Social relationships and healthy ageing : epidemiological evidence for the development of a local intervention programme

Introduction In view of the growing number of older people in our society and the related consequences for health and well-being, research focussing on healthy ageing is essential. Already, the associations between supportive social relationships and healthy ageing have been established. However, there is as yet no consensus about whether or not it is the structure of the social network, its function- ing or a combination that is most important for health, and in addition, about which aspects of structure and function are important. Aim The main objective of this thesis was to investigate aspects of the structure and functioning of social relationships and their influence on mental, physical and social health in older people. This was relevant to obtain scientific evidence for practice-based research to support local policy making on healthy ageing. Methods Different characteristics and functions of social relationships, such as frequency of contact, different sources of social network ties, satisfaction with relationships, positive and negative perceptions of social support and social engagement have been analysed in cross-sectional and prospective studies. Cross-sectional data are from six community health services in the eastern part of the Netherlands. The overall sample size constituted of 24,936 people aged 65 and over (response 79%). Prospective data are from the Doetinchem Cohort Study. The first examination round (1987-1991) comprised 12,448 men and women aged 20 to 59 years. The overall response rate was 62% for the baseline measurement and 79%, 75% and 78% for rounds 2, 3 and 4 respectively. Results Cross-sectional analyses showed that satisfaction with the social contacts was strongly related to physical (OR 2.36; 95% CI 2.11-2.64), mental (OR 4.65; 95% CI 4.20-5.15) and self-perceived health (OR 2.52; 95% CI 2.29-2.78). Longitudinal analyses underlined this finding by showing that unfavourable levels of social support were predictive for health-compromising behaviours and poor health over a 10-year period of follow-up, and for increased mortality risk over a 15- year period of follow-up (HR 1.57; 95% CI 1.03-2.39). Furthermore, neighbours were found to be an important source of the social network ties of older people in relation to physical (OR 1.87; 95% CI 1.68-2.07), mental (OR 1.53; 95% CI 1.39-1.69) and self-perceived health (OR 1.42; 95% CI 1.30-1.54). Further exploration of the relationship between social support and loneliness using structural equation modelling identified that social support in everyday situations may serve as a good start- ing point for health promotion activities to prevent loneliness. To better target health promotion activities for healthy ageing, analyses were performed to group older people into subgroups with similar social engagement activity patterns. Five clusters were identified: 1) less socially engaged elderly; 2) less socially engaged caregivers; 3) socially engaged caregivers; 4) leisure-engaged elderly; and 5) productive-engaged elderly. Older people who were not engaged in any social activity other than the care for a sick person, were identified as a possible target group, given the relatively high share of unhealthy people among them. In this non-socially engaged target group, the prevalence of loneliness was 48%, compared to 30% in the socially engaged groups; poor self-perceived health: 41% compared to 14%; poor mental health: 25% compared to 9%; poor physical health: 27% compared to 2%. Conclusion Well-functioning social relationships were favourably associated with health. By integrating all results, the local data have strengthened the scientific evidence-base for local policy making and have contributed to the development of an evidence-based community intervention supporting social participation among older people. <br/

Poor health, unhealthy behaviors, and unfavorable work characteristics influence pathways of exit from paid employment among older workers in Europe: A four year follow-up study

Objectives The aim of this study was to get insight into the role of poor health, unhealthy behaviors, and unfavorable work characteristics on exit from paid employment due to disability pension, unemployment, and early retirement among older workers. Methods Respondents of the longitudinal Survey of Health, Ageing, and Retirement in Europe (SHARE) in 11 European countries were selected when (i) aged between 50 years and the country-specific retirement age, (ii) in paid employment at baseline, and (iii) having information on employment status during the 4-year follow-up period (N=4923). Self-perceived health, health behaviors, and physical and psychosocial work characteristics were measured by interview at baseline. Employment status was derived from follow-up interviews after two and four years. Cox proportional hazards regression analyses were used to identify determinants of unemployment, disability pension, and early retirement. Results Poor health was a risk factor for disability pension [hazard ratio (HR) 3.90, 95% confidence interval (95% CI) 2.51-6.05], and a lack of physical activity was a risk factor for disability pension (HR 3.05, 95% CI 1.68-5.55) and unemployment (HR 1.84, 95% CI 1.13-3.01). A lack of job control was a risk factor for disability pension, unemployment, and early retirement (HR 1.30-1.77). Conclusions Poor health, a lack of physical activity, and a lack of job control played a role in exit from paid employment, but their relative importance differed by pathway of labor force exit. Primary preventive interventions focusing on promoting physical activity as well as increasing job control may contribute to reducing premature exit from paid employment

