[Sustainable age(ing) in the context of climate change: state of research and conceptional considerations]. / Nachhaltiges Alter(n) im Kontext des Klimawandels: Stand der Forschung und konzeptioneller Ausblick.

BACKGROUND: Research on age and ageing is starting to consider challenges related to climate change; however, most work focuses on reaction needs rather than action possibilities of older people. MATERIAL AND METHODS: Based on a scoping review of 39 papers from the scientific literature the construction of age(ing) in the context of climate change and sustainability were analyzed and constrictions were revealed. Following these considerations, a model of "sustainable age(ing) in times of climate change" is proposed, which enables successful, active and sustainable ageing to be reconciled. RESULTS: The scoping review shows that older people are often considered as a homogeneous, vulnerable group and more or less helpless in the face of climate change. In the context of sustainability, they are attributed the role of a central cause or as part of the solution for environmental crises. The focus is broadened and contradictions and ambivalences are reconciled in this model of sustainable age(ing). DISCUSSION: Climate change can only be dealt with together. Research on age and ageing can support this on the basis of the model of sustainable age(ing) by providing important contributions to handling climate change and (re)actions regarding environmental crises.

Wealth inequalities in physical and cognitive impairments across Japan and Europe: the role of health expenditure and infrastructure.

Although prior research has provided insights into the association between country-level factors and health inequalities, key research gaps remain. First, most previous studies examine subjective rather than objective health measures. Second, the wealth dimension in health inequalities is understudied. Third, a handful of studies explicitly focus on older adults. To bridge these research gaps, this study measures wealth-related inequalities in physical and cognitive impairments and examines the extent to which welfare states moderate wealth inequalities in physical and cognitive impairments among older people across Japan and Europe. We utilized harmonized data on non-institutionalized individuals aged 50-75 from the Japanese Study of Aging and Retirement (JSTAR) and the Survey of Health, Ageing and Retirement in Europe (SHARE) (N = 31,969 for physical impairments and 31,348 for cognitive impairments). Our multilevel linear regression analyses examined whether national public health spending and healthcare access resources explained cross-country differences in wealth inequalities in physical and cognitive impairments. We applied a concentration index to quantify the degree of wealth inequalities in impairments. The findings indicate that inequalities in both impairment outcomes favored wealthier individuals in all countries, but the magnitude of inequality varied by country. Furthermore, a higher share of public health spending, lower out-of-pocket expenditure, and higher investment in healthcare resources were associated with lower wealth inequalities, especially for physical impairments. Our findings suggest that different health interventions and policies may be needed to mitigate specific impairment inequalities.

Deaths during the first year of the COVID-19 pandemic: insights from regional patterns in Germany and Poland.

BACKGROUND: Given the nature of the spread of SARS-CoV-2, strong regional patterns in the fatal consequences of the COVID-19 pandemic related to local characteristics such as population and health care infrastructures were to be expected. In this paper we conduct a detailed examination of the spatial correlation of deaths in the first year of the pandemic in two neighbouring countries - Germany and Poland, which, among high income countries, seem particularly different in terms of the death toll associated with the COVID-19 pandemic. The analysis aims to yield evidence that spatial patterns of mortality can provide important clues as to the reasons behind significant differences in the consequences of the COVID-19 pandemic in these two countries. METHODS: Based on official health and population statistics on the level of counties, we explore the spatial nature of mortality in 2020 in the two countries - which, as we show, reflects important contextual differences. We investigate three different measures of deaths: the officially recorded COVID-19 deaths, the total values of excessive deaths and the difference between the two. We link them to important pre-pandemic regional characteristics such as population, health care and economic conditions in multivariate spatial autoregressive models. From the point of view of pandemic related fatalities we stress the distinction between direct and indirect consequences of COVID-19, separating the latter further into two types, the spatial nature of which is likely to differ. RESULTS: The COVID-19 pandemic led to much more excess deaths in Poland than in Germany. Detailed spatial analysis of deaths at the regional level shows a consistent pattern of deaths officially registered as related to COVID-19. For excess deaths, however, we find strong spatial correlation in Germany but little such evidence in Poland. CONCLUSIONS: In contrast to Germany, for Poland we do not observe the expected spatial pattern of total excess deaths and the excess deaths over and above the official COVID-19 deaths. This difference cannot be explained by pre-pandemic regional factors such as economic and population structures or by healthcare infrastructure. The findings point to the need for alternative explanations related to the Polish policy reaction to the pandemic and failures in the areas of healthcare and public health, which resulted in a massive loss of life.

