Early-life circumstances and late life loneliness trajectories among Finnish older adults.

BACKGROUND: Later life loneliness has become a significant public health concern worldwide. Research has focused on the prevalence, risk factors and consequences of loneliness in different age groups. This study aimed to advance the understanding of the impact of early-life circumstances on later life loneliness by examining the associations between adversities in childhood and youth and loneliness trajectories in Finnish older adults. METHODS: The data were derived from the 10-year follow-up survey study Good Aging in the Lahti Region (n = 1552, mean age 64.89 years). The baseline study was conducted in 2002 with a regionally and locally stratified random sample of older persons living in the Lahti Region located in southern Finland. The follow-up surveys were carried out in 2005, 2008 and 2012. Loneliness was measured using a single question at the three follow-ups. Childhood conditions were retrospectively assessed at baseline with questions regarding the death of parents, household affection, relocation, and fear of a family member. Latent class growth analysis with time invariant covariates was used to identify loneliness trajectories and to examine the associations between loneliness trajectories and adverse circumstances in childhood and youth. RESULTS: The results identified three distinct loneliness trajectories: low, moderate, and severe, including 36%, 50% and 14%, respectively, of the study population. The non-significant slopes of the three trajectories indicate that trajectories were stable during the seven years of follow-up. Being afraid of a family member, having a cold childhood, and death of a father or mother in childhood or youth significantly increased the odds of having a severe loneliness trajectory as compared to low loneliness trajectory. None of the early-life circumstances differentiated between severe and moderate levels of loneliness. CONCLUSIONS: The findings suggest that some adverse early-life circumstances increase the odds of an unfavorable loneliness trajectory in later life. The results highlight the need to recognize the role of diverse life-course adversities in loneliness research and interventions. The study also underscores the importance of identifying individuals who are at risk of long-term and severe loneliness and providing them with appropriate support to decrease and/or prevent the negative health consequences of loneliness in old age.

Loneliness prevalence of community-dwelling older adults and the impact of the mode of measurement, data collection, and country: A systematic review and meta-analysis.

OBJECTIVES: The aim of this systematic review and meta-analysis is to assess the prevalence of loneliness in many countries worldwide which have different ways of assessing it. DESIGN: Systematic review and meta-analysis. SETTING: We searched seven electronic databases for English peer-reviewed studies published between 1992 and 2021. PARTICIPANTS: We selected English-language peer-reviewed articles, with data from non-clinical populations of community-dwelling older adults (>60 years), and with "loneliness" or "lonely" in the title. MEASUREMENTS: A multilevel random-effects meta-analysis was used to estimate the prevalence of loneliness across studies and to pool prevalence rates for different measurement instruments, data collection methods, and countries. RESULTS: Our initial search identified 2,021 studies of which 45 (k = 101 prevalence rates) were included in the final meta-analysis. The estimated pooled prevalence rate was 31.6% (n = 168,473). Measurement instrument was a statistically significant moderator of the overall prevalence of loneliness. Loneliness prevalence was lowest for single-item questions and highest for the 20-item University of California-Los Angeles Loneliness Scale. Also, differences between modes of data collection were significant: the loneliness prevalence was significantly the highest for face-to-face data collection and the lowest for telephone and CATI data collection. Our moderator analysis to look at the country effect indicated that four of the six dimensions of Hofstede also caused a significant increase (Power Distance Index, Uncertainty Avoidance Index, Indulgence) or decrease (Individualism) in loneliness prevalence. CONCLUSIONS: This study suggests that there is high variability in loneliness prevalence rates among community-dwelling older adults, influenced by measurement instrument used, mode of data collection, and country.

Patterns and correlates of old-age social exclusion in the Balkan states.

Social exclusion (SE), or the separation of individuals and groups from mainstream society, is associated with poor health and wellbeing, yet a substantial number of older people are socially excluded. There is increasing agreement that SE is multidimensional, comprising among others social relations, material resources, and/or civic participation. However, measuring SE is still challenging as exclusion may occur in more than one dimension, whereas its sum does not reflect the content of SE. To account for these challenges, this study provides a typology of SE and describes how SE types differ from each other in terms of severity and risk factors. We concentrate on Balkan states, which are among the European countries with the highest prevalence of SE. Data come from the European Quality of Life Survey (N = 3030, age 50 +). Latent Class Analysis revealed four SE types: low SE risk (50%), material exclusion (23%), material and social exclusion (4%), and multidimensional exclusion (23%). A higher number of dimensions from which a person is excluded are associated with more severe outcomes. Multinomial regression further revealed that lower levels of education, lower subjective health, and lower social trust increase the risks of any SE type. Younger age, unemployment, and not having a partner are associated with specific SE types. This study is in line with the limited evidence that different types of SE exist. Policies designed to reduce SE should take account of the different SE types and specific associated risk factors in order to enhance the impact of interventions to reduce social exclusion.