Differences in school environment, school policy and actions regarding overweight prevention between Dutch schools. A nationwide survey

<p>Abstract</p> <p>Background</p> <p>Schools are regarded as an important setting for the prevention of overweight. This study presents a nationally representative picture of the obesogenity of the school environment, the awareness of schools regarding overweight, and actions taken by the schools aiming at overweight prevention. In addition, differences between school levels were studied.</p> <p>Methods</p> <p>In 2006-2007, questionnaires were sent to all Dutch secondary schools (age group 12-18 years). Prevalences of the outcome variables were calculated for the schools in total and by school level. The association between school level and outcome variables were analysed by a log linear regression.</p> <p>Results</p> <p>Unhealthy foods and drinks are widely available at secondary schools. One third of the schools indicated that overweight has increased among students and half of the schools agreed that schools were (co)responsible for the prevention of overweight. Only 3% of the schools have a policy on overweight prevention. Small differences were observed between vocational education schools and higher education schools. The presence of vending machines did not differ by school level, but at vocational education schools, the content of the vending machines was less healthy.</p> <p>Conclusion</p> <p>This study describes the current situation at schools which is essential for the development and evaluation of future overweight prevention policies and interventions. In general, secondary schools are not actively involved in overweight prevention and the nutritional environment at most schools could be improved. The small differences between school levels do not give reason for a differential approach for a certain school level for overweight prevention.</p

Evaluation design for a complex intervention program targeting loneliness in non-institutionalized elderly Dutch people

<p>Abstract</p> <p>Background</p> <p>The aim of this paper is to provide the rationale for an evaluation design for a complex intervention program targeting loneliness among non-institutionalized elderly people in a Dutch community. Complex public health interventions characteristically use the combined approach of intervening on the individual and on the environmental level. It is assumed that the components of a complex intervention interact with and reinforce each other. Furthermore, implementation is highly context-specific and its impact is influenced by external factors. Although the entire community is exposed to the intervention components, each individual is exposed to different components with a different intensity.</p> <p>Methods/Design</p> <p>A logic model of change is used to develop the evaluation design. The model describes what outcomes may logically be expected at different points in time at the individual level. In order to address the complexity of a real-life setting, the evaluation design of the loneliness intervention comprises two types of evaluation studies. The first uses a quasi-experimental pre-test post-test design to evaluate the effectiveness of the overall intervention. A control community comparable to the intervention community was selected, with baseline measurements in 2008 and follow-up measurements scheduled for 2010. This study focuses on changes in the prevalence of loneliness and in the determinants of loneliness within individuals in the general elderly population. Complementarily, the second study is designed to evaluate the individual intervention components and focuses on delivery, reach, acceptance, and short-term outcomes. Different means of project records and surveys among participants are used to collect these data.</p> <p>Discussion</p> <p>Combining these two evaluation strategies has the potential to assess the effectiveness of the overall complex intervention and the contribution of the individual intervention components thereto.</p

Is being overweight associated with engagement in self-injurious behaviours in adolescence, or do psychological factors have more “weight”?

Introduction The purpose of this study was to examine the prevalence of non-suicidal self-injurious behaviours (NSSI) among healthy weight and overweight adolescents and to examine the role of age, gender, weight status, treatment condition for weight control, and psychological variables (psychopathological symptoms and emotional skills) in the prediction of NSSI. Methods The study had a cross-sectional design, and participants (n = 370) were aged 14-19 years and were divided in three groups: 205 adolescents with normal weight, 82 adolescents from the community with overweight/obesity, and 83 adolescents with overweight/obesity and in outpatient treatment for weight control. Results The prevalence of these behaviours in the overweight community group (25.6 %) and in the overweight clinical group (14.5 %) was similar to their healthy weight peers (19 %). Not attending an outpatient treatment for weight control, higher psychopathology and less ability to regulate emotions predict the presence of NSSI. Conclusion Being overweight is not associated with NSSI, but psychosocial variables such as psychopathology, emotional deregulation and the absence of medical care predict these behaviours.info:eu-repo/semantics/publishedVersio

