Trends in the Use of Home LTC Services in Large, Medium and Small Municipalities in Italy: Lessons for the Post-COVID-19 Reappraisal.

Italian Long-Term Care is considered largely inadequate, and the recent COVID-19 pandemic has dramatically exposed its limitations. Public Home Care Services in particular were revealed as under-financed and unable to cover the potential demand for care from the older population. But does the type of municipality and its geographic location play a role in creating or mitigating unmet demand? This is the first study addressing this research question in Italy. Our hypothesis is that older people's care preferences and care possibilities may vary between small, medium and metropolitan areas, as will the organisation, funding and availability of services, and the combination will influence (unmet) demand for public home care services. In this paper, using nationally representative survey data collected by the Italian National Statistical Institute in 2003 and 2016, we investigate changes and differences in the use of public and private home care services among people aged 75 or older in Italy by size of the municipality. Our results reveal inequalities in service use between Northern and Southern areas of the country and in particular between metropolitan areas, medium and small municipalities. Such differences reinforce post-pandemic calls for new investment and changes in the design of the Italian Long-Term Care system.

Gender inequality in Latin American Neuroscience community.

Gender bias in Science, Technology, Engineering, and Mathematics (STEM) has been identified since a long time ago. However, gender imbalance in neuroscience has not yet been adequately explored worldwide. Here we report the first study on the development of the careers of men and women neuroscientists in Latin America in relation to family life and their perceptions of obstacles to success. Apart from revealing gender inequality in the neuroscience field, distinctive Latin American traits have become evident, thus providing novel insights into the global comprehension of gender imbalance in the region, which is required for guiding future actions, including the design of public policies in the region.

Marital history, health and mortality among older men and women in England and Wales.

BACKGROUND: Health benefits of marriage have long been recognised and extensively studied but previous research has yielded inconsistent results for older people, particularly older women. At older ages accumulated benefits or disadvantages of past marital experience, as well as current marital status, may be relevant, but fewer studies have considered effects of marital history. Possible effects of parity, and the extent to which these may contribute to marital status differentials in health, have also been rarely considered. METHODS: We use data from the Office for National Statistics Longitudinal Study, a large record linkage study of 1% of the population of England & Wales, to analyse associations between marital history 1971-1991 and subsequent self-reported limiting long-term illness and mortality in a cohort of some 75,000 men and women aged 60-79 in 1991. We investigate whether prior marital status and time in current marital status influenced risks of mortality or long term illness using Poisson regression to analyse mortality differentials 1991-2001 and logistic regression to analyse differences in proportions reporting limiting long-term illness in 1991 and 2001. Co-variates included indicators of socio-economic status at two or three points of the adult life course and, for women, number of children borne (parity). RESULTS: Relative to men in long-term first marriages, never-married men, widowers with varying durations of widowerhood, men divorced for between 10 and twenty years, and men in long-term remarriages had raised mortality 1991-2001. Men in long-term remarriages and those divorced or widowed since 1971 had higher odds of long-term illness in 1991; in 2001 the long-term remarried were the only group with significantly raised odds of long-term illness. Among women, the long-term remarried also had higher odds of reporting long-term illness in 1991 and in 2001 and those remarried and previously divorced had raised odds of long-term illness and raised mortality 1991-2001; this latter effect was not significant in models including parity. All widows had raised mortality 1991-2001 but associations between widowhood of varying durations and long-term illness in 1991 or 2001 were not significant once socio-economic status was controlled. Some groups of divorced women had higher mortality risks 1991-2001 and raised odds of long-term illness in 1991. Results for never-married women showed a divergence between associations with mortality and with long-term illness. In models controlling for socio-economic status, mortality risk was raised but the association with 1991 long-term illness was not significant and in 2001 never-married women had lower odds of reporting long-term illness than women in long-term first marriages. Formally taking account of selective survival in the 20 years prior to entry to the study population had minor effects on results. CONCLUSIONS: Results were consistent with previous studies in showing that the relationship between marital experience and later life health and mortality is considerably modified by socio-economic factors, and additionally showed that taking women's parity into account further moderated associations. Considering marital history rather than simply current marital status provided some insights into differentials between, for example, remarried people according to prior marital status and time remarried, but these groups were relatively small and there were some disadvantages of the approach in terms of loss of statistical power. Consideration of past histories is likely to be more important for later born cohorts whose partnership experiences have been less stable and more heterogeneous.

Differences over time in the relationship between partnership disruptions and support in early old age in Britain.

