nordic countries. Altogether, 6132 individuals from Danish Longitudinal Study of Ageing, Norwegian Life Course, Ageing and Generation study, Swedish Panel Study of Living Conditions of the Oldest Old, the 5-Country Oldest Old (Sweden) and Vitality 90 + Study were analysed. First, associations of education level with SRH, mobility, and ADL were estimated for each individual study by means of age- and gender-adjusted logistic regression. Second, results from individual studies were synthesized in a meta-analysis. Older adults with higher education level were more likely to report good SRH, and they were more often independent in mobility and ADL than those with basic education when all age groups were combined. In mobility and ADL, differences between education groups remained stable across the age groups but for SRH, differences seemed to be weaker in older ages. With only a few exceptions, in all age groups, individuals with higher education had more favourable health and functioning than those with basic education. This study shows remarkable persistence of health and functioning inequalities in the Nordic countries throughout later life

Exclusion from Social Relations in Later Life and the Role of Gender : A Heuristic Model

Articles Being socially connected is a universal human need, but a substantial number of older men and women are or become excluded from these connections in later life. Exclusion from social relations (ESR) is unwanted as it undermines people's ability to lead a healthy, active, and independent life. Policies to reduce this form of exclusion have been limited in effectiveness, due in part to a broader lack of knowledge about the dynamics of social exclusion in older ages and the intersection of social exclusion with gender constructions. To advance our understanding of ESR in later life, we develop a heuristic model based on theories and previous empirical studies. Considering the gendered constructing forces of ESR in older age that can potentially lead to loneliness and reduced health and wellbeing, the model identifies individual drivers, such as biopsychosocial conditions, personal standards and life- -course transitions, and macro-level drivers, such as norms and welfare state provisions. This model can serve as a conceptual platform for further theoretical development and empirical study on the gendered construction of ESR in later life. While our focus is on drivers of ESR and its outcomes, potential reversed effects are also discussed

Life course socioeconomic conditions and frailty at older ages

Objectives: This paper aimed to assess associations of childhood socioeconomic conditions (CSC) with the risk of frailty in old age and whether adulthood socioeconomic conditions (ASC) influence this association. Methods: Data from 21 185 individuals aged 50 years and older included in the longitudinal Survey of Health, Ageing, and Retirement in Europe were used. Frailty was operationalized as a sum of presenting weakness, shrinking, exhaustion, slowness, or low activity. Confounder-adjusted multilevel logistic regression models were used to analyze associations of CSC and ASC with frailty. Results: While disadvantaged CSC was associated with higher odds of (pre-)frailty in women and men (OR=1.73, 95%CI 1.34, 2.24; OR=1.84, 95%CI 1.27, 2.66, respectively), this association was mediated by ASC. Personal factors and demographics, such as birth cohort, chronic conditions and difficulties with activities of daily living, increased the odds of being (pre-)frail. Discussion: Findings suggest that CSC are associated with frailty at old age. However, when taking into account ASC, this association no longer persists. The results show the importance of improving socioeconomic conditions over the whole life course in order to reduce health inequalities in old age

Physiological Correlates of Volunteering

We review research on physiological correlates of volunteering, a neglected but promising research field. Some of these correlates seem to be causal factors influencing volunteering. Volunteers tend to have better physical health, both self-reported and expert-assessed, better mental health, and perform better on cognitive tasks. Research thus far has rarely examined neurological, neurochemical, hormonal, and genetic correlates of volunteering to any significant extent, especially controlling for other factors as potential confounds. Evolutionary theory and behavioral genetic research suggest the importance of such physiological factors in humans. Basically, many aspects of social relationships and social activities have effects on health (e.g., Newman and Roberts 2013; Uchino 2004), as the widely used biopsychosocial (BPS) model suggests (Institute of Medicine 2001). Studies of formal volunteering (FV), charitable giving, and altruistic behavior suggest that physiological characteristics are related to volunteering, including specific genes (such as oxytocin receptor [OXTR] genes, Arginine vasopressin receptor [AVPR] genes, dopamine D4 receptor [DRD4] genes, and 5-HTTLPR). We recommend that future research on physiological factors be extended to non-Western populations, focusing specifically on volunteering, and differentiating between different forms and types of volunteering and civic participation