Exclusion from social relations in later life: on the gendered associations of social networks with mental wellbeing.

Objectives: This study addresses the gendered risks of loneliness and depression in later life from a social exclusion perspective. Exclusion from social relations (ESR) in older age is an unwanted situation associated with increased loneliness and depressive symptoms, with gender differences in the perception of solitude, and the evaluation of existing social networks, potentially accounting for the increased susceptibility of older women.Method: Secondary analyses was conducted in a sample of 60,918 participants in the Survey on Health, Aging and Retirement in Europe (SHARE). Older persons' subjective perception of solitude (i.e. solitude satisfaction), and their satisfaction with established relations (i.e. network satisfaction), were examined in gender-stratified regression models, predicting loneliness and depressive symptomatology, controlling for network size, demographics, and health.Results: There was no convincing evidence for significant associations between solitude satisfaction (SoS) and loneliness among older men, nor between network satisfaction (NeS) and loneliness for both genders. Low SoS and low NeS were independently associated with more depressive symptoms and an increased probability of depression, especially among older women. This vulnerability could not be attributed to increased loneliness, as only among older women, low SoS was associated with lower levels of loneliness, and lower levels of loneliness was anaemically associated with more depressive symptoms.Conclusions: The perception of solitude, and the evaluation of social relations, are associated with gendered risks of depression among older persons who are challenged by objective and subjective ESR states.

Lonely societies: low trust societies? Further explanations for national variations in loneliness among older Europeans.

Cross-national studies in Europe reveal sharp regional differences in the prevalence of loneliness among older adults, with the highest prevalence of loneliness in Eastern European countries. In this study, we investigate an alternative explanation for differences in loneliness prevalence based on differences in trust. Many of the Eastern European countries were ruled by totalitarian regimes that undermined people's trust in other people and in the system, potentially leading to higher loneliness prevalence. Data are derived from the sixth round of the European Social Survey conducted in 2012, based on 12,042 respondents, of which 4827 live in post-totalitarian countries and 7215 in other European countries and Israel. We estimate a path model with trust in people, trust in the system, and social engagement included as latent variables and one dichotomous outcome (lonely or not). We control for age, gender, health limitations, marital status, income adequacy, and education. The results reveal that loneliness is partly constructed by the social-cultural and historical-political characteristics of the countries in which people live. The higher prevalence of loneliness in the Eastern-European post-totalitarian countries can be linked to a low level of trust in other people through social disengagement. Considering the role of trust in the creation of individuals feelings of loneliness contributes to the understanding of country variations in loneliness and opens a new perspective in loneliness research and the development of policies aimed at reducing loneliness.

Life-course income trajectories of men and women in Norway: implications for self-rated health in later life.

BACKGROUND: Socioeconomic inequalities in health are well-established, but studies addressing lagged effects of income or of fluctuations in income over the life course are relatively rare. The current study aims to (i) identify and describe life-course income trajectories for men and women who are currently in later life; and (ii) assess the association of income trajectories with self-rated health in older adults. METHODS: The study sample consisted of 1625 men and 1634 women born between 1937 and 1955 who participated in the third wave of the Norwegian Life course, Ageing and Generation Study. Latent class growth analyses were used to estimate dominant income trajectories from ages 30 through 62 in men and women. Stepwise logistic regression analyses were specified to analyze the association of income trajectories with self-rated health in later life. RESULTS: Four trajectories in women and three trajectories in men were estimated as dominant patterns of income over the life course. Differences in the level of income were considerable at age 30 and accumulated over time. Continued exposure to low income showed statistically significant higher odds for poor self-rated health in older men and women. This association remained significant after taking differences in educational attainment, working life, family formation and accumulated wealth into account. CONCLUSION: The findings suggested remarkable rigidity in income groups that had formed by age 30. A significant share of men and women remain mired in relatively low-income status across the life course with negative implications for health in later life.

Network and solitude satisfaction as modifiers of disadvantages in the quality of life of older persons who are challenged by exclusion from social relations: a gender stratified analysis.

