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Background: Iran has experienced a very fast fertility transition. The process of demographic transition, coupled with modernization, has had considerable consequences for the structure and function of families. There is rising concern in Iran about a potential decline in family care and support for older people as a result of these changes. The main aim of this study was to provide a benchmark by examining current associations between family factors and older people's social support, both perceived and received. Methods: A cross-sectional survey of a random sample of 644 people aged 60 + years resident in Tehran was conducted using stratified cluster random sampling method in 2015. Outcome variables were perceived social support, as measured by Social Provision Scale, and received instrumental social support. Multilevel mixed-effects models were used to examine the hypotheses. Results: The analyses showed that most of the family factors measured, including family size (p = 0.01), living arrangements (p = 0.05), and amount of contact with family members (p = 0.001) were associated with older people's receipt of instrumental social support. Living arrangements and quality of relationships with family members were associated with older people's perceptions of social support (p < 0.001). Also, a significant gender interaction was found in associations between family size and SPS (p = 0.03). Having a large size family was positively associated with higher SPS for women (Coef. = 3.9, p = 0.009) but not for men (Coef. = -0.4, p = 0.7). Conclusion: findings of this study support the premise that most of family factors play an important role in provision and perception of social support for Iranian older people. Further policies should mostly be selective of those at higher risk of low support such as widowed, childless, those living alone, having poor relationship with their relatives and those with worse health status. The results of this study may be utilized to target older populations who are at higher risk of low support with innovative programs that focus on building social networks and enhancing social support. [ABSTRACT FROM AUTHOR]

The Targeted Translation Research Accelerator program was created to address cardiovascular disease and diabetes in Australia. To maximise the impact of the considerable investment in this program, a structured prioritisation project was undertaken to determine the highest priority health and medical unmet needs in cardiovascular disease and diabetes. The project was led by Monash University's Behaviour Works Australia in collaboration with Australian National University, Research Australia, and MTPConnect. We conducted an online survey with 318 experts and community representatives to generate a 'long list' of unmet needs for (1) cardiovascular disease; (2) diabetes; and (3) interactions in the pathogenesis of Type 1 diabetes, Type 2 diabetes, and cardiovascular disease. We then convened roundtables of clinical, research, and community leaders to discuss survey results. They prioritised unmet needs against six predefined criteria then discussed results. We present the final priority areas for funding. We demonstrate how a feasible, reproducible, and collaborative prioritisation methodology can be used when designing research funding programs. Such approaches can ensure that funding is directed towards projects that are valuable to the community and reflective of expert opinion. [ABSTRACT FROM AUTHOR]

Objectives To investigate the slowdown in mortality improvement in the United States, United Kingdom, and comparator countries observed in the first decade of the twenty-first century and critically evaluate proposed explanations. Methods Change-point analysis to identify the year of change in comparison of national mortality trends and linear spline models in the investigation of subnational differences using data from the Human Mortality Database, Global Burden of Disease cause-specific data, and, for the United Kingdom, national statistics data. Consideration of the impact of using different methods to estimate overall mortality is also concluded together with a review of methodological assumptions made in previous studies. Results The results confirm the slowdown in mortality improvement observed in the early twenty-first century but indicate that proposed explanations for this are inadequate on a range of counts. Discussion Mortality improvement slowed down in the early twenty-first century but the explanations advanced, such as opioid use in the United States or influenza epidemics and austerity programs in the United Kingdom, seem unlikely to account for this. Further research considering longer-term life course and cohort influences is needed. [ABSTRACT FROM AUTHOR]

Socio-economic inequalities in physical and mental health persist at older ages and previous studies have shown that partnership and parenthood histories are also associated with differentials in later-life health. These domains of adult life interact, and both may be influenced by earlier life circumstances, indicating a need for a holistic approach to understanding lifecourse influences on health at older ages. In this paper, we identify classes of lifecourse types for a United Kingdom (UK) cohort born 1933–1945 and investigate differences between the latent classes identified in physical and mental health, and changes in health over a five-year follow-up period. Data were drawn from Waves 1–5 (2009–2013) of the nationally representative UK Household Longitudinal Study. Multi-level models were used to analyse associations with summary indicators of physical and mental health measured using the SF-12, and changes in health, controlling for childhood circumstances and taking account of support from family and friends in later life. Lifecourses characterised by lower socio-economic position, early parenthood and large family size were associated with worse physical and mental health in later life, with respondents who had combined a high socio-economic position and two children being the most advantaged. The study indicates that socio-economic disparities in later-life health vary depending on the way in which individuals combine work and family life. [ABSTRACT FROM AUTHOR]

