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

Older people now constitute the majority of those with health problems in developed countries so an understanding of health variations in later life is increasingly important. In this paper, we use data from three rounds of the Health Survey for England, a large nationally representative sample, to analyse variations in the health of adults aged 65-84 by indicators of attributes acquired in childhood and young adulthood, termed personal capital; and by current social resources and current socio-economic circumstances, while controlling for smoking behaviour and age. We used six indicators of health status in the analysis, four based on self-reports and two based on nurse collected data, which we hypothesised would identify different dimensions of health. Results showed that socio-economic indicators, particularly receipt of income support (a marker of poverty) were most consistently associated with raised odds of poor health outcomes. Associations between marital status and health were in some cases not in the expected direction. This may reflect bias arising from exclusion of the institutional population (although among those under 85 the proportion in institutions is very low) but merits further investigation, especially as the marital status composition of the older population is changing. Analysis of deviance showed that social resources (marital status and social support) had the greatest effect on the indicator of psychological health (GHQ) and also contributed significantly to variation in self-rated health, but among women not to variation in taking three or more medicines and among men not to self-reported long-standing illnesses. Smoking, in contrast, was much more strongly associated with these indicators than with self-rated health. These results are consistent with the view that self-rated health may provide a holistic indicator of health in the sense of well-being, whereas measures such as taking prescribed medications may be more indicative of specific morbidities. The results emphasise again the need to consider both socio-economic and socio-psychological influences on later life health

Book review: managing and sharing research data: a guide to good practice by Louise Corti et al.

Research funders across the world are implementing data management and sharing policies to maximize openness of data, transparency and accountability of the research they support. This guide aims to cover guidance on how to plan your research using a data management checklist, how to format and organize data, and how to publish and cite data. This is a useful guide for students and researchers on a topic of increasing importance, writes Emily Grundy

Pathways from fertility history to later life health: results from analyses of the English study of ageing

Background: Previous research shows associations between fertility histories and later life health. The childless, those with large families, and those with a young age at entry to parenthood generally have higher mortality and worse health than parents of two or three children. These associations are hypothesised to reflect a range of biosocial influences but underlying mechanisms are poorly understood. Objectives: To identify pathways from fertility histories to later life health by examining mediation through health related behaviours, social support and strain, and wealth. Additionally to examine mediation through allostatic load –an indicator of multisystem physical dysregulation hypothesised to be an outcome of chronic stress. Methods: Associations between fertility histories, mediators and outcomes were analysed using path models. Data were drawn from the English Longitudinal Study of Ageing. Outcomes studied were a measure of allostatic load based on 9 biomarkers and self-reported long-term illness which limited activities. Results: Early parenthood (<20 for women, <23 for men) was positively associated with higher (worse) allostatic load and long-term illness. These associations were partly mediated through wealth, smoking, and physical activity. Wealth, smoking, physical activity and and social strain also mediated associations between larger family size, itself associated with early parenthood, and health outcomes. We found no significant associations between childlessness and allostatic load or long-term illness except for an assocaition between childlessness and long-term illness among women in models adjusted only for age. Conclusions: In England early parenthood and larger family size are associated with less wealth and poorer health behaviours and this accounts for much of the association with health. At least part of this operates through stress related physiological dysfunction (allostatic load)

Health effects of parental deaths among adults in Norway: purchases of prescription medicine before and after bereavement

We analyse effects of parental deaths on the health of women and men aged 18–59 in 2004–2008, indicated by purchases of prescription medicines. Register data covering the entire Norwegian population were used, and fixed-effects models were estimated to control for unobserved time-invariant individual factors. A parent's death seemed to have immediate adverse consequences in both main age groups considered (18–39, 40–59), although effects were lower in the older group. Some results suggested that this health disadvantage widened with increasing time since the parent's death. However, effects were weak: the annual number of different medicines purchased was only increased by 1–7% as a result of losing a parent. Death of a parent was associated with an immediate increase in purchases of medication for mental diseases, and there were indications of a physical response as well. As time since the parental death increased, there was a decline in the purchase of medication for mental diseases, but an opposite trend with respect to medication for other diseases. On the whole, maternal and paternal deaths had the same impact, and effects on daughters and sons were of the same magnitude

The dynamics of paid and unpaid activities among people aged 50-69 in Denmark, France, Italy, and England

In the context of the current policy emphasis on extending working lives, we investigate whether the relationship between participation in paid work, other formal, and informal activities among people aged 50–69 is complementary or competitive. We also investigate differences in associations between countries using comparable longitudinal data from Denmark, France, Italy, and England. We find positive associations between informal and formal engagement in cross-sectional and longitudinal analyses. Paid work was negatively associated with formal and informal engagement, and respondents who stopped working were more likely to be engaged in formal (Denmark and France) and informal activities (England and Italy) at follow-up than respondents who continued working. However, the strongest predictor of formal and informal engagement at follow-up was baseline engagement. In the context of policy aims to extend working lives and broaden older people’s participation in other productive activities, new balances between work and other forms of engagement are still to be found