OBJECTIVE: We examined variations over time in the relationship between past partnership disruption (due to divorce, separation, and death) and present support (coresidence with, help to and from, and contact with children) in early old age in Britain. METHODS: Employing data from the 2001/2 British Household Panel Survey and the 1988/9 Survey of Retirement and Retirement Plans, we investigated whether differences in support over time were due to changes in (a) the composition of the population (e.g., the percentage divorced) or (b) the strength of the covariates (e.g., the effect of divorce). RESULT: Our findings showed an increase in the experience of partnership disruption in early old age. Nonetheless, the percentage of people who reported receiving and providing support increased. A comparison of the two points in time showed that there was little change in the effects of partnership disruptions on support in early old age. DISCUSSION: The fact that the level of support has remained stable or increased over time among this age group despite the increasing prevalence of divorce suggests that the negative effect of partnership disruption on support in early old age may be weakening over time.

Grandparents providing childcare in Italy.

Research on the choices of childcare arrangements in Italy shows the fundamental role of grandparents in providing informal childcare. Therefore, it is important to understand how grandparents provide different types of childcare, especially in terms of differences in their socio-economic, demographic and physical status, jointly with the characteristics of their grandchildren. Grandparents aged 50 and over with at least one non-co-resident grandchild aged 13 years or less were selected from the 2009 Italian household survey. Multilevel multinomial logistic regression models for grandmothers and grandfathers were used to identify the determinants of the probability of providing childcare intensively, occasionally or during school holidays rather than never. The probability of a grandparent providing intensive childcare is significantly reduced by being: male, unmarried, in bad health and with inadequate economic resources. Nevertheless, when analysing the probability of providing childcare occasionally or during holidays, the individual characteristics of grandparents and grandchildren are less significant compared to intensive childcare, meaning that grandparents provide non-intensive care regardless of their individual characteristics, and this is particularly true for grandmothers. Results confirm the fundamental importance of grandparents in providing informal childcare in Italy, and they offer useful information to understand the individual characteristics associated with different types of grandparental childcare.

What do we know about grandparents? Insights from current quantitative data and identification of future data needs.

Against the background of a 'new wave' of empirical studies investigating various aspects of grandparenthood across a broad range of regional contexts, this article aims to take stock of what has been achieved so far and which lessons we can learn from this for the future. Our focus is on the measurement of grandparenthood and grandparenting in quantitative social surveys and the implications this has for the substantive questions we can ask and the answers we can get out of such data. For several broader questions-who is a grandparent and when does this transition happen; what does it mean to be a grandparent; and what are the implications of grandparenthood for families?-we review previous questionnaire items from a variety of surveys as well as studies in which they were used. We identify relevant issues related to these questions which cannot be adequately addressed with currently available data, but should be considered in new or ongoing survey projects. The answers provided by recent studies as well as the many still open questions identified here indicate excellent prospects for scholarship on grandparents in the years to come.

Twins and their health cost: consequences of multiple births on parental health and mortality in Denmark and England and Wales.

The rapid increase in twinning rates in developed countries has increased interest in the question as to whether twin mothers have higher mortality and more health problems than mothers of singletons. Here we use a national survey, the Office for National Statistics Longitudinal Study of England & Wales, and a linkage between the Danish Twin Registry and the Danish population register to examine mortality patterns after age 45 (50 for fathers) for twin parents and the whole population born from 1911 to 1950. For England and Wales, presence of limiting long-term illnesses and self-rated health status was also investigated. Overall similar health and mortality was found for twin parents and the whole population although both life table methods and survival analysis suggested a slight excess mortality among older cohorts of twin mothers in England and Wales.

The oldest old in Great Britain: change over the last 20 years.

This article examines twenty-year trends in several demographic and socio-economic characteristics of the oldest old. Using data obtained by merging consecutive waves of the General Household Survey (GHS), this study offers detailed descriptive and multivariate analyses of the use of selected health services and the living arrangements of the oldest old over the last 20 years. The results provide an insight into the characteristics of the oldest old and changes over time in the selected characteristics, that is, the increase in the proportion living alone and in hospital out-patient visits, in contrast with the stability in the proportion visiting their General Practitioner (GP).

Fertility history and health in later life: a record linkage study in England and Wales.

