20-Year trends in the social participation of the oldest old.

AIMS: To investigate 20-year trends in social participation among the oldest old (77+ years) in Sweden and assess the extent to which changes in educational attainment and functional abilities explain these trends. METHODS: Seven waves of the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) spanning 2002-2021 were used with a repeated cross-sectional design. To analyse the association between time and social participation we employed the Karlson-Holm-Breen method of decomposition. The study focused on informal social participation (contact with friends and family), leisure participation (public or semi-public gatherings), and formal participation (organisational engagement and study circle attendance). RESULTS: Both leisure and informal participation peaked in 2014 and declined in 2021, influenced by the COVID-19 pandemic, whereas formal participation showed a slight increase in 2021. Total participation increased at least until 2011. Overall, older adults have increased their levels of social participation in recent decades, disregarding the influence of the pandemic. Decomposition analysis revealed that population-level changes in educational attainment and functional abilities explained a substantial portion of the observed trends. CONCLUSIONS: As the proportion of older adults continues to rise, it becomes increasingly important to understand the developments and drivers of behavioural change in the older population. As more people are socially active, there may be increasing differences between those participating and those not - which could lead to increased inequalities. The observed trend in increasing participation, influenced by changes in education and health, emphasises the importance of fostering age-friendly environments and addressing potential social inequalities among older adults.

Does losing family members in midlife matter for late-life mental and cognitive health? A longitudinal study of older Swedes spanning 30 years.

OBJECTIVES: Mental and cognitive health is crucial to ensure well-being in older age. However, prolonged periods of stress, grief, and bereavement might compromise mental health balance, leading to profound changes. This study investigated the sex-stratified associations between midlife bereavement experiences (e.g. sibling loss, spousal loss, and multiple losses) and late-life depression (LLD) and cognitive impairment. METHOD: Linked data from the Swedish Level-of-Living Survey and the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) were used. Multiple logistic regressions were performed to examine the associations between midlife bereavement and LLD (n = 1078) and cognitive impairment (n = 995), separately. RESULTS: Sibling loss and multiple losses in midlife were associated with lower odds of LLD, especially among women. Among men, sibling loss in midlife was associated with lower odds of cognitive impairment, while the experience of two losses among women suggested an increased (but non-significant) risk of cognitive impairment. Interaction analyses did not show significant effects between bereavement and gender on LLD and cognitive impairment. CONCLUSION: Midlife bereavement might have gendered implications on LLD and cognitive impairment, but associations need to be confirmed by well-powered studies. Further research is warranted to elucidate the association between multiple midlife losses and reduced LLD risk.

Increasing inequalities in disability-free life expectancy among older adults in Sweden 2002-2014.

BACKGROUND: In an aging society with increasing old age life expectancy, it has become increasingly important to monitor the health development in the population. This paper combines information on mortality and disability and explores educational inequalities in disability-free life expectancy in the aging population in Sweden, and to what extent these inequalities have increased or decreased over time. METHODS: A random sample of the Swedish population aged 77 years and above (n=2895) provided information about disability in the population in the years 2002, 2004, 2011 and 2014. The prevalence of disability was assessed by five items of personal activities of daily living and incorporated in period life tables for the corresponding years, using the Sullivan method. The analyses were stratified by sex and educational attainment. Estimates at ages 77 and 85 years are presented. RESULTS: Disability-free life expectancy at age 77 years increased more than total life expectancy for all except men with lower education. Women with higher education had a 2.7-year increase and women with lower education a 1.6-year increase. The corresponding numbers for men were 2.0 and 0.8 years. The educational gap in disability-free life expectancy increased by 1.2 years at age 77 years for both men and women. CONCLUSIONS: While most of the increase in life expectancy was years free from disability, men with lower education had an increase of years with disability. The educational differences prevailed and increased over the period as the gains in disability-free life expectancy were smaller among those with lower education.

Impact of the COVID-19 pandemic on Swedish adults aged 77 years and older: Age differences in lifestyle changes.