Household debt and depressive symptoms among older adults in three continental European countries

In this comparative study focusing on the population aged 50 and over in three European countries, we investigate the association between household debt and depressive symptoms, and possible country differences in this association, using data from waves 1, 2, 4, 5 and 6 of the Surveys of Health, Ageing and Retirement in Europe (SHARE) for Belgium, France and Germany. Multilevel regression models with random intercepts for individuals were used to analyse the association between household debt status and number of depressive symptoms (EURO-D score). Country differences in the household debt-depression nexus were tested using country interaction models. After controlling for other measures of socioeconomic position and physical health, low or substantial financial debt was associated with a higher number of depressive symptoms in all countries. Housing debt was strongly linked to depressive symptoms for women while the association was weaker for men. The only country difference was that for both sexes substantial financial debt (more than 5,000€) was strongly associated with depressive symptoms in Belgium and Germany, but the association was weak or non-significant in France. Associations between financial debt and depression were also evident in analyses of within individual changes in depressive symptoms for a longitudinal subgroup, and in analyses using a dichotomised, rather than a continuous, measure of depression. The findings indicate that measures of household indebtedness should be taken into consideration in investigations of social inequalities in depression and suggest a need for mental health services targeted at indebted older people

Demography and public health

The health and health care needs of a population cannot be measured or met without knowledge of its size and characteristics. Demography is concerned with this and with understanding population dynamics - how populations change in response to the interplay between fertility, mortality and migration. This understanding is a pre-requisite for making the forecasts about future population size and structure which should underpin health care planning. Such analyses necessitate a review of the past. The number of very old people in a population, for example, depends on the number of births eight or nine decades earlier and risks of death at successive ages throughout the intervening period. The proportion of very old people depends partly on this numerator but more importantly on the denominator, the size of the population as a whole. The number of births in a population depends on current patterns of family building, and also on the number of women 'at risk' of reproduction - itself a function of past trends in fertility and mortality. Similarly, the number and causes of deaths are strongly influenced by age structure. Demography is largely concerned with answering questions about how populations change and their measurement. The broader field of population studies embraces questions of why these changes occur, and with what consequences. This chapter presents information on demographic methods and data sources and their application to health and population issues, together with information on demographic trends and their implications and the major theories about demographic change in order to elucidate the complex inter-relationship between population change and human health

Revisiting convergence and divergence: support for older people in Europe

Recent commentators have distinguished ‘weak’ from ‘strong’ family societies, arguing that older people in less family-oriented societies receive less support from family members than those in countries with strong family ties (e.g. Southern Europe). This study explored the north-south divide in various dimensions associated with support for older people among selected European countries participating in a European Scientific Foundation network, ‘Family Support for Older People: Determinants and Consequences’ (FAMSUP). Employing data from a wide variety of sources (e.g. nationally representative surveys, censuses, and official publications) we used principal components and cluster analysis to investigate patterns across countries in four dimensions designed to be indicative of the balance between family and formally provided resources for older people and the socio-economic, demographic and policy contexts in which these are provided. Rather than a clear-cut north-south division European countries reflect a more complex classification in terms of support for older individuals when a wide range of measures associated with different dimensions of support for older people are used. Future research requires comparable cross-national data on key indicators of family support

Loneliness among Polish migrants in the Netherlands: the impact of presence and location of partners and offspring

Background: Research using nonmigrant samples indicates that having a partner and children is protective against loneliness. Such beneficial effects may be weaker for migrants with partners and/or children living in different countries. Objective: We assess how feelings of loneliness among Polish migrants in the Netherlands compare to levels among the general Dutch population and how migrants’ feelings of loneliness vary by presence and location of partners and offspring. Methods: We used weighted data from the Families of Poles in the Netherlands survey (n=1,129). Wald tests were used to compare levels of loneliness among Polish migrants with scores reported in a different study for the general Dutch population. Linear regression was used to estimate how presence and location of partners and children were associated with loneliness. Results: Polish migrants in the Netherlands were lonelier than the general Dutch population. Among men, those who had been in the Netherlands for longer were lonelier than those who had more recently arrived. Unpartnered men and men with a partner living abroad were lonelier than men with a partner living in the Netherlands. For women, no effects of presence and location of a partner were found. Presence and location of children made little difference. Conclusions: Although loneliness is often considered a problem for older individuals, feelings of loneliness are also strong among working-age Polish migrants. Consistent with studies on nonmigrant samples, we found that men with a partner were less lonely than unpartnered men, but only when the partner also resided in the Netherlands