INTRODUCTION There has been significant speculation regarding the association between the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pathogen, coronavirus disease (COVID-19) and smoking. We provide an overview of the available literature regarding the association between smoking, risk of SARS-CoV-2 infection, and risk of severe COVID-19 and poor clinical outcomes, with the aim of informing public health policy and practice, particularly in England. METHODS Publications were identified utilising a systematic search approach on PUBMED and Google Scholar. Publications presenting a systematic review or meta-analysis considering the association between smoking and SARS-COV-2 infection or COVID-19 outcomes were included. RESULTS Eight studies were identified. One considered the relationship between smoking and the probability of SARS-CoV-2 infection, three considered the association between COVID-19 hospitalisation and smoking history, and six reviewed the association between smoking history and development of severe COVID-19. One study specifically investigated the risk of mortality. The studies considering risk of severe disease indicate that there is a significant association between COVID-19 and current or ever smoking. CONCLUSIONS This is a rapidly evolving topic. Current analysis remains limited due to the quality of primary data, although, early results indicate an association between smoking and COVID-19 severity. We highly recommend public health messaging to continue focusing on smoking cessation efforts. [ABSTRACT FROM AUTHOR]

We examine pathways between indicators of fertility tempo/quantum and depressive symptoms among parents aged 55+ with at least two children, using three waves of the English Longitudinal Study of Ageing. Using standard regression approaches and path analysis within the structural equation framework, we also investigate whether fertility trajectories mediated the association between childhood disadvantage and later-life depression. Results provide limited support for direct influences of fertility trajectories on depression, but indicate indirect linkages for both women and men. Associations are mediated by partnership history, social support, wealth, later-life smoking, and functional limitation. Associations between childhood disadvantage and later-life depression are partially mediated by fertility stressors. Results confirm the influence of life course experiences on depression at older ages and demonstrate the interlinked role of family and other life course pathways on later-life well-being. [ABSTRACT FROM AUTHOR]

The impact that providing care to ageing parents has on adult children's lives may depend on the long-term care (LTC) context. A common approach to test this is to compare whether the impact of care-giving varies between countries with different LTC coverage. However, this approach leaves considerable room for omitted variable bias. We use individual fixed-effects analyses to reduce bias in the estimates of the effects of informal care-giving on quality of life, and combine this with a difference-in-difference approach to reduce bias in the estimated moderating impact of LTC coverage on these effects. We draw on longitudinal data for Sweden and Denmark from the Survey of Health, Ageing and Retirement in Europe (SHARE) collected between 2004 and 2015. Both countries traditionally had generous LTC coverage, but cutbacks were implemented at the end of the 20th century in Sweden and more recently in Denmark. We use this country difference in the timing of the cutbacks to shed light on effects of LTC coverage on the impact care-giving has on quality of life. Our analyses show that care-giving was more detrimental for quality of life in Sweden than in Denmark, and this difference weakened significantly when LTC coverage was reduced in Denmark, but not in Sweden. This suggests that LTC coverage shapes the impact of care-giving on quality of life. [ABSTRACT FROM AUTHOR]

In this comparative study focusing on the population aged 50 and over in three European countries, we investigate the association between household debt and depressive symptoms, and possible country differences in this association, using data from Waves 1, 2, 4, 5 and 6 of the Surveys of Health, Ageing and Retirement in Europe (SHARE) for Belgium, France and Germany. Multi-level regression models with random intercepts for individuals were used to analyse the association between household debt status and number of depressive symptoms (EURO-D score). Country differences in the household debt–depression nexus were tested using country interaction models. After controlling for other measures of socio-economic position and physical health, low or substantial financial debt was associated with a higher number of depressive symptoms in all countries. Housing debt was strongly linked to depressive symptoms for women while the association was weaker for men. The only country difference was that for both sexes substantial financial debt (more than €5,000) was strongly associated with depressive symptoms in Belgium and Germany, but the association was weak or non-significant in France. Associations between financial debt and depression were also evident in analyses of within-individual changes in depressive symptoms for a longitudinal sub-group, and in analyses using a dichotomised, rather than a continuous, measure of depression. The findings indicate that measures of household indebtedness should be taken into consideration in investigations of social inequalities in depression and suggest a need for mental health services targeted at indebted older people. [ABSTRACT FROM AUTHOR]