This study examined from a gender-sensitive perspective the associations of exclusion from social relations (ESR) with the quality of life (QoL) of excluded older persons. Being satisfied with existing relations (i.e., network satisfaction) may be particularly important for the QoL of older persons with small networks, whereas the QoL of "network-less" older persons may be associated with their perception of solitude (i.e., solitude satisfaction). This study examined the moderating role of network satisfaction (NS) in the gendered associations between network size and QoL, as well as the gendered associations of solitude satisfaction (SS) with the QoL of older "network-less" persons. In addition, the comparative disadvantages in the QoL of "network-less" older persons with low-to-high SS, compared to the QoL of socially embedded persons with low-to-high NS were examined. Cross-sectional gender stratified secondary analyses of data from participants (N = 72.433) in the Survey on Health, Aging and Retirement in Europe (SHARE) did not provide convincing evidence that a higher NS is particularly important for the QoL of older persons with smaller networks. Among older "network-less" persons, lower SS was associated with lower QoL, comparatively more so among older women. Older persons embedded in a social network with low NS, as well as older "network-less" persons with low SS, have comparatively the lowest levels of QoL. It was concluded that the subjective evaluation of social relations and the subjective evaluation of solitude are associated with gendered disadvantages in the QoL of older persons challenged by ESR.

How Welfare Regimes Moderate the Associations Between Cognitive Aging, Education, and Occupation.

OBJECTIVES: Previous studies have shown the importance of individual markers of cognitive reserve, such as education and occupation, for cognitive health in old age. However, there has been only little investigation so far on how this relationship varies across contexts. METHODS: We analyzed data from the Survey of Health, Ageing, and Retirement in Europe, using second-order latent growth models, to assess the moderating role of welfare regimes on the relationship between education and occupation skill level in explaining overall cognitive functioning and decline in old age. Our sample includes 13 European countries using data from 5 regular waves of the survey (2004-2007 and 2011-2015) and 2 retrospective ones (2008-2009 and 2017). Cognitive functioning was modeled as a latent variable measured by immediate and delayed recall, verbal fluency, and numeracy. RESULTS: 74,193 participants were included from the survey. Our analysis showed that the association of education with cognition was weaker overall in Scandinavian countries, but stronger in Southern European countries, relative to Bismarckian ones. However, educational differences in the decline of cognition were more pronounced only in Scandinavian compared to Bismarckian countries. Additionally, higher-skilled occupations in Scandinavian countries had better overall functioning compared to the same occupations in Bismarckian countries, but there was no difference in the decline in cognitive functioning. DISCUSSION: Our findings indicate that the associations of cognitive functioning and its decline with individuals' cognitive reserve markers (education and occupational skill level) vary according to welfare regimes, showing the importance of contextual factors in cognitive aging processes.

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.

A critical review and development of a conceptual model of exclusion from social relations for older people.

Social exclusion is complex and dynamic, and it leads to the non-realization of social, economic, political or cultural rights or participation within a society. This critical review takes stock of the literature on exclusion of social relations. Social relations are defined as comprising social resources, social connections and social networks. An evidence review group undertook a critical review which integrates, interprets and synthesizes information across studies to develop a conceptual model of exclusion from social relations. The resulting model is a subjective interpretation of the literature and is intended to be the starting point for further evaluations. The conceptual model identifies individual risks for exclusion from social relations (personal attributes, biological and neurological risk, retirement, socio-economic status, exclusion from material resources and migration). It incorporates the evaluation of social relations, and the influence of psychosocial resources and socio-emotional processes, sociocultural, social-structural, environmental and policy contextual influences on exclusion from social relations. It includes distal outcomes of exclusion from social relations, that is, individual well-being, health and functioning, social opportunities and social cohesion. The dynamic relationships between elements of the model are also reported. We conclude that the model provides a subjective interpretation of the data and an excellent starting point for further phases of conceptual development and systematic evaluation(s). Future research needs to consider the use of sophisticated analytical tools and an interdisciplinary approach in order to understand the underlying biological and ecopsychosocial associations that contribute to individual and dynamic differences in the experience of exclusion from social relations.

Do Welfare Regimes Moderate Cumulative Dis/advantages Over the Life Course? Cross-National Evidence from Longitudinal SHARE Data.