AIMS: This study aimed to describe the impact of the COVID-19 pandemic on lifestyle and social activities among older adults in Sweden, with a special focus on differences between the 'younger old' (aged 77-84) and 'older old' (aged 85-109). METHODS: This study is based on a nationally representative sample of older adults (aged ⩾77 years) in Sweden (SWEOLD). Data were collected between May 2021 and April 2022, when many recommendations were removed but the virus was still classified as a public health disease. We studied occurrences and differences between the two age groups in several lifestyle factors and social activities. RESULTS: The younger old displayed larger changes in lifestyles because of the pandemic than the older old. Most changes were found in social interactions with family. CONCLUSIONS: Our results highlight the large heterogeneity within the Swedish population aged ⩾77 years, and that the younger old experienced a bigger lifestyle change than the older old. Previous activity levels might be important to consider in order to understand how regulations may affect the older population. Finally, our findings indicate large age differences in Internet use, which require attention to prevent digital exclusion of an already vulnerable group.

Is the mental health of older adults receiving care from their children related to their children's dual burden of caregiving and work stress? A linked lives perspective.

OBJECTIVES: Mental health problems are a major concern in the older population in Sweden, as is the growing number of older adults aging alone in their homes and in need of informal care. Using a linked lives perspective, this study explored if older parents' mental health is related to their children's dual burden of informal caregiving and job strain. METHODS: Data from a nationally representative Swedish survey, SWEOLD, were used. Mental health problems in older age (mean age 88) were measured with self-reported 'mild' or 'severe' anxiety and depressive symptoms. A primary caregiving adult child was linked to each older parent, and this child's occupation was matched with a job exposure matrix to assess job strain. Logistic regression analyses were conducted with an analytic sample of 334. RESULTS: After adjusting for covariates, caregiving children's lower job control and greater job strain were each associated with mental health problems in their older parents (OR 2.52, p = 0.008 and OR 2.56, p = 0.044, respectively). No association was found between caregiving children's job demands and their older parents' mental health (OR 1.08, p = 0.799). CONCLUSION: In line with the linked lives perspective, results highlight that the work-life balance of informal caregiving adult children may play a role in their older parent's mental health.

Association between psychosocial working conditions in mid-life and leisure activity in old age.

Aims: Leisure activity helps people engage with life, and it promotes health and well-being as we age. This study investigated whether individuals with active jobs (high psychological demands, high control) in mid-life were more active during leisure time in old age compared with those with less active jobs. Methods: Two individually linked Swedish surveys were used (N=776) with 23 years of follow-up. Data were analysed with logistic regression. Results: Having an active job in mid-life was associated with greater engagement in intellectual/cultural, social and physical activity in old age, even when leisure activity in mid-life was taken into account. Conclusions: The results suggest that active jobs in mid-life may be replaced by active leisure during retirement. Active job conditions may promote engagement in society in old age, which in turn may have positive health consequences.

Stable or improved health status in the population 65 years and older in Stockholm, Sweden - an 8-year follow-up of self-reported health items.

BACKGROUND: Previous studies have reached different conclusions about whether health is improving in the ageing population. More studies with narrow age groups analyzed separately for men and women will contribute to the literature. AIM: To describe trends in self-reported indicators of health and health-related quality of life between 2002 and 2010, focusing on differences between gender and age groups. A population-based survey of individuals 65+ in the Stockholm County was used. RESULTS: Prevalence of health problems increased with age both among men and women. Men generally reported having no health problems to a larger extent than women, but the proportions reporting severe problems were similar. The larger picture is one of stability in health-related quality of life, even if several items developed for the better, especially among women. While the proportions reporting no health/functional problems increased for many items, the proportions reporting severe problems remained unchanged among men and improved only for two items among women. CONCLUSIONS OVERALL, IMPROVEMENTS WERE SEEN IN MANY OF THE HEALTH-RELATED QUALITY OF LIFE ITEMS AS WELL AS FOR SELF-RATED HEALTH AMONG WOMEN THE PROPORTIONS REPORTING LONG-TERM ILLNESS OR PERSISTENT HEALTH PROBLEMS INCREASED, BUT FEWER SEEM TO BE LIMITED IN THEIR DAILY ACTIVITIES BY THESE PROBLEMS THE STABLE PROPORTIONS OF POOR SELF-RATED HEALTH INDICATES THAT WHILE HEALTH AND FUNCTIONING SEEM TO BE IMPROVING FOR THE MAJORITY OF THE OLDER POPULATION, SOME GROUPS MAY BE LAGGING BEHIND FUTURE STUDIES SHOULD PAY ATTENTION TO CHANGES BOTH IN THE UPPER AND LOWER ENDS OF THE HEALTH SPECTRUM.

