Strand organiser: Cecilia Tomassini, Office for National Statistics
Does social vulnerability predict mortality in older adults?
Melissa K. Andrew, Arnold B. Mitnitski, and Kenneth Rockwood,
Division of Geriatric Medicine, Dalhousie University, Halifax, Canada
Background
Numerous social factors, including social support & networks, social engagement, and social capital, have been individually associated with health. Whether these factors can be conceptually unified (e.g. as "social vulnerability") is debated. This study aims to investigate the usefulness and properties of a social vulnerability index (analogous to a previously described frailty index 1
Study population
Adults aged >=65 in two longitudinal Canadian studies: The Canadian Study of Health and Aging (CSHA) and the National Population Health Survey.
Methods
Variables relating to social factors, including social support, community engagement, socio-economic status, leisure activities, and life satisfaction were identified. Each response was assigned a 0-1 point value as follows: 0 if the respondent did not report the particular problem, 1 if he/she did, and intermediate values where the original variable had ordered response categories. A social vulnerability index was constructed by summing each respondent's point values and dividing by the total number of social variables to generate a proportion of social "deficits". In the CSHA (N=3716), the social vulnerability index was constructed from 39 variables. Association with survival was analyzed using logistic regression, Kaplan-Meier curves, and Cox regression.
Results
In the CSHA, social vulnerability increased with increasing age (r=0.0042, p<0.001) and was higher in women (0.270; 95%CI:0.266-0.273) than men (0.234; 95%CI:0.230-0.238; p<0.001). Adjusting for frailty, age, sex and education, each additional social deficit was associated with increased odds of mortality (OR 1.07; 95%CI:1.04-1.09).
Conclusion
Social vulnerability appears to be a valid construct that can readily be operationalized from questionnaire data.
1 Mitnitski, A.B., X. Song, and K. Rockwood, The estimation of relative fitness and frailty in community-dwelling older adults using self-report data. J Gerontol A Biol Sci Med Sci, 2004. 59(6): p. M627-32.
Email: mandrew@dal.ca
Mortality after widowhood in later life: short-term and long-term consequences of bereavement on mortality using the co-twin control method.
D. Rasulo, K. Christensen, C. Tomassini
Office for National Statistics
The aim of this paper is to analyse the relation between the length of the bereavement period and mortality at old ages in Denmark. This aim was addressed by applying the co-twin control method, which is an optimal procedure as it compares an outcome among twins using their co-twins as control group.
Data were taken from the Longitudinal Study of Ageing Danish Twins, which is a panel study carried out from 1995 to 2001 on all eligible old twins in Denmark. In particular, we selected the sample of twin pairs, composed by two-twin in each pair discordant for their marital status (widowed, married). To track the effect of widowhood on mortality risk during the study time we applied the Gompertz model. Results showed that the mortality risk increases significantly in the short period after the loss of the spouse and that this effect is especially strong for men.
E-mail: domenica.rasulo@ons.gsi.gov.uk
Elisabeth Schröder-Butterfill
St. Antony's College, Oxford
Early research on ageing in developing countries regarded elderly people as traditionally protected by extensive family networks, but increasingly imperilled by the forces of 'modernisation'. This generalisation of all elderly as vulnerable has given way to what might be termed a 'risk group approach' in which specified subsets of elders-the poor, the childless, widows, those living alone or with migrant children-are defined as vulnerable. This remains unsatisfactory, as vulnerability is the result of the combined and cumulative effects of exposure (e.g. childlessness), threats (e.g. health crises) and coping strategies (e.g. social networks, assets), all of which are shaped by individual life histories and wider social, demographic and economic context.
Using longitudinal data from a village study in East Java, this paper asks: which elderly are vulnerable, and why?
In 1999, 200 elderly people were interviewed, and for a subset (N=30) detailed life histories and kin network data were collected. Randomised household surveys allowed the economic stratification of the study population. High levels of childlessness, divorce, and migration have created network discontinuities over time and left some elders with small effective networks, whilst reproductive and economic success mean others are apparently secure. However, continuing economic participation in old age and relatively low levels of acute need for care and support at any given time make an analysis of vulnerability impossible with cross-sectional data alone, as the reliability of social networks often only becomes manifest in a crisis. Thus, in 2004 surviving respondents were followed-up and interviews with close relatives of deceased elders conducted; re-surveys are planned for March 2005.