Worries about inadequate medical treatment in case of a COVID-19 infection: the role of social inequalities, COVID-19 prevalence and healthcare infrastructure.

BACKGROUND: This study investigates individual and regional determinants of worries about inadequate medical treatment in case of a COVID-19 infection, an important indicator of mental wellbeing in pandemic times as it potentially affects the compliance with mitigation measures and the willingness to get vaccinated. The analyses shed light on the following questions: Are there social inequalities in worries about inadequate medical treatment in case of a COVID-19 infection? What is the role of the regional spread of COVID-19 infections and regional healthcare capacities? METHODS: Based on data derived from the German Socioeconomic Panel (SOEP), a representative sample of the German population aged 18 years and over, we estimated multilevel logistic regression models with individual-level (level 1) and regional-level (level 2) variables. The regional variables of interest were (a) the number of COVID-19 infections, (b) the number of hospital beds as an overall measure of the regional healthcare capacities, and (c) the number of free intensive care units as a measure of the actual capacities for treating patients with severe courses of COVID-19. RESULTS: Women, older respondents, persons with migrant background and those with a lower socioeconomic status were more likely to report worries about inadequate medical treatment in case of a COVID-19 infection. Moreover, respondents with chronic illness, lower subjective health and those who consider COVID-19 as a threat for their own health were more likely to report worries. In addition, also regional characteristics were relevant. Worries were more common in poorer regions with higher COVID-19 infections and worse health infrastructure as indicated by the number of hospital beds. CONCLUSIONS: The analysis not only indicates that several social groups are more concerned about inadequate medical treatment in case of a COVID-19 infection, but also highlights the need for considering regional-level influences, such as the spread of the virus, poverty rates and healthcare infrastructure, when analyzing the social and health-related consequences of the pandemic.

Socioeconomic inequalities in the wellbeing of informal caregivers across Europe.

OBJECTIVES: Due to increasing care needs and decreasing care potentials, research around informal caregiving gains attention. Relatively new - but of utmost importance - is the role of socioeconomic inequalities in care and wellbeing. Although caregiving can be rewarding, a growing body of research shows that informal caregiving often has negative consequences for individuals' wellbeing. Theoretically, we expect these negative outcomes to be more pronounced among caregivers with lower socioeconomic resources. The current study examines socioeconomic inequalities in the consequences of caregiving inside the household for life satisfaction. METHODS: We draw on longitudinal data from the Survey of Health, Ageing, and Retirement in Europe (SHARE waves 2, 4, 5, and 6). We estimated pooled ordinary least squares and fixed-effects regression models to examine the consequences of informal care provision within the household for individuals' life satisfaction, and whether household wealth moderates this relationship, controlling for individuals' sociodemographic and health characteristics. RESULTS: Care provision inside the household was negatively associated with older adults' life satisfaction. The longitudinal analyses accordingly show that the uptake of care led to declines in life satisfaction. Differentiating by socioeconomic background, we find that caregivers with higher socioeconomic resources in terms of wealth generally experienced higher life satisfaction. Our longitudinal analyses on wellbeing declines reveal, however, that these mechanisms did not significantly differ by socioeconomic status of the caregiver. DISCUSSION: Our findings suggest the need for increased investments in support services for informal caregivers to mitigate caregiving burdens, irrespective of socioeconomic status, and enhance later life wellbeing.

Partner Care Arrangements and Well-Being in Mid- and Later Life: The Role of Gender Across Care Contexts.

OBJECTIVES: We assess gender moderation in the association between partner care arrangements and individuals' well-being, and the extent to which gender differences vary across European care contexts. METHODS: We use 2015 data from the Survey of Health, Ageing and Retirement in Europe for 3,465 couples aged 50+, where at least 1 partner receives care. We assess gender differences in individuals' life satisfaction and depressive symptoms across 5 partner care arrangements: solo-; shared formal; shared informal; outsourced formal; and outsourced informal care. We explore heterogeneity in the gendered associations across 4 care contexts: Northern, Western, Southern, and Eastern Europe. RESULTS: Sharing care with formal providers is associated with lower well-being among women than men, with a significant well-being "penalty" among Southern European women with partners in shared formal care. Outsourcing partner care to informal providers is associated with higher well-being than other care arrangements for men across care contexts, but with lower well-being for women in Southern Europe. DISCUSSION: Policies to support caregivers' well-being need to be sensitive to the coordination of formal and informal caregiving support for men and women in their respective care contexts.