Trends in health expectancies among the oldest old in Sweden, 1992-2011.

BACKGROUND: Information on the extent to which older people's increasing life expectancy is characterized by good or poor health is important for policy and fiscal planning. This study explores trends in health expectancies among the oldest old in Sweden from 1992 to 2011. METHODS: Cross-sectional health expectancy estimates at age 77 were obtained for 1992, 2002, 2004 and 2011 by Sullivan's method. Health expectancy was assessed by severe disability, mild disability and mobility problems. Changes in health expectancies were decomposed into the contributions attributed to changes of mortality rates, and changes in disability and mobility prevalence. Mortality data were obtained from Statistics Sweden and prevalence data from two nationally representative surveys, the Swedish Panel Study of Living Conditions of the Oldest Old and the Survey of Health, Ageing and Retirement in Europe. RESULTS: Years free from severe disability, mild disability and mobility problems increased in both men and women. Decomposition analysis indicates that the increase was mainly driven by the change in health status rather than change in mortality. In relation to total life expectancy, the general patterns suggest that women had a compression of health problems and men an expansion. CONCLUSION: Men's life expectancy increased more than women's; however, the increased life expectancy among men was mainly characterized by disability and mobility problems. The results suggest that the gender gap in health expectancy is decreasing.

Do postal health surveys capture morbidity and mortality in respondents aged 65 years and older? A register-based validation study.

AIMS: Non-response to population surveys is a common problem in epidemiological and public health research. Systematic non-response threatens the validity of results. Researchers rarely evaluate the magnitude of systematic non-response because of limited access to population data. This study explores how well morbidity and mortality in postal survey respondents aged 65 years and older represented that of the target population. METHODS: The 2010 Stockholm Public Health Survey and the Swedish Population Register were linked to the Cause of Death Register and the National Patient Register in Sweden. Differences were analysed between the response group and the corresponding population in mortality, hospital admission, days spent in hospital and number of diagnoses. Finally, data were weighted for non-response to see if this improved generalizability. RESULTS: Non-response increased with age, and this increase was more pronounced among women than men. Respondents were marginally less often admitted to hospital, hospitalized fewer days and had slightly fewer diagnoses than the population, in particular after age 80. Significantly fewer women died in the response group than in the population as a whole. In terms of mortality among men and in terms of hospitalizations for most age groups, the respondents represented the population fairly well. Non-response weighting adjustment did not improve generalizability. CONCLUSIONS: Postal questionnaires are likely to capture morbidity (hospitalization) among women and men aged 65-80 years old and mortality among men, while morbidity after age 80 and mortality in women are likely to be underestimated.

Smoking trajectories from midlife to old age and the development of non-life-threatening health problems: a 34-year prospective cohort study.

OBJECTIVE: To examine how trajectories of smoking observed over a 34-year period, were associated with the progression of mobility impairment, musculoskeletal pain, and symptoms of psychological distress from midlife to old age. METHOD: The Swedish Level of Living Survey (LNU) and the Swedish Panel Study of the Oldest Old (SWEOLD) were merged to create a nationally representative longitudinal sample of Swedish adults (aged 30-50 at baseline; n=1060), with four observation periods, from 1968 through 2002. Five discrete smoking trajectory groups were treated as predictors of variation in health trajectories using multilevel regression. RESULTS: At baseline, there were no differences in mobility impairment between smoking trajectory groups. Over time all smokers, particularly persistent and former heavy smokers, exhibited faster increases in mobility problems compared with persistent non-smokers. Additionally, all smoking groups reported more pain symptoms than the non-smokers, at baseline and over time, but most of these differences did not reach statistical significance. Persistent heavy smokers reported elevated levels of psychological distress at baseline and over time. CONCLUSION: Smokers, and even some former smokers, who survive into old age appear to be at increased risk for non-life-threatening conditions that can diminish quality of life and increase demands for services.