Assessing the impact of caregiving for older parents on caregivers' health is increasingly important in the context of population changes and curtailment of state provided services. This has been extensively studied but results are inconsistent, possibly reflecting a lack of attention to health-related selection into the caregiver role. We use data from a nationally representative UK longitudinal study to analyse differences in the health of people aged 40–69 at baseline by whether they were 'eligible' to provide parent care (with a living parent/parent-in-law) and by whether they subsequently assumed a caregiver role. We measured initial health status using a latent variable derived from three observer-recorded indicators as well as self-reported health. We analysed trajectories of physical and mental health over a seven-year follow-up for those providing intensive care (20+ hours per week) to a parent or parent-in-law, providers of lesser amounts of care, and non-caregivers. Outcomes were measured using the SF-12 indicators of mental and physical health. showed that those with a living parent or parent-in-law had better health than those lacking these relatives. However, among potential caregivers for a parent or parent-in-law, those assuming intensive caregiving had poorer initial health than non-caregivers or those who became providers of less intensive care. Fixed effects analyses of follow-up data showed that the mental health of intensive caregivers deteriorated. However, the physical health of intensive caregivers with low levels of education improved. show the importance of taking account of whether people are at risk of providing parental care and initial health status when assessing impacts of caregiving on health. They also indicate differential effects of caregiving on health depending on socio-demographic characteristics and reaffirm the need for greater supports for those providing substantial amounts of care to older parents. • There is a double and divergent health-related selection into caregiving for a parent • Healthier potential caregivers; worse health in those assuming intensive care roles • Initial health predicts subsequent physical and mental health trajectories. • Providing intensive care is detrimental for mental health. • The physical health of light caregivers with poor health or low education improved [ABSTRACT FROM AUTHOR]

This study aimed to assess whether children's age at their parents' divorce is associated with depression in early and mid-adulthood, as indicated by medication purchase. A sibling comparison method was used to control for unobserved factors shared between siblings. The data were extracted from the Norwegian Population Register and Norwegian Prescription Database and included about 181,000 individuals aged 20-44 who had experienced parental divorce and 636,000 who had not. Controlling for age in 2004, sex, and birth order, children who were aged 15-19 when their parents divorced were 12 per cent less likely to purchase antidepressants as adults in 2004-08 than those experiencing the divorce aged 0-4. The corresponding reduction for those aged 20+ at the time of divorce was 19 per cent. However, the association between age at parental divorce and antidepressant purchases was only evident among women and those whose mothers had low education. [ABSTRACT FROM AUTHOR]

Objectives To investigate associations between number of children and partnership with depressive symptoms among older Europeans and assess whether associations are greater in Eastern than Western countries. We further analyze whether associations are mediated by provision and receipt of emotional and financial support. Methods Using cross-sectional data for five Eastern (Bulgaria, Czech Republic, Georgia, Romania, and Russia) and four Western European countries (Belgium, France, Norway, and Sweden) (n = 15,352), we investigated variation in depressive symptoms using linear regression. We fitted conditional change score models for depressive symptoms using longitudinal data for four countries (Bulgaria, Czech Republic, Georgia, and France) (n = 3,978). Results Unpartnered women and men had more depressive symptoms than the partnered. In Eastern, but not Western, European countries childlessness and having one compared with two children were associated with more depressive symptoms. Formal tests indicated that partnership and number of children were more strongly associated with depressive symptoms in Eastern than Western Europe. Discussion Availability of close family is more strongly associated with older people's depressive symptoms in Eastern than Western Europe. The collapse of previous state supports and greater economic stress in Eastern Europe may mean that having a partner and children has a greater psychological impact than in Western countries. [ABSTRACT FROM AUTHOR]