Women born at different periods within the 20th century in England and Wales have followed varying fertility pathways with large changes in, for example, proportions having no children or only one child. Among the consequences of these changes may be effects on women's health later in life. Links between fertility histories and later health and mortality have been investigated in several studies, but in many of these socio-economic characteristics have not been allowed for, even though there are socio-economic differences in both fertility and mortality patterns and results are conflicting. Here we analyse associations between the fertility histories of women born 1911-1940 in England and Wales and their mortality and health status after age 50. We used data from the Office for National Statistics Longitudinal Study; a record linkage study of approximately 1% of the population initially based on those enumerated in the 1971 Census of England and Wales. We used survival analysis to investigate the effects of parity, short birth intervals, and timing of fertility on mortality from age 50 to the end of 2000, controlling for a range of relevant socio-demographic characteristics. For survivors to 1991, we additionally used logistic regression to model probability of having a limiting long-term illness in 1991. We found that nulliparous women and women with five or more children had significantly higher mortality than other women, and that in the oldest groups women with just one child also had raised mortality. Women who had been teenage mothers had higher mortality and higher odds of poor health than other parous women. Mothers with short birth intervals, including mothers of twins, also had elevated risks in some cohorts. Late childbearing (after age 39) was associated with lower mortality. Personal demographic history is an important factor to consider in analyses of health and mortality variations in later life. More research is needed to further elucidate causal pathways.

The influence of social relations on mortality in later life: a study on elderly Danish twins.

PURPOSE: We examined whether the presence of a spouse and the frequency of interaction with children, relatives, and friends significantly influence the risk of dying in late life. We assessed these effects separately by gender, controlling for self-reported health. In addition, we examined whether interaction with the co-twin has a different impact on mortality for identical and fraternal twins. DESIGN AND METHODS: The data set consists of 2,147 Danish twins aged 75 years and older, who were followed prospectively from 1995 to 2001. We modeled the effect of social ties on mortality by using event history analysis. RESULTS: Survival is extended by having a spouse and close ties with friends and the co-twin. However, contact frequency with friends and the co-twin is significant, respectively, only for women and identical twins. IMPLICATIONS: Investigating social relations sheds light on the life span of individuals older than 75 years of age. We stress the importance of social relations beyond the presence of the spouse for survival even at very old ages.

Sex differences in mortality, a comparison of the United Kingdom and other developed countries.

Women, on average, live longer than men, though sex differences in mortality vary from country to country and over time. This study includes a description of recent changes in life expectancies at different ages, followed by a more detailed analysis of death rates by age in selected countries. Additionally it provides a historical perspective on the sex differences in mortality in France and England and Wales. Possible explanations for the differences among countries are explored using trends in mortality by cause of death.

The health consequences of multiple roles at older ages in the UK.

Increasing proportions of men and women are combining family (including care-giving) and work responsibilities in later life; however, the relationship between multiple role commitments and health at older ages remains unclear. Employing data from the longitudinal Retirement Survey (1988-1989 and 1994), the present authors applied logistic regression models to investigate the relationship between multiple role occupancy (1) cross-sectionally in 1988-1989 and health status in 1994; (2) retrospectively over the respondent's lifetime up to 1988-1989 and health outcomes in 1988-1989; and (3) retrospectively between 1988-1989 and 1994, and health status in 1994. The health outcomes considered were (1) general health status, (2) functional ability and (3) severity of disability category. Overall, simultaneous role occupancy (e.g. care-giving and employment) at older ages does not appear to be associated with poor health. The authors report a positive association between employment and health, as expected. There were mixed results concerning the association between care-giving and health. Where adverse health outcomes were found, the parental role, alone or in combination with other roles, was most frequently related to poor health. Thus, for a nationally representative sample of mid-life men and women, the combination of care-giving with other family and work roles appears to have few negative health consequences. Further research is needed on whether continued parental demands in mid-life have a negative impact on health.

The demographic characteristics of the oldest old in the United Kingdom.

Those aged 85 and over (the oldest old) are the fastest growing age group in the population of many developed countries. However it is still uncommon to find statistics and analysis of this age group in current reporting. This article draws together demographic characteristics of people aged 85 and over from various different national data sources to provide an up-to-date picture of the oldest old.

Demographic data needs for an ageing population.

A consequence of population ageing is an increased need for demographic information on the older population. This presents new challenges for data collection. This article analyses several key aspects of data collection on older people, including survey design and questions. It also critically examines the current range of UK and international sources for data on older people. Specifically, it addresses the under-representation of the following groups in some UK statistical sources: ) older people in institutions, 2) the oldest old and 3) older people from ethnic minorities.

Changes in the distribution of marital age differences in England and Wales, 1963 to 1998.