Trajectories of social activities from middle age to old age and late-life disability: a 36-year follow-up.

OBJECTIVES: to examine the association between 34-year trajectories of social activity, from middle age to old age and late-life disability. METHODS: data from the Swedish Level of Living Survey (LNU) and the Swedish Panel Study of the Oldest Old (SWEOLD) were used. LNU data from 1968, 1981, 1991 and 2000 were merged with SWEOLD data from 1992, 2002 and 2004 to create a longitudinal data set with five observation periods. Trajectories of social activities covered 1968-2002, and late-life disability was measured in 2004. The sample consisted of 729 individuals aged 33-61 at baseline (1968), who participated in at least four observation periods and who were free from mobility limitations at baseline. Four trajectories of social activity were identified and used as predictors of late-life disability. RESULTS: reporting low/medium levels of social activity from mid-life to old age was the most common trajectory group. Persons reporting continuously low/medium or decreasing levels of social activity had higher odds ratios for late-life disability (OR = 2.33 and OR = 2.15, respectively) compared with those having continuously high levels of activity, even when adjusting for age, sex and mobility limitations, and excluding persons with baseline mobility limitations. CONCLUSIONS: results suggest that the disability risk associated with social activities is related to recent levels of activity, but also that risk may accumulate over time, as indicated by the higher disability risk associated with the continuously low/medium level social activity trajectory.

Paying the price? The impact of smoking and obesity on health inequalities in later life.

AIMS: The aims of the study are twofold: (i) to explore the impact of socioeconomic position, as measured 13 years earlier, on cognitive functioning and mobility impairment in later life, and (ii) to explore the extent to which obesity and smoking status can explain socioeconomic inequalities in cognitive and mobility impairments in later life. METHODS: Data from a nationally representative sample of Swedish adults aged 56-76 in 1991 who were re-interviewed 13 years later in 2004, was analysed to explore the impact of socioeconomic position, smoking, and obesity on cognitive and physical functioning in late life. RESULTS: The results showed that both smoking and obesity in late mid-life were stratified by socioeconomic position. Moreover, the results showed significant associations between socioeconomic position and both cognitive and physical functioning in later life. However, these inequalities in late life function could only partially be explained by the socioeconomic differences in smoking and obesity. CONCLUSIONS: The findings of this study suggest that socioeconomic differences in the rates of smoking and obesity may explain some, but not all, of the socioeconomic inequalities in physical and cognitive functioning during old age.

A prospective cohort study of health behavior profiles after age 50 and mortality risk.

BACKGROUND: This study examines the mortality risk associated with distinct combinations of multiple risk behaviors in middle-aged and older adults, and assesses whether the mortality risks of certain health behaviors are moderated by the presence of other risk behaviors. METHODS: Data for this prospective cohort study are from the Health and Retirement Study (HRS), a nationwide sample of adults older than 50 years. Baseline data are from respondents (n = 19,662) to the 1998 wave of the HRS. Twelve distinct health behavior profiles were created, based on each respondent's smoking, physical activity, and alcohol use status in 1998. Mortality risk was estimated through 2008 using Cox regression. RESULTS: Smoking was associated with elevated risk for mortality within all behavioral profiles, but risk was greatest when combined with heavy drinking, both for middle-aged (ages 51-65) and older (ages 66+) adults. Profiles that included physical inactivity were also associated with increased mortality risk in both age groups. However, the impact of inactivity was clearly evident only among non-smokers; among smokers, the risk of inactivity was less evident, and seemingly overshadowed by the risk of smoking. Moderate drinking was protective relative to abstinence among non-smokers, and relative to heavy drinking among smokers. CONCLUSIONS: In both middle-aged and older adults, multiple unhealthy behaviors increase mortality risk. However, the level of risk varies across unique combinations of unhealthy behaviors. These findings highlight the role that lifestyle improvements could play in promoting healthy aging, and provide insight into which behavioral combinations should receive top priority for intervention.

Part-time work and health in late careers: Evidence from a longitudinal and cross-national study.

