The nature and cross-domain correlates of subjective age in the oldest old: Evidence from the OCTO Study.

Self-reflections of age and aging are predictors for key outcomes such as mortality, but little is known about the nature and potential antecedents of subjective age in very old age. We used cross-sectional data from the Swedish OCTO study (N = 267; B. Johansson & S. H. Zarit, 1995) and found that almost two thirds of the 84- to 90-year-olds reported not feeling old. Multinomial logistic regression analyses indicated that younger age and better physical functioning as well as higher well-being and mastery beliefs were all related to not feeling old. In multivariate analyses, however, mastery beliefs emerged as the most consistent and robust predictor of subjective age. Our findings suggest that adaptive capacities may be preserved into advanced age and highlight the pivotal role of perceived control for successful aging.

Older people's "voices"--on paper: obstacles to influence in welfare states--a case study of Sweden.

The official rhetoric of welfare states unconditionally pays tribute to older people's right to express dissatisfaction. In practice, users of older services in welfare states may be deprived of their "exit" options and face considerable constraints when it comes to raising their "voices." For example, when older people in nursing homes would like to lodge a complaint, they may well be referred to the very staff members they depend on in their everyday lives. This article analyzes a national case study in which these contradictory tendencies are especially explicit: formal influence channels for older people in Sweden. Using data from structured interviews with 100 representatives of Swedish municipalities and drawing on Hirschman's (1970) theory on exit and voice, the article analyzes obstacles to older service users' influence in Sweden and develops explanations for these obstacles in terms of social contexts.

Genotype-environment interactions: cognitive aging and social factors.

The possibility of genotype-environment interaction for memory performance and change was examined in 150 monozygotic (MZ) twin pairs from the Swedish Adoption Twin Study of Aging (SATSA). We used an MZ twin pair difference approach to examine the possibility that genotype was associated with intrapair variability and thus suggestive of genotype-nonshared environment interactions. Multiple 'variability genes' were found for longitudinal change in a semantic memory task including candidates coding for apolipoprotein E (APOE) and estrogen receptor alpha (ESR1) as well as serotonin candidates (HTR2A and 5HTT). One candidate also related to variability in change in episodic memory (5HTT). Of the significant associations observed, generally results indicated that MZ pairs who carry putative risk alleles were less variable than noncarriers, suggesting that noncarriers may be more sensitive to environmental contexts. We sought to 'contextualize' the possible nonshared environmental influences for found gene-environment (G x E) effects by considering intrapair differences in measured social and stress factors, including social support, life events and depressive symptoms. Results suggested that nonshared environmental influences associated with depressive symptoms may moderate the G x E relationship observed for ESR1 and APOE and longitudinal semantic memory change whereby noncarriers of putative risk alleles may be relatively more sensitive to depressionevoking environmental contexts than carriers of the risk allele. Thus, the contexts that facilitate or reduce depressive symptoms may affect semantic memory resiliency dependent on genotype. Further work ought to consider larger sample sizes as well as consider additional social and contextual factors.

Life on the edge: patterns of formal and informal help to older adults in the United States and Sweden.

OBJECTIVE: Our objective in this study was to compare assistance received by individuals in the United States and Sweden with characteristics associated with low, moderate, or high 1-year placement risk in the United States. METHODS: We used longitudinal nationally representative data from 4,579 participants aged 75 years and older in the 1992 and 1993 waves of the Medicare Current Beneficiary Survey (MCBS) and cross-sectional data from 1,379 individuals aged 75 years and older in the Swedish Aging at Home (AH) national survey for comparative purposes. We developed a logistic regression equation using U.S. data to identify individuals with 3 levels (low, moderate, or high) of predicted 1-year institutional placement risk. Groups with the same characteristics were identified in the Swedish sample and compared on formal and informal assistance received. RESULTS: Formal service utilization was higher in Swedish sample, whereas informal service use is lower overall. Individuals with characteristics associated with high placement risk received more formal and less informal assistance in Sweden relative to the United States. DISCUSSION: Differences suggest formal services supplement informal support in the United States and that formal and informal services are complementary in Sweden.

Exploring assistance in Sweden and the United States.

PURPOSE: Few international comparisons of health services are performed using microlevel data. Using such data, this paper compares the need for and receipt of assistance with activities of daily living (ADLs) in comparable samples in the United States and Sweden, a country with a universal system of community-based services. DESIGN AND METHODS: Data from national surveys of community residents completed at approximately the same time in each nation are used to create comparable measures of need and assistance. Descriptive and logistic regression analyses compare need and assistance patterns across the nations and identify individual factors that explain receipt of assistance and unmet needs. RESULTS: Our results indicate that a simple story of greater use of paid formal services in Sweden and more unpaid informal use in the United States masks a more complex relationship. Assistance with ADLs seems to be more targeted in Sweden; narrow differences in assistance widen considerably when the analysis is limited to those reporting need. IMPLICATIONS: Although these two different health systems result in similar levels of overall ADL assistance, a detailed microlevel comparison reveals key distinctions. Further microlevel comparisons of access, cost, and quality in cross-national data can further aid our understanding of the consequences of health policy.

Mortality in three different cohorts of 70-year olds: the impact of social factors and health.

BACKGROUND AND AIMS: Little is known about changes in mortality among elderly over time, especially in subgroups differing in social and other background factors. The aim of this study was to analyze differences in mortality in three different cohorts of 70-year olds regarding social factors, social network, self-assessed health and number of diseases. METHODS: We used data from 3 random samples of 70-year olds born in 1901/02 (N=973), 1906/07 (N=1036) and 1911/12 (N=619). At age 70 all participants were given medical examinations and interviewed regarding social background, social network, self-assessed health, need of care and number of diseases. Death records were obtained up to and including 1998. RESULTS: The youngest cohorts had significantly decreased mortality compared to the oldest cohort (RR 0.86; CI 0.78-0.95 and RR 0.88; CI 0.78-0.995 respectively). There were no differences between the two youngest cohorts. Decrease in mortality in the younger cohorts was found among those who lived in their own home, did not feel tired, were non- or ex-smokers and had one or more diseases. CONCLUSIONS: There was a small difference in total mortality between these cohorts of 70-year olds. There were differences in development of mortality in subgroups distributed by health and social factors, indicating more years of life, partly due to life-style factors such as non-smoking.