Assumptions about the 'typical' age gap between spouses underlie much social policy (e.g. the five-year difference in men's and women's state pension ages). In order to test the basis for these assumptions, detailed marriage registration statistics were obtained for 1963 and 1998, for England and Wales. Age differences between spouses were calculated and analysed by year, age at marriage and previous marital status. The median age gap hardly changed between 1963 and 1998 but this concealed considerable increase in the proportion of marriages where the man was younger than the woman or--to a lesser extent--where the man was six or more years older.

Living arrangements among older people: an overview of trends in Europe and the USA.

This article compares the trends in living arrangements of older people in several European countries and in the United States. Trends and cross-country variability in several factors that could account for these cross-national differences, including marital status, fertility, labour force participation and attitudes, are also examined. In most countries the proportion of older people living alone increased substantially between 1970 and 1990. However the increase in living alone stabilised or even declined between 1990 and 2000 in most of the countries analysed indicating a possible reversal in the trend. Increases in proportions of older women who are married and reductions in the proportions childless may partially explain this. Considerable variability in both trends and levels of older people's living arrangements was seen especially between north-western and southern European countries. These variations mirrored contrasts in attitudes towards residential care and parent-child coresidence between the countries.

Sex Differences in Medication and Primary Healthcare Use before and after Spousal Bereavement at Older Ages in Denmark: Nationwide Register Study of over 6000 Bereavements.

Background. The study aimed to examine sex differences in healthcare use before and after widowhood to investigate whether reduced healthcare use among widowers compared with widows may partially explain excess mortality and more adverse health outcomes among men than women after spousal loss. Methods. All individuals alive and aged at least 60 years in 1996 and who became widowed in the period from 1996 to 2003 were selected from the 5% sample of the total Danish population and all Danish twins. The healthcare use was assessed as the average daily all-cause and major system-specific medication use and the average annual number of visits to general physicians (GPs). Results. The average daily use of all-cause and major system-specific medications, as well as the number of GP visits increased over the period from 1 year before and up to 5 years after a spouse's death, but there were no sex-specific patterns in the trajectories of medication use and number of GP visits after conjugal loss. Conclusion. We found little support for the hypothesis that reduced healthcare use contributes to the explanation of more adverse health outcomes after conjugal loss in men compared with women in Denmark.

Multiple role occupancy and social participation among midlife wives and husbands in the United Kingdom.

We investigated the relationship between intensive multiple role occupancy and one key dimension of well-being, social participation (i.e., frequency of participation in social and leisure activities and meeting friends or relatives). Moreover, we examined gender differences in the association between individual, spousal and couple intensive multiple role commitments and individual social participation. Our research is based on a sample of mid-life wives (45-59) and their husbands from the 2000 British Household Panel Study (BHPS). Our findings show that, among wives whose husbands were providing care to a dependent for 20 or more hours a week, there was a negative association with social and leisure activity participation, whereas husbands' level of participation in social and leisure activities was higher if their wives were in full-time paid work. We also found lower odds of meeting friends or relatives among wives and husbands in full-time employment, and higher odds of meeting friends and relatives among wives providing care for 20 or more hours a week. Our results will aid policy thinking in addressing how people can be best supported to balance work and family commitments in order to optimize different dimensions of well-being in later life and help alleviate the pressures associated with multiple-role occupancy in mid-life.

Marital disruptions and loss of support in later life: a longitudinal study of the United Kingdom.

Marital disruption (i.e. due to death, divorce or separation) at older ages is an important issue as it removes the usual primary source of help and support: a husband or wife. To date, few studies have investigated the support implications (both informal, here defined as perceived support and social embeddedness and formal, defined as use of domiciliary care services) of marital disruptions in later life. This issue needs addressing as widow(er)hood and divorce are increasingly occurring at older ages. Employing data from the longitudinal British Household Panel Survey (BHPS) (1991-2003) we investigated the association between marital disruption and first loss of (a) perceived support and (b) at least weekly contact with at least one non-relative friend, among those aged 50 and over. We also examined first use of domiciliary care services (i.e. health visitor or district nurse, home help or meals-on-wheels) among those aged 70 and over. Our findings show that marital separation increased the odds of losing perceived support whereas widow(er)hood showed no significant association among people aged 50 and over. Separation and widow(er)hood increased the odds of losing weekly contact with non-relative friends (although the odds were greater for separation) in this age group. Finally, widow(er)hood increased the odds of using domiciliary care services among respondents aged 70 and over.