Socio-demographic and lifestyle factors associated with overweight in a representative sample of 11-15 year olds in France: Results from the WHO-Collaborative Health Behaviour in School-aged Children (HBSC) cross-sectional study

<p>Abstract</p> <p>Background</p> <p>The prevalence of overweight in children and adolescents is high and overweight is associated with poor health outcomes over short- and long-term. Lifestyle factors can interact to influence overweight. Comprehensive studies linking overweight concomitantly with several demographic and potentially-modifiable lifestyle factors and health-risk behaviours are limited in adolescents - an age-group characterized by changes in lifestyle behaviours and high prevalence of overweight. Thus, the objective of the current study was to examine the association of overweight with several socio-demographic and lifestyle variables simultaneously in a representative sample of adolescents.</p> <p>Methods</p> <p>A nationally representative sample of 11-15 year-olds (n = 7154) in France participated as part of the WHO-Collaborative Health Behaviour in School-aged Children (HBSC) study. Students reported data on their age, height, weight, socio-demographic variables, lifestyle factors including nutrition practices, physical activity at two levels of intensity (moderate and vigorous), sedentary behaviours, as well as smoking and alcohol consumption patterns using standardized HBSC protocols. Overweight (including obesity) was defined using the IOTF reference. The multivariate association of overweight with several socio-demographic and lifestyle factors was examined with logistic regression models.</p> <p>Results</p> <p>The adjusted odds ratios for the association with overweight were: 1.80 (95% CI: 1.37-2.36) for low family affluence; 0.73 (0.60-0.88) for eating breakfast daily; 0.69 (0.56-0.84) for moderate to vigorous physical activity (MVPA); and 0.71 (0.59-0.86) for vigorous physical activity (VPA). Significant interactions between age and gender as well as television (TV) viewing and gender were noted: for boys, overweight was not associated with age or TV viewing; in contrast, for girls overweight correlated negatively with age and positively with TV viewing. Fruit and vegetable intake, computer and video-games use, smoking and alcohol consumption were not associated with overweight.</p> <p>Conclusions</p> <p>In multivariate model, family affluence, breakfast consumption and moderate to vigorous as well as vigorous physical activity were negatively associated with overweight. These findings extend previous research to a setting where multiple risk and protective factors were simultaneously examined and highlight the importance of multi-faceted approaches promoting physical activity and healthy food choices such as breakfast consumption for overweight prevention in adolescents.</p

Success and failure in narrowing the disability employment gap: comparing levels and trends across Europe 2002–2014

Background: International comparisons of the disability employment gap are an important driver of policy change. However, previous comparisons have used the European Union Statistics on Income and Living Conditions (EU-SILC), despite known comparability issues. We present new results from the higher-quality European Social Survey (ESS), compare these to EU-SILC and the EU Labour Force Survey (EU-LFS), and also examine trends in the disability employment gap in Europe over the financial crisis for the first time. Methods: For cross-sectional comparisons of 25 countries, we use micro-data for ESS and EU-SILC for 2012 and compare these to published EU-LFS 2011 estimates. For trend analyses, we use seven biannual waves of ESS (2002–2014) with a total sample size of 182,195, and annual waves of EU-SILC (2004–2014) with a total sample size of 2,412,791. Results: (i) Cross-sectional: countries that have smaller disability employment gaps in one survey tend to have smaller gaps in the other surveys. Nevertheless, there are some countries that perform badly on the lower-quality surveys but better in the higher-quality ESS. (ii) Trends: the disability employment gap appears to have declined in ESS by 4.9%, while no trend is observed in EU-SILC – but this has come alongside a rise in disability in ESS. Conclusions: There is a need for investment in disability measures that are more comparable over time/space. Nevertheless, it is clear to policymakers there are some countries that do consistently well across surveys and measures (Switzerland), and others that do badly (Hungary)

Do positive or negative experiences of social support relate to current and future health? Results from the Doetinchem Cohort Study

Cross-sectional studies have reported associations between social support and health, but prospective evidence is less conclusive. This study aims to investigate the associations of positive and negative experiences of social support with current and future lifestyle factors, biological risk factors, self-perceived health and mental health over a 10-year period