The focus in this paper is on the effects of specific crises (loss of spouse or other key network member, and dramatic health declines) on outcomes in old age, with a bad outcome-and thus vulnerability-defined as a lack of physical or medical care and/or a 'bad death'. It is argued that the vulnerable elderly can only be identified by understanding social networks and their adaptability over time.
Key words: vulnerability; elderly; social networks; stratification; anthropological demography; longitudinal data; Indonesia
Email: elisabeth.schroeder-butterfill@sant.ox.ac.uk
Who cares when parents die? Changing marital histories, intergenerational ties and mortality.
Hilke Brockmann and Andreas Timm
University of Bremen
Since 1830 it has been shown in countless studies and for numerous countries that married people live longer. But today people also experience very different marital histories than they did a century or even decades ago. They marry less often and later in life, they are more likely to divorce or separate, they cohabitate with new partners, remarry and many women live for a long time as widows. It is also a robust finding that intergenerational ties, particularly having a daughter, protects parents' health and lowers their mortality. But intergenerational networks are in flux in modern countries, where fertility rates drop, parents separate, and spatial mobility increases.
Our study analyzes how the marital and parental histories affect mortality in Germany today. The analysis is based on the German Socio-Economic Panel study that collects individual data from 1984 to 2002. We use a proportional multi-level hazard model to interrogate our research question while controlling for selectivity into marriage and parenthood.
The analysis yields three major findings: Firstly, protection through marriage and parenthood results from long-term accumulation of survival advantages and from the attenuation of higher mortality risks that occur immediately after a transition into or out of a marriage. Secondly, women should be more likely to keep survival advantages from previous marriages and from their children than men. Thirdly, we assume that women should cope more easily with survival disadvantages from divorces and widowhood than men, especially when men are divorced or separated from the mother of their child.
Prof. Dr. Hilke Brockmann
Dr. Andreas Timm
Graduate School of Social Sciences
University of Bremen
Mail Box 33 04 40
28334 Bremen
Germany
Demographic implications for palliative care provision in the UK.
Briony Eckstein and Angela Armstrong-Coster
Office for National Statistics
The UK has an aging population. Whilst this statement is not a surprise, the impact of this aging on care providers in the near future appears to be not fully anticipated by care providers. This paper considers the increased demands that will be made for palliative care in the next twenty years. Currently a variety of palliative care options are offered (in varying degrees) to the terminally ill as well as to those who are in the immediate process of dying. The paper considers whether palliative care can continue to be provided at the level it currently is, or whether it will need to contract the services it provides and to focus only on patients in their final stages of life. Whilst providing no solutions to the issues presented, areas of concern are highlighted.
Email: briony.eckstein@ons.gov.uk
The dynamics of social care
Maria Evandrou and Jane Falkingham
University of Southampton
The proportion of the population aged 65 and over has increased from 13% to 16% over the period 1971-2004 and this is expected to rise to 23% in 2031 as the cohorts born during the baby boom in the early1960s reach retirement. Moreover, the older population is also ageing with those aged 85 and over making up a greater share of the total older population. This changes place greater pressure on health and social service provision, as well as informal support networks.
Although the number of older people receiving home care services is well documented from administrative data, less is known about the characteristics of service beneficiaries, and what is known is based on cross-sectional data. This paper uses data from the British Household Panel Study to investigate the factors associated with making the transition into receipt of social care and predictors associated with continued receipt of care. It is hypothesised that starting to receive social care services is associated with a change in the individual's characteristics (eg their health), a change in their living arrangements (eg death of a spouse), or a change in their spouse's characteristics. Similarly, cessation of formal care receipt may be related to a number of factors including change in the availability of informal care or entry into institutional care. Such associations cannot be captured using cross-sectional data. Understanding the dynamics of social care will place us in a better position to plan for the care needs of older people today but also in the future.