[Changes in well-being and private support for older people: a closer look at the impact of the COVID-19 pandemic in early summer 2020]. / Veränderungen von Wohlbefinden und privater Unterstützung für Ältere: ein Blick auf die Auswirkungen der COVID-19-Pandemie im Frühsommer 2020.

BACKGROUND: The pilot study "Health and Support in Times of Corona" (TU Dortmund University) collected data on support and well-being of individuals aged 40 plus years in the light of the first wave of the COVID-19 pandemic from May to July 2020. OBJECTIVE: The aim was to study the social and mental effects of the pandemic. We focused on individuals living in private households aged 40 years and older. Participants were asked about pandemic-related changes in receiving and providing support (e.g. personal care, help with household chores), problems arising in taking care of older persons and changes in well-being. MATERIAL AND METHODS: We conducted descriptive and multivariate analyses to show how support changed, problems with support came up and well-being changed in the light of the pandemic and how all this was related. RESULTS: Due to the pandemic older respondents in particular were no longer able to provide the necessary support for others. Especially women reported problems in taking care of older individuals. We found a decrease in well-being for all respondents but most significantly for women and individuals aged 80 years and older. Moreover, problems in the provision of care due to the pandemic and lower well-being were clearly linked. CONCLUSION: Our study showed significant changes in support patterns and well-being due to the COVID-19 pandemic. A substantial part of the respondents reported more loneliness and lower life satisfaction compared to before the pandemic, especially women supporting others. In these pandemic times, informal caregiving is severely hampered. Future pandemic-related measures should be carefully planned bearing such issues in mind.

Diverging ideas of health? Comparing the basis of health ratings across gender, age, and country.

BACKGROUND: Self-rated health (SRH) is arguably the most widely used generic health measurement in survey research. However, SRH remains a black box for researchers. In our paper, we want to gain a better understanding of SRH by identifying its determinants, quantifying the contribution of different health domains to explain SRH, and by exploring the moderating role of gender, age groups, and the country of residence. METHOD: Using data from 61,365 participants of the fifth wave (2013) of the Survey of Health, Ageing and Retirement in Europe (SHARE) living in fifteen European countries, we explain SRH via linear regression models. The independent variables are grouped into five health domains: functioning, diseases, pain, mental health, and behavior. Via dominance analysis, we focus on their individual contribution to explaining SRH and compare these contributions across gender, three age groups, and fifteen European countries. RESULTS: Our model explains SRH rather well (R2 = .51 for females/.48 for males) with functioning contributing most to the appraisal (.20/.18). Diseases were the second most relevant health dimension (.14/.16) followed by pain (.08/.07) and mental health (.07/.06). Health behavior (.02/.01) was less relevant for health ratings. This ranking held true for almost all countries with only little variance overall. A comparison of age groups indicated that the contribution of diseases and behavior to SRH decreased over the life-course while the contribution of functioning to R2 increased. CONCLUSION: Our paper demonstrates that SRH is largely based on diverse health information with functioning and diseases being most important. However, there is still room for idiosyncrasies or even bias.

Gendered patterns of depression and its determinants in older Europeans.

BACKGROUND: Few studies consider multiple pathways for explaining the gendered patterns of depression in Europe's aged population, although ageing is often associated with an increased exposure to risk factors for depression, and the relevance of these risk factors is likely to differ between countries. METHODS: Based on the Survey of Health, Ageing and Retirement in Europe (SHARE), we assess the relevance of gender inequalities in the exposure to psychosocial, socio-economic, and health-related factors for explaining the gender gap in depression. Further, we investigate the association between depressive symptoms and these explanatory variables by gender and analyse whether their relevance differs between countries. RESULTS: Both the prevalence of depression by gender and the magnitude of the gender gap were low in Northern Europe and rather high in Southern Europe. Part of the gender gap was explained by psychosocial, socio-economic, and health-related factors but significant gender differences remained. Health-related factors were of outstanding importance for explaining within-country variation in depressive symptoms for both women and men. With regard to psychosocial and socio-economic factors, the results were less clear. CONCLUSION: The assessment of gender inequalities in depression and their determinants within different social policy contexts enables evidence-based interventions to reduce the gender gap and ensure high quality of life for older men and women. To that end, the reduction of health-related risk factors seems to be of utmost importance in all European countries, whereas interventions in the area of socio-economic and psychosocial risk factors should be gender- and context-specific.