In this exploratory study, we examine how older workers' part-time employment and health are associated in four countries promoting this type of employment in late careers but with a different welfare regime: the United States, Germany, Sweden, and Italy. Using data from two large representative panel surveys and conducting multichannel sequence analysis, we identified the most typical interlocked employment and health trajectories for each welfare regime and for three different age groups of women and men. We found that there is more heterogeneity in these trajectories in countries with a liberal welfare regime and among older age groups. Overall, women are more strongly represented in the part-time employment trajectories associated with lower health levels. In countries with a social-democratic or corporatist welfare regime, part-time employment in late careers tends to be associated with good health. Our findings suggest that the combination of a statutory right to work part-time in late careers with a more generous welfare regimes, may simultaneously maintain workers' health and motivate them to remain active in the labor force.

Physical functioning as a predictor of retirement: Has its importance changed over a thirty-year period in Sweden?

Many countries, including Sweden, are implementing policies aimed at delaying retirement and encouraging older workers to remain on the labour market for longer. During recent decades, there have been several major reforms to the pension and social security systems in Sweden. Moreover, the nature of occupations has shifted towards more non-manual and sedentary activities, older women are today almost as active in the labour market as men in Sweden, and physical functioning has improved over time. In this study, we investigate whether the importance of physical functioning as a predictor for retirement has changed over time, for women and men, respectively. We used four waves of nationally representative data from The Swedish Level of Living Survey from 1981, 1991, 2000, and 2010, together with income register data. We found that greater severity of musculoskeletal pain and mobility limitations increased the likelihood of retirement in all waves. Results from logistic regression models with average marginal effects and predictive margins showed that there is a trend towards physical functioning becoming less important for retirement towards the end of the study period, especially for women, when controlling for occupational-based social class, age, adverse physical working conditions, and job demands. People, especially women, reporting impaired physical functioning did not retire to the same extent as in previous decades. This indicates that people stayed longer in the labour market despite impaired physical functioning, which may have repercussions on well-being and quality of life. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-022-00725-y.

Heavy alcohol consumption before and after negative life events in late mid-life: longitudinal latent trajectory analyses.

BACKGROUND: People who experience negative life events report more heavy alcohol consumption compared with people without these experiences, but little is known about patterns of change within this group. This study aims to identify trajectories of heavy alcohol consumption before and after experiencing either divorce, or severe illness or death in the family. Furthermore, the aim is to examine characteristics of individuals belonging to each trajectory. METHODS: Longitudinal study of public sector employees from the Finnish Retirement and Aging Study with up to 5 years of annual follow-ups (n=6783; eligible sample n=1393). Divorce and severe illness or death in the family represented negative life events. Heavy alcohol consumption was categorised as >14 units/week. RESULTS: Based on latent trajectory analysis, three trajectories of heavy drinking were identified both for divorce and for severe illness or death in the family: 'No heavy drinking' (82% illness/death, 75% divorce), 'Constant heavy drinking' (10% illness/death, 13% divorce) and 'Decreasing heavy drinking' (7% illness/death, 12% divorce). Constant heavy drinkers surrounding illness or death in the family were more likely to be men, report depression and anxiety and to smoke than those with no heavy drinking. Constant heavy drinkers surrounding divorce were also more likely to be men and to report depression compared with those with no heavy drinking. CONCLUSIONS: Most older workers who experience divorce or severe illness or death in the family have stable drinking patterns regarding heavy alcohol consumption, that is, most do not initiate or stop heavy drinking.

How to Measure Retirement Age? A Comparison of Survey and Register Data.

Due to an increasing heterogeneity in retirement transitions, the measurement of retirement age constitutes a major challenge for researchers and policymakers. In order to better understand the concept of retirement age, we compare a series of measures for retirement age assessed on the basis of survey and register data. We use data from Sweden, where flexible retirement schemes are implemented and register data are available. We link survey data from the Swedish Level of Living Survey with register data from the Swedish Longitudinal Integration Database for Health Insurance and Labour Market Studies. We create four measures of retirement age based on these datasets, applying approaches that have been used in previous literature. We analyse the means and distributions of these measures and evaluate the correlations between them. Finally, we regress common predictors of retirement age such as gender or education on the four measures of retirement age to examine potential differences in size, direction and statistical significance of the associations. We find that the survey measure of retirement age resembles the following two ways of defining retirement age in the register data: first, the age at which people receive more than half their income from old-age or disability pension and, second, the age at which they were not gainfully employed for at least 2 years. This insight gives us a better understanding of when in the retirement transition process, individuals identify with retirement. Moreover, it provides decision support for researchers working with register data to determine which measure to use.