Professor Maria Evandrou, Centre for Research on Ageing, University of Southampton. Email: maria.evandrou@soton.ac.uk
Professor Jane Falkingham, School of Social Science, University of Southampton.
Informal caring at working age: effects of job characteristics and family configuration
Ursula Henz
London School of Economics
The ageing of Western societies has raised concerns about the provision of informal care for sick, disabled or elderly people, as the demand for care is expected to increase in the coming decades (Allen & Perkins, 1995). Informal carers are typically spouses, children or children-in-law. Whereas spouses have often reached retirement age when they start caring, the child generation is typically of working age when care needs arise in the parental generation. Most men and an increasing number of women are employed at this stage of their lives, experiencing limitations of their time and energy to provide informal care.
This paper studies the impact of various personal and job circumstances on the propensity of providing informal care and on the consequences of caregiving for carer's employment. Employment conditions are captured by distinguishing between full-time and part-time work and by distinguishing between seven socio-economic classes. The impact of employment is studied in the context of the carer's partnership and parenthood roles, thereby taking the respective resources and constraints into account. As these roles differ by gender, the analyses are carried out separately for men and women. In addition, the paper studies effects of employment and the nuclear family separately on whether a person takes up caring and on whether a carer leaves the labour market. Thereby, crucial differences between these two processes can be uncovered. This latter point allows answering another important question about the situation of carers. For Britain it has been shown that informal carers have a weaker attachment to the labour market that non-carers (Arber & Ginn, 1995; Evandrou, 1995; Hancock & Jarvis, 1994). Most of this research cannot determine to which extent caring duties actually have had an impact on this; carers could have had a weaker attachment to the labour market already before they started caring, and the weaker attachment to the labour market may have enabled them in the first place to take up caring. By estimating hazard rate models with longitudinal data on employment and caring from the 1994-5 British Family and Working Life Survey (FWLS) the project shows that a weaker attachment to the labour market is not a condition but a consequence of caregiving.
Ursula Henz, London School of Economics, Dep. of Sociology, Houghton Street, London WC2A 2AE, United Kingdom. Email: U.Henz@lse.ac.uk
Who becomes an informal caregiver? A life course perspective.
Harriet Young *, Emily Grundy
London School of Hygiene & Tropical Medicine
Although much is known about differences between carers and non-carers in terms of characteristics, less is known about how life histories of carers diverge from those who don't have this role. Surveys collecting information on caregiving to date have small sample sizes, and most are cross-sectional. Many of the debates about characteristics associated with being a carer or consequences of caregiving cannot be disentangled without a longitudinal perspective. To take one example, there is a debate as to whether differences in the employment profile of caregivers compared to non caregivers reflect prior characteristics or role changes brought about by assumption of the carer role.
Unfortunately, British longitudinal sources including caregiving information are sparse. There are some surveys including retrospective data which have been used to examine pathways to becoming a caregiver, although these sources are restricted to particular age groups. Hirst et al have used the British Household Panel Study, however this is constrained by small sample size.
Here we use newly available data from the Office of National Statistics Longitudinal Study (ONS LS), a nationally representative record linkage study for England and Wales containing, to date, Census and event data from 1971 to 2001. The 2001 UK Census included a question on informal caregiving for the first time. We use the ONS LS to compare the previous life course trajectory of care providers in 2001 compared to non-caregivers, focusing on differential marital status and fertility histories, employment histories and socio-economic status.
This research is funded by the 2001 Census Program of the Joseph Rowntree Foundation.