Co-resident adult children may be a source of emotional and instrumental support for older parents, but also a source of conflict and stress. Results from previous research are far from conclusive and indicate that intergenerational co-residence may have both negative and positive effects on parents' depressive symptoms and physical health. We analyse longitudinal data from four waves of the Survey of Health, Ageing and Retirement in Europe (2007-2015) to examine whether returns to the parental home by adult children are associated with changes in the quality of life of parents aged 50-75. Results from fixed effects linear regression models show that returns to the parental home by adult children were associated with decreases in parents' quality of life and that this largely reflected declines associated with the return of a child to an ‘empty nest’ where no other children were still co-resident. In line with previous research which has indicated differing effects of co-residence on parents' depressive symptoms by cultural tradition, this effect was largely driven by decreases in parents' quality of life in a grouping of Nordic/social-democratic. There were no associations between changes in parental quality of life and the returning child's characteristics, although unemployment of a child was negatively, and new partnership of a child, positively associated with changes in parental quality of life. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association between fertility history and cognition in older men and women. Method: We analyzed associations between number of children (parity) and timing of births with level and change in cog- nition among 11,233 men and women aged 50+ in England using latent growth curve models. Models were adjusted for age, socioeconomic position, health, depressive symptoms, control, social contacts, activities, and isolation. Results: Low (0-1 child) and high parity (3+ children) compared to medium parity (2 children) were associated with poorer cognitive functioning, as was an early age at entry to parenthood (<20 women/23 men). Many of these associations disappeared when socioeconomic position and health were controlled. For women, however, adjusting for socioeconomic position and social contacts strengthened the association between childlessness and poor cognition. Late motherhood (>35) was associated with better cognitive function. Conclusion: Associations between fertility history and cognition were to large extent accounted for socioeconomic position, partly because this influenced health and social engagement. Poorer cognition in childless people and better cognition among mothers experiencing child birth at higher ages suggest factors related to childbearing/rearing that are beneficial for later cognitive functioning, although further research into possible earlier selection factors is needed. [ABSTRACT FROM AUTHOR]

In the context of the current policy emphasis on extending working lives, we investigate whether the relationship between participation in paid work, other formal, and informal activities among people aged 50–69 is complementary or competitive. We also investigate differences in associations between countries using comparable longitudinal data from Denmark, France, Italy, and England. We find positive associations between informal and formal engagement in cross-sectional and longitudinal analyses. Paid work was negatively associated with formal and informal engagement, and respondents who stopped working were more likely to be engaged in formal (Denmark and France) and informal activities (England and Italy) at follow-up than respondents who continued working. However, the strongest predictor of formal and informal engagement at follow-up was baseline engagement. In the context of policy aims to extend working lives and broaden older people’s participation in other productive activities, new balances between work and other forms of engagement are still to be found. [ABSTRACT FROM AUTHOR]

The article discusses the association between early parenthood and poorer later health in Western and Eastern Europe. Topics include the challenges facing young mothers and fathers including physiological challenges for young women like pregnancy, parturition, and lactation, and the social implications of early parenthood including disruptions in educational and career progression and the increased chances of divorce.

Research on admissions to care homes for older people has paid more attention to individual and social characteristics than to geographical factors. This paper considers rural–urban differences in household composition and admission rates. Cohort: 51,619 people aged 65 years or older at the time of the 2001 Census and not living in a care home, drawn from a data linkage study based on c.28% of the Northern Ireland population. Living alone was less common in rural areas; 25% of older people in rural areas lived with children compared to 18% in urban areas. Care home admission was more common in urban (4.7%) and intermediate (4.3%) areas than in rural areas (3.2%). Even after adjusting for age, sex, health and living arrangements, the rate of care home admission in rural areas was still only 75% of that in urban areas. People in rural areas experience better family support by living as part of two or three generation households. Even after accounting for this difference, older rural dwellers are less likely to enter care homes; suggesting that neighbours and relatives in rural areas provide more informal care; or that there may be differential deployment of formal home care services. [ABSTRACT FROM AUTHOR]