Trends in older people's drinking habits, Sweden 2004-2017.

Aims: To examine if and how the drinking habits of older people aged 60-79 years in Sweden have changed during 2004-2017, with a specific focus on age groups and gender. Data and measures: A Swedish, nationally representative, repeated cross-sectional telephone survey covering the years 2004-2017 (n = 225,134) was used. Four aspects of alcohol consumption were investigated: proportion of alcohol consumers, frequency of drinking, amount per drinking occasion, and prevalence of heavy episodic drinking. Results: Three of the four measures investigated showed increases in alcohol consumption in the older age groups, particularly among women. Proportion of alcohol consumers, frequency of drinking and prevalence of heavy episodic drinking during the past month increased in most older age groups among both women and men, while the average amount per drinking occasion remained stable. Thus, total consumption in older age groups has increased over time, since the proportion of drinkers and the frequency of drinking has increased. Increases were particularly marked among women and in the age groups 70-74 and 75-79 years. In age groups below 60 years, these measures showed either declines or stability. Conclusions: There has been a steady increase in alcohol consumption across all the older age groups studied, which implies that the changing drinking habits are not isolated only to certain birth cohorts. Instead there seems to be a continuous shift in older people's drinking habits which can be expected to continue. However, these increases are from very low levels, and older people's drinking is still at modest levels. Public health implications must be studied further.

Trends in the Mortality Risk of Living Alone during Old Age in Sweden, 1992-2011.

Objectives: This study investigates the association between living alone and mortality over a recent 19-year period (1992-2011). Method: Data from a repeated cross-sectional, nationally representative (Sweden) study of adults ages 77 and older are analyzed in relation to 3-year mortality. Results: Findings suggest that the mortality risk associated with living alone during old age increased between 1992 and 2011 (p = .076). A small increase in the mean age of those living alone is partly responsible for the strengthening over time of this association. Throughout this time period, older adults living alone consistently reported poorer mobility and psychological health, less financial security, fewer social contacts, and more loneliness than older adults living with others. Discussion: Older adults living alone are more vulnerable than those living with others, and their mortality risk has increased. They may have unique service needs that should be considered in policies aiming to support aging in place.

Comparing older people's drinking habits in four Nordic countries: Summary of the thematic issue.

Aim: The present article summarises status and trends in the 21st century in older people's (60-79 years) drinking behaviour in Denmark, Finland, Norway and Sweden and concludes this thematic issue. Each country provided a detailed report analysing four indicators of alcohol use: the prevalence of alcohol consumers, the prevalence of frequent use, typical amounts of use, and the prevalence of heavy episodic drinking (HED). The specific aim of this article is to compare the results of the country reports. Findings: Older people's drinking became more common first in Denmark in the 1970s and then in the other countries by the 1980s. Since 2000 the picture is mixed. Denmark showed decreases in drinking frequency, typically consumed amounts and HED, while in Sweden upward trends were dominant regarding prevalence of consumers and frequency of drinking as well as HED. Finland and Norway displayed both stable indicators except for drinking frequency and proportion of women consumers where trends increased. In all four countries, the gender gap diminished with regard to prevalence and frequency of drinking, but remained stable in regard to consuming large amounts. In Norway the share of alcohol consumers among women aged 60-69 years exceeded the share among men. During the late 2010s, Denmark had the highest prevalence of alcohol consumers as well as the highest proportion drinking at a higher frequency. Next in ranking was Finland, followed by Sweden and Norway. This overall rank ordering was observed for both men and women. Conclusion: As the populations aged 60 years and older in the Nordic countries continue to grow, explanations for the drivers and consequences of changes in older people's drinking will become an increasingly relevant topic for future research. Importantly, people aged 80 years and older should also be included as an integral part of that research.