Long-term Care Provision and the Well-Being of Spousal Caregivers: An Analysis of 138 European Regions.

Objectives: The individual burden of caring for one's relatives not only depends on care characteristics but is also related to contextual factors. The objective of this study is to determine whether regional formal long-term care provision is linked to the well-being of spousal caregivers introducing the concept of "control" as central pathway to explain this link. Method: We applied multilevel analysis using data from the Survey of Health, Ageing and Retirement in Europe (SHARE) from over 29,000 Europeans and 1,800 spousal caregivers located in 138 regions in 11 countries to analyze the effects of regional contexts on caregiver well-being. The provision of formal care in a region was measured by the number of long-term care beds in nursing and residential homes among the older population. Results: We found that spousal caregivers' well-being, measured in terms of life satisfaction, loneliness, and depression, was positively linked to the regional availability of formal care, which is partly due to higher perceived control in regions with more formal care provision. Discussion: Our results suggest that formal care supply is essential not only for care recipients but also for caregivers: perceived alternatives to the private care arrangement go along with greater well-being of informal caregivers.

[Gerontological research in social and behavioral sciences in Germany since 1968 : Review, critical assessment and perspectives]. / Gerontologische Forschung im Bereich der Sozial- und Verhaltenswissenschaften in Deutschland seit 1968 : Rückblick, kritische Würdigung und Perspektiven.

This article addresses the development of German social and behavioral aging research during the last 50 years based on four propositions: (a) the development and unfolding of social and behavioral aging research in the 1960s and 1970s was tedious. (b) During the 1980s and 1990s the significance of social and behavioral aging research grew considerably. (c) The last 20 years brought increasing and strong recognition of social and behavioral aging research. (d) Currently, social and behavioral aging research in Germany follows high and internationally established standards, and findings are published in internationally recognized journals. In a resume and outlook the structural aspects, future research topics, funding dynamics, and issues of the application of social and behavioral aging science are discussed.

Health effects of informal caregiving across Europe: A longitudinal approach.

Due to an expected increase of people in need of care, sound knowledge about health effects of informal care provision is becoming more and more important. Theoretically, there might be positive as well as negative health effects due to caregiving to relatives. Moreover, we suppose that such health effects differ by national context - since care is differently organized in Europe - and depend on the social setting in which the care relationship takes place. Using data from the Survey of Health, Ageing and Retirement (SHARE, waves 1, 2, 3, and 5) and from the English Longitudinal Study of Ageing (ELSA, waves 2-5) we examined the connection between informal caregiving and self-perceived as well as mental health in a country comparative perspective. Taking advantage of the longitudinal structure of the data, pooled ordinary least squares (OLS) and fixed-effects models (FEM) were estimated. Our results show distinct differences in the relationship between reported health and the provision of informal care depending on whether individuals give care to someone inside or outside the household. Caregivers inside the household reported worse health, caregivers from outside the household reported better health than non-caregivers. We find that this correlation is largely due to selection into caregiving: people in worse health took up care inside while people in better health took up care outside the household. However, in most countries people who started caregiving inside the household experienced a decline in their mental health. This suggests that caregiving inside the household results in psychological stress irrespective of the type of welfare state. The results regarding self-perceived health and caregiving outside the household are less distinct. All in all our results show that health consequences of caregiving vary not only between different welfare regimes but also between countries of similar welfare state types.

Data Resource Profile: the Survey of Health, Ageing and Retirement in Europe (SHARE).

SHARE is a unique panel database of micro data on health, socio-economic status and social and family networks covering most of the European Union and Israel. To date, SHARE has collected three panel waves (2004, 2006, 2010) of current living circumstances and retrospective life histories (2008, SHARELIFE); 6 additional waves are planned until 2024. The more than 150 000 interviews give a broad picture of life after the age of 50 years, measuring physical and mental health, economic and non-economic activities, income and wealth, transfers of time and money within and outside the family as well as life satisfaction and well-being. The data are available to the scientific community free of charge at www.share-project.org after registration. SHARE is harmonized with the US Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA) and has become a role model for several ageing surveys worldwide. SHARE's scientific power is based on its panel design that grasps the dynamic character of the ageing process, its multidisciplinary approach that delivers the full picture of individual and societal ageing, and its cross-nationally ex-ante harmonized design that permits international comparisons of health, economic and social outcomes in Europe and the USA.