Background Short and very long interbirth intervals are associated with worse perinatal, infant and immediate maternal outcomes. Accumulated physiological, mental, social and economic stresses arising from raising children close in age may also mean that interbirth intervals have longer term implications for the health of mothers and fathers, but few previous studies have investigated this. Methods Discrete-time hazards models were estimated to analyse associations between interbirth intervals and mortality risks for the period 1980–2008 in complete cohorts of Norwegian men and women born during 1935–1968 who had had two to four children. Associations between interbirth intervals and use of medication during 2004–2008 were also analysed using ordinary least-squares regression. Covariates included age, year, education, age at first birth, parity and change in coparent since the previous birth. Results Mothers and fathers of two to three children with intervals between singleton births of less than 18 months, and mothers of twins, had raised mortality risks in midlife and early old age relative to parents with interbirth intervals of 30–41 months. For parents with three or four children, longer average interbirth intervals were associated with lower mortality. Short intervals between first and second births were also positively associated with medication use. Very long intervals were not associated with raised mortality or medication use when change of coparent since the previous birth was controlled. Conclusions Closely spaced and multiple births may have adverse long-term implications for parental health. Delayed entry to parenthood and increased use of fertility treatments mean that both are increasing, making this a public health issue which needs further investigation. [ABSTRACT FROM AUTHOR]

Background 'Active ageing' has been promoted as a strategy for extending quality of life and healthy life expectancy. However, there is limited evidence from nationally representative longitudinal studies on whether engagement among older adults is associated with better outcomes and few studies have considered possible bias arising from differential study attrition. Methods We investigate associations between the engagement of people aged 50-69 in three types of activity with self-rated health and depression 2 years later using nationally representative longitudinal data from four European countries (Denmark, France, Italy and England). Data were drawn from waves 1 and 2 of the Survey of Health, Ageing and Retirement in Europe and the English Longitudinal Study of Ageing. Multivariable analysis was used to analyse associations between baseline activity and outcomes at follow-up controlling for socioeconomic, demographic and health-related variables at baseline. Multiple imputation techniques and sensitivity analyses were undertaken to investigate possible bias arising from sample attrition. Results Respondents in paid work at baseline were less likely to be depressed or to report poor or fair health at follow-up than those who were 'inactive', although not in Italy. Engagement in formal and informal activities was not significantly associated with health at follow-up. Sensitivity analyses showed that assuming that those in bad health were over-represented among study attritors weakened the association between work at baseline and health at follow-up. Conclusions Engagement in paid work may help maintain health in later life, although mechanisms and contextual influences need further investigation. [ABSTRACT FROM AUTHOR]

Abortion rates in Russia, particularly repeat abortions, are among the highest in the world, and abortion complications make a substantial contribution to the country's high maternal mortality rate. Russia also has a very high rate of hazardous alcohol use. However, the association between alcohol use and abortion in Russia remains unexplored. We investigated the longitudinal predictors of first and repeat abortion, focussing on women's alcohol use as a risk factor. Follow-up data from 2,623 women of reproductive age (16–44 years) was extracted from 14 waves of the Russian Longitudinal Monitoring Survey (RLMS), a nationally representative panel study covering the period 1994–2009. We used discrete time hazard models to estimate the probability of having a first and repeat abortion by social, demographic and health characteristics at the preceding study wave. Having a first abortion was associated with demographic factors such as age and parity, whereas repeat abortions were associated with low education and alcohol use. After adjustment for demographic and socioeconomic factors, the risk of having a repeat abortion increased significantly as women's drinking frequency increased (P<0.001), and binge drinking women were significantly more likely to have a repeat abortion than non-drinkers (OR 2.28, 95% CI 1.62–3.20). This association was not accounted for by contraceptive use or a higher risk of pregnancy. Therefore the determinants of first and repeat abortion in Russia between 1994–2009 were different. Women who had repeat abortions were distinguished by their heavier and more frequent alcohol use. The mechanism for the association is not well understood but could be explained by unmeasured personality factors, such as risk taking, or social non-conformity increasing the risk of unplanned pregnancy. Heavy or frequent drinkers constitute a particularly high risk group for repeat abortion, who could be targeted in prevention efforts. [ABSTRACT FROM AUTHOR]