OBJECTIVES: This study aimed to examine the cumulative disadvantage of different forms of childhood misfortune and adult-life socioeconomic conditions (SEC) with regard to trajectories and levels of self-rated health in old age and whether these associations differed between welfare regimes (Scandinavian, Bismarckian, Southern European, and Eastern European). METHOD: The study included 24,004 respondents aged 50-96 from the longitudinal SHARE survey. Childhood misfortune included childhood SEC, adverse childhood experiences, and adverse childhood health experiences. Adult-life SEC consisted of education, main occupational position, and financial strain. We analyzed associations with poor self-rated health using confounder-adjusted mixed-effects logistic regression models for the complete sample and stratified by welfare regime. RESULTS: Disadvantaged respondents in terms of childhood misfortune and adult-life SEC had a higher risk of poor self-rated health at age 50. However, differences narrowed with aging between adverse-childhood-health-experiences categories (driven by Southern and Eastern European welfare regimes), categories of education (driven by Bismarckian welfare regime), and main occupational position (driven by Scandinavian welfare regime). DISCUSSION: Our research did not find evidence of cumulative disadvantage with aging in the studied life-course characteristics and age range. Instead, trajectories showed narrowing differences with differing patterns across welfare regimes.

Life Course Socioeconomic Conditions and Frailty at Older Ages.

OBJECTIVES: This article 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 (odds ratio [OR] = 1.73, 95% confidence interval [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.

Spousal Loss and Change in Cognitive Functioning: An Examination of Temporal Patterns and Gender Differences.

OBJECTIVES: The study investigates whether the disadvantaged position of men in the adverse consequences of widowhood for health and mortality also exists for changes in cognitive health. METHODS: We used data of up to 1,269 men and women aged 65 years and older who participated in the Longitudinal Aging Study Amsterdam in 3-yearly assessments between 1992 and 2012 (5,123 person-observations). All were married and without cognitive impairment (Mini-Mental State Examination ≥ 24) at baseline and up to 419 lost their spouse. In fixed effects regression models, the effect of spousal loss on change in four domains of cognitive functioning was estimated independently of age-related cognitive change. RESULTS: For women, a robust temporary decrease was found in the second year after spousal loss in the reasoning domain, but not in global cognitive functioning, processing speed, or memory. No robust effects were found for men. DISCUSSION: Considering that only one cognitive domain was affected and effects were temporary, cognitive functioning seems rather robust to the experience of spousal loss. Despite men having often been reported to be in a disadvantaged position in other health domains, our analyses indicate no such pattern for cognitive functioning.

Life-Course Circumstances and Frailty in Old Age Within Different European Welfare Regimes: A Longitudinal Study With SHARE.

OBJECTIVES: This study aimed to assess whether cumulative disadvantage in childhood misfortune and adult-life socioeconomic conditions influence the risk of frailty in old age and whether welfare regimes influence these associations. METHOD: Data from 23,358 participants aged 50 years and older included in the longitudinal SHARE survey were used. Frailty was operationalized according to Fried's phenotype as presenting either weakness, shrinking, exhaustion, slowness, or low activity. Confounder-adjusted mixed-effects logistic regression models were used to analyze associations of childhood misfortune and life-course socioeconomic conditions with frailty. RESULTS: Childhood misfortune and poor adult-life socioeconomic conditions increased the odds of (pre-)frailty at older age. With aging, differences narrowed between categories of adverse childhood experiences (driven by Scandinavian welfare regime) and adverse childhood health experiences (driven by Eastern European welfare regime), but increased between categories of occupational position (driven by Bismarckian welfare regime). DISCUSSION: These findings suggest that childhood misfortune is linked to frailty in old age. Such a disadvantaged start in life does not seem to be compensated by a person's life-course socioeconomic trajectory, though certain types of welfare regimes affected this relationship. Apart from main occupational position, our findings do not support the cumulative dis/advantage theory, but rather show narrowing differences.

The Social Support-Health Link Unraveled: Pathways Linking Social Support to Functional Capacity in Later Life.

Objective: Despite evidence that social support is strongly related to health, very little is known about the mechanisms underlying this association. This study investigates whether physical activity, depressive symptoms, and chronic diseases mediate the associations between social support and functional capacity. Method: Data from the Longitudinal Aging Study Amsterdam on 954 participants, aged 75 and older, covering 9 years, are analyzed with latent growth mediation models. Results: Only the indirect path from the initial level of emotional support to the initial level of functional capacity through the initial level of depressive symptoms was significant. All mediators however were significantly associated with the level of and changes in functional capacity. Models with reversed pathways were estimated, but model fit was worse. Discussion: Because only initial levels of social support relate to functional capacity, and changes in social support do not, older adults likely receive the support they need.

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.