SHARELIFE-One century of life histories in Europe.

Welfare state interventions shape our life courses in almost all of their multiply linked domains. In this introduction, we sketch how cross-nationally comparative retrospective data can be fruitfully employed to better understand these links and the long-run effects of the welfare state at the same time. We briefly introduce SHARE, the Survey of Health, Ageing and Retirement in Europe, and SHARELIFE, which collected 30,000 life histories of SHARE respondents from 14 European countries, providing a unique data infrastructure for interdisciplinary research on the various influences of contextual structures on the lives of Europeans during the last century until today. The eight studies in this special issue show that the multidisciplinary cross national approach of SHARELIFE allows a much more detailed understanding of life histories in Europe than was possible before.

Tracing the origins of successful aging: the role of childhood conditions and social inequality in explaining later life health.

This study investigates the role of childhood conditions and social inequality in older Europeans' propensity to age successfully, controlling for later life risk factors. Successful aging was assessed following Rowe and Kahn's conceptualization, using baseline interviews from the first two waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). These data were merged with retrospective information on participants from 13 Continental European countries, collected as part of the SHARELIFE project. Our sample consists of 22,464 men and women, who are representative of the non-institutionalized population aged 50 or older (mean age: 63.3) in their respective country. Estimating multilevel logistic models, we controlled for demographics (age, sex), childhood conditions (SES, health, cognition), later life risk factors (various dimensions of SES and health behaviors), as well as social inequality (measured by country-specific Gini coefficients). There is an independent association of childhood living conditions with elders' odds of aging well. Higher parental SES, better math and reading skills, as well as self-reports of good childhood health were positively associated with successful aging, even if contemporary characteristics were controlled for. Later life SES and health behaviors exhibited the expected correlations with our dependent variable. Moreover, lower levels of income inequality were associated with a greater probability of meeting Rowe and Kahn's successful aging criteria. We conclude that unfavorable childhood conditions exhibit a harmful influence on individuals' chances to age well across all European welfare states considered in this study. Policy interventions should thus aim at improving the conditions for successful aging throughout the entire life course.

Gendered support to older parents: do welfare states matter?

The aim of this study is to examine the association of welfare state policies and the gendered organisation of intergenerational support (instrumental help and personal care) to older parents. The study distinguishes between support to older parents provided at least weekly, i.e. time-intensive and often burdening support, and supplemental sporadic support. Three policy instruments were expected to be associated with daughters' and sons' support or gender inequality in intergenerational support respectively: (1) professional social services, (2) cash-for-care payments and (3) legal obligations to provide or co-finance care for parents. The analyses based on the Survey of Health, Ageing and Retirement in Europe showed that daughters provided somewhat more sporadic and much more intensive support than sons throughout Europe. While about half of all children who sporadically supported a parent were men, this applied to only one out of four children who provided intensive support. Logistic multilevel models revealed that legal obligations were positively associated with daughters' likelihood of giving intensive support to parents but did not affect the likelihood of sons doing so. Legal obligations thus stimulate support in a gender-specific way. Both legal obligations and cash-for-care schemes were also accompanied by a more unequal distribution of involvement in intensive support at the expense of women. Social services, in contrast, were linked to a lower involvement of daughters in intensive support. In sum, the results suggest that welfare states can both preserve or reduce gender inequality in intergenerational support depending on specific arrangements.

Erratum to: Gendered support to older parents: do welfare states matter?

[This corrects the article DOI: 10.1007/s10433-011-0197-1.].

[Reciprocity between adult generations: family transfers over the life course]. / Reziprozität zwischen erwachsenen Generationen: Familiale Transfers im Lebenslauf.

Intergenerational relations are characterised by reciprocal transfers and solidarity over the shared life span. Children care for their elderly parents, and parents support their adult children financially, for example, during their education or when they start their own household and family. From a life course-perspective, we analysed mutual transfers between parents and their adult children: Are transfers balanced over the life course and family-stages? Do we find patterns of direct or indirect reciprocity? Which factors facilitate exchange, and which do not? Using multinomial multilevel regression analyses based on the Survey of Health, Ageing and Retirement in Europe (SHARE) we trace transfers of time and money between parents and adult children back to opportunity, need and family structures. Remaining differences between European countries are explained by cultural contextual structures, here: family expenditures. The exchange between generations is reciprocal, but not necessarily balanced in various phases of family life.