Background Many studies have suggested that caregiving has a detrimental impact on health. However, these conclusions are challenged by research which finds evidence of a comparative survivorship advantage, as well as work which controls for group differences in the demand for care. Methods We use a large record linkage study of England and Wales to investigate the mortality risks of carers identified in the 2001 Census. The analysis focuses on individuals aged 35-74 living with others in private households and a distinction is made between those providing 1-19 and 20 or more hours of care per week. Logit models identify differences in carers' health at baseline and postcensal survival is analysed using Cox proportional hazards models. Results 12.2% of study members reported providing 1-19 h of care and 5.4% reported providing 20 or more hours. While carers were significantly more likely to report poorer health at baseline, survival analyses suggested that they were at a significantly lower risk of dying. This comparative advantage also held when the analyses were restricted to individuals living with at least one person with poor health. Conclusions The comparative mortality advantage revealed in this analysis challenges common characterisations of carers' health and draws attention to important differences in the way carers are defined in existing analyses. The survival results are consistent with work using similar data for Northern Ireland. However, the study also affords more uniform conclusions about carers' baseline health and this provides grounds for questioning existing hypotheses about the reasons for this advantage. [ABSTRACT FROM AUTHOR]

The article discusses the implications of population ageing for health, long-term care and welfare systems in the European Union (EU). It notes that societies need to embrace policy options to improve to robustness of health including prevention and health promotion and increased coordination of care. Particular focus is given to population trends in the region, such as migration and fluctuating birth rates. Increases in age-associated public expenditure are also addressed.

Using data on all Norwegians born 1935-68, we analyze the associations between mortality and a combined indicator of fertility and marital or partnership status and history. The focus is on ages 40-73 and the years 1980-2008 (30 million person-years of observations and 117,000 deaths). Among men in first marriages, the childless have 36 percent higher mortality than those with two or more children. The corresponding figure for women is 61 percent. The never-married have higher mortality and are differentiated even more by parenthood status. Thus, childless never-married men and women have mortality three times as high as those who are married and have two or more children. The apparent advantage associated with having at least two children is smallest among men who divorced before their oldest child's tenth birthday. Having step-children has no association with mortality for those without natural children but is associated with higher mortality among the parous. [ABSTRACT FROM AUTHOR]

Background Previous research has shown that home ownership is associated with a reduced risk of admission to institutional care. The extent to which this reflects associations between wealth and health, between wealth and ability to buy in care or increased motivation to avoid admission related to policies on charging is unclear. Taking account of the value of the home, as well as housing tenure, may provide some clarification as to the relative importance of these factors. Aims To analyse the probability of admission to residential and nursing home care according to housing tenure and house value. Methods Cox regression was used to examine the association between home ownership, house value and risk of care home admissions over 6 years of follow-up among a cohort of 51 619 people aged 65 years or older drawn from the Northern Ireland Longitudinal Study, a representative sample of ≈28% of the population of Northern Ireland. Results 4% of the cohort (2138) was admitted during follow-up. Homeowners were less likely than those who rented to be admitted to care homes (HR 0.77, 95% CI 0.70 to 0.85, after adjusting for age, sex, health, living arrangement and urban/rural differences). There was a strong association between house value/tenure and health with those in the highest valued houses having the lowest odds of less than good health or limiting long-term illness. However, there was no difference in probability of admission according to house value; HRs of 0.78 (95% CI 0.67 to 0.90) and 0.81 (95% CI 0.70 to 0.95), respectively, for the lowest and highest value houses compared with renters. Conclusions The requirement for people in the UK with capital resources to contribute to their care is a significant disincentive to institutional admission. This may place an additional burden on carers. [ABSTRACT FROM AUTHOR]