Centre for Population Studies, London School of Hygiene and Tropical Medicine
50 Bedford Square, London WC1B 3DP
* Presenter: Tel: 020 7299 4670
Fax: 020 7299 4637
Email: harriet.young@lshtm.ac.uk
The cost of population ageing: forecasting future hospital expenditure in Germany
Hilke Brockmann & Jutta Gampe
Bremen University & Max Planck Institute for Demographic Research
Forecasts are always wrong. Still, they paint potential future scenarios and provide a platform for policy decisions today. The paper aims at gauging the future effect of longevity on hospital expenses in Germany. We use a probabilistic forecast model comprising a stochastic demographic component that exploits historical mortality trends, a stochastic cost component based on typical hospital costs over the life-course, and a quality measure of medical progress, which builds on past advances in hospital treatment. Three different scenarios are yielding: Firstly, there is an increase in overall hospital expenditure until the German baby boomers will die out (2040 to 2050). Secondly, the increase is comparably moderate because the average
individual costs are likely to decline as elderly health improves and since medical
progress has an ambiguous influence on hospital expenditures. Finally, the cost
increase varies significantly by gender and disease. In conclusion, chronological age is a misleading indicator for the impact of longevity on hospital expenses as long as it is not broken down into life-cycle needs. By doing so, there is evidence that we can afford longevity without implementing further age discriminating policies
Email: brockman@gsss.uni-bremen.de
Children and standard of living in old age*
Gustavo De Santis1, Chiara Seghieri2 & Maria Letizia Tanturri3
University of Florence
A cross sectional data source, the Bank of Italy Survey on Household Income and Wealth
(SHIW) for 2000 and 2002, is used to assess the association between the economic conditions in one's old age and some covariates, including past fertility, marital status and living arrangements. For an elderly person, having had children does not have any clear impact on current economic status, except that it is associated with fewer assets. However, ceteris paribus, having (adult) co-residing children corresponds to worse economic conditions, both objectively (equivalent income, poverty, assets) and subjectively. In short, having children does not seem to protect from poverty in old age (and may make things worse). Prospects are better when there are other grown-up members in the household (especially if they are males), when education is high, and when the household resides in the North of Italy.
Keywords: Elderly people, Economic well-being, Poverty, Fertility, Living arrangement.
* We gratefully acknowledge financial support from the EU (Contract No. QLRT -2001-02310; FELICIE - 5th European Research Framework; cf. http://www.felicie.org) and from the Italian MIUR (PRIN)
1DESAGT, V. T. Cannizzaro 278, 98122 Messina, Italy. Email: desantis@ds.unifi.it.
2 Dip. di Statistica "G. Parenti", Viale Morgagni 59, 50134 Firenze, Italy. Email: seghieri@ds.unifi.it
3 Dip. di Statistica "G. Parenti", Viale Morgagni 59, 50134 Firenze, Italy. Email: tanturri@ds.unifi.it
Unhealthy life expectancy at age 65 across time and space: what do we know now?
Judith Shapiro
University of Kent at Canterbury
Eurostat has produced a new structural indicator, "healthy life expectancy" estimates for EU member states, on Commission instructions, an accomplishment of the Euro-REVES project. These 1996-2003 Disability-Free Life Expectancies, more accurately "hampering free," are presently based on European Community Household Panel (ECHP) data. We utilize the eight waves of the ECHP, Eurobarometer 58.2 (2002), and preliminary data from wave one of the SHARE 50+ sample of some 22,000 across 10 countries, to consider the value of the new indicator and what problems remain in its construction. Questioning if we are able at present to overcome barriers to comparability in measuring disability, we consider alternate strategies for achieving this goal. We focus on (un)healthy life expectancy at age 65 and beyond, as our interest is in international differences in ageing. (A sidewise glance is given at implications for gender.)
An empirical investigation of key data issues - chiefly attrition and weighting - in the ECHP, and an analysis of its particular data difficulties (eg a deficit of deaths) leads to an assessment of whether these can be handled by standard econometric tools for panel data. A focus is on national differences in reporting of health and disability, and how this issue may be tackled, with an attempt at doing so in two different ways, including the SHARE experiment in "anchoring vignettes," following use by WHO, contrasted with a model based on Eurobarometer 58.2 (which was led by Jagger and Robine.) The paper also reports on the dynamic behaviour of individual "disability" (hampering) in the ECHP, and its interaction with self-reported health, as much less is known the behaviour of this variable, whilst self-reported health, has had, in some sense, two decades of validation within countries.
Dr Judith Shapiro, PSSRU, University of Kent at Canterbury, Canterbury CT2 7NF
+44 1227 82 4022
Intergenerational relations and support in Italy
R. Fraboni, C. Freguja, B. Baldazzi, L. L. Sabbadini
ISTAT, Italy
Recent decades have been characterised by declining fertility rates and increasing longevity in Italy: this has meant a higher proportion of people across a larger number of generations being alive at the same time and needing to support each other. In Italy, an informal network has always been the basic source of support, due to the weakness of the welfare system.
The aim of this paper is twofold. Firstly, it aims to explore the structure and function of intergenerational relations. Secondly, it aims to study the effects of social change upon family ties, in response to macro-social trends in populations aging, female labour force participation, family formation and dissolution.
Data used are based on the Multipurpose household surveys, conducted in 1983, 1998 and 2003, in Italy. The method applied is descriptive analysis.
Women are the crucial "pivots" of the informal support network and they carry most of the workload as caregivers. The solidarity networks are still large, but they are starting to show signs of crisis. Compared to 1998, social groups characterised by a scarcity of ties have emerged in 2003. The needs of the elderly population have to compete with the care needs of working mothers with children, towards which caregivers are increasingly drawn. Extended family continues to fulfil important functions and the intergenerational dimension of the ties is seen as being of increased importance due to the greater longevity and increased availability of grandparents.
Email: fraboni@istat.it
Ageing and daughter preference: comparative perspectives from Indonesia
Philip Kreager
University of Oxford
Daughter preference in Indonesia presents us with an apparently radical contrast. On one side, there is the formidable matrilineal structure of the Minangkabau, where not to have a daughter renders a couple effectively childless, however many sons they may have. For the Minangkabau, daughters are a formal or prescriptive requirement of respectable status and identity. On the other, in Java, there are informal and seemingly endless variations in support relations for elders that involve children of both sexes, in which some elders may express a preference for their daughters' support, and take steps to secure this. If we look beneath this formal/informal contrast regarding daughter preference, however, we find that in both systems day-to-day arrangements are worked out informally, and most elders who have children gain support from a mixture of sons and daughters. In sum, the imperative to have daughters (like the imperative to have sons in much of Asia) introduces constraints that restrict some elders' options, and may trouble them deeply. The vast majority of intergenerational support for elders, including most troubled elders in societies with formal prescriptions, rests nonetheless on networks and personal ties between family members.
Email: philip.kreager@some.ox.ac.uk
Relationship between disruptions in family (and work) life and social support at older ages in the United Kingdom
*Rachel Stuchbury, Karen Glaser, Cecilia Tomassini and Janet Askham,
*Institute of Gerontology, Kings College London
Our aim is to investigate the relationship between key life course events, in particular family disruption due to divorce, death, or re-partnering and social support among people aged 50 and over in 2001 in the U.K. This is a critical issue as social support (e.g. social engagement and assistance including care) is a key dimension of quality of life and has important implications for care. Little research has examined how social support systems of older people may have been affected by changes in family behaviour (e.g. rises in divorce) and work patterns. Employing data from the British Household Panel Study (1991-2001) we will investigate the association between marital disruptions and the following measures of social support:
1) co-residence
2) social contact
3) financial assistance
4) help with transportation or housework
5) personal care
6) use of health and welfare services.
In addition we will also examine:
1) social contact with friends and neighbours
2) participation in community, religious and voluntary organisations
3) involvement in social and leisure activities
4) indicators of social isolation.
We will model the association between marital (and work) disruptions and social support using Ordinary Least Squares (OLS) regression, bivariate logistic regression or conditional multinomial models as appropriate for the dependent variable.
This is part of a wider ESRC-funded project investigating family and work disruptions and social support in later life (RES-000-23-0662).
*King's College London, Waterloo Bridge Wing, Franklin-Wilkins Building
Waterloo Road, London SE1 9NH, UK
Tel.: 44 (0)207-848-3292
Fax: 44 (0)207-848-3235
Email: rachel.stuchbury@kcl.ac.uk