Background Previous research has shown that home ownership is associated with a reduced risk of admission to institutional care. The extent to which this reflects associations between wealth and health, between wealth and ability to buy in care or increased motivation to avoid admission related to policies on charging is unclear. Taking account of the value of the home, as well as housing tenure, may provide some clarification as to the relative importance of these factors. Aims To analyse the probability of admission to residential and nursing home care according to housing tenure and house value. Methods Cox regression was used to examine the association between home ownership, house value and risk of care home admissions over 6 years of follow-up among a cohort of 51 619 people aged 65 years or older drawn from the Northern Ireland Longitudinal Study, a representative sample of ≈28% of the population of Northern Ireland. Results 4% of the cohort (2138) was admitted during follow-up. Homeowners were less likely than those who rented to be admitted to care homes (HR 0.77, 95% CI 0.70 to 0.85, after adjusting for age, sex, health, living arrangement and urban/rural differences). There was a strong association between house value/tenure and health with those in the highest valued houses having the lowest odds of less than good health or limiting long-term illness. However, there was no difference in probability of admission according to house value; HRs of 0.78 (95% CI 0.67 to 0.90) and 0.81 (95% CI 0.70 to 0.95), respectively, for the lowest and highest value houses compared with renters. Conclusions The requirement for people in the UK with capital resources to contribute to their care is a significant disincentive to institutional admission. This may place an additional burden on carers. [ABSTRACT FROM AUTHOR]

We investigated associations between later-life health and fertility history for women and men, using the British Household Panel Survey. We modelled health and its rate of change jointly with sample retention over an 11-year period. For women, childlessness is associated with limitation of activity for health reasons and faster acquisition of the limitation. High parity (four or more children) is associated with poorer health for both women and men. For the parous, this association is also found when age at first birth is controlled. Early parenthood is associated with poorer health. For parents of two or more children, a birth interval of less than 18 months is associated with having a health limitation and an accelerated rate of acquiring it. We conclude that biosocial pathways link parenthood careers and the later-life health of both women and men, and that implications of closely spaced births for parents merit further attention. [ABSTRACT FROM AUTHOR]

Our primary aim is to develop and validate a population health metric for survey-based health assessment that combines information from both self-reported and observer-measured health indicators. A secondary objective is to use this index to examine gender and socioeconomic differentials in the health status of older people. We use data from the second wave of the English Longitudinal Study of Ageing (ELSA) conducted in 2004 (N = 8,870). Information from three observer-measured and three self-reported health indicators was combined, using a latent variable modeling approach. A model that decomposed the manifest health indicators to valid health, systematic error, and random error was found to fit the data best. The latent health dimension represented somatic health, and was tested against three external criteria: height, waist-hip ratio, and smoking status. We present the Latent Index of Somatic Health (LISH), as well as a procedure for deriving the LISH in surveys employing both self- and observer-measured health indicators. Observer-measured and self-reported indicators were found to be equally biased in indexing population somatic health, with the exception of self-reports of functional limitations, which was the most reliable somatic health indicator. As expected, results showed that women had worse health than men and that socioeconomic advantage is associated with better somatic health. [ABSTRACT FROM AUTHOR]

Purpose: As shared family context may be an important influence on mental health, and gender differences in mental health, in later life we investigated how gender, family-related variables and gender roles were associated with mental health in older married couples. Methods: Using data on a sample of 2,511 married couples born between 1923 and 1953 (drawn from the British Household Panel Survey) we analysed differences in the mental health of husbands and wives by fertility history, length of marriage, presence of co-resident children, reported social support, hours of household work, attitudes to gender roles and health of husband and wife. Mental health in 2001 was measured using the General Health Questionnaire (GHQ-12). Multilevel modelling was used to assess effects in husbands and wives and variations between husbands and wives. Results: Results showed that although the mental health of married couples was correlated, wives had poorer mental health than their husbands. The gender difference was smaller in couples who lived with a child aged 16 or more (and had no younger co-resident children) and in couples in which both spouses had experienced early parenthood. The influence of individual and family characteristics on mental health also differed between husbands and wives. For husbands, early fatherhood and co-residence with a child or children aged 16 or more increased the odds of poor mental health. For wives, having had a child when aged 35 or more appeared protective while having traditional gender role attitudes increased the odds of poorer mental health. Conclusions: The role of family characteristics in the shared marital context has complex associations with mental health, some of which seem gender specific. Although wives express more mental distress, husbands in general show poorer mental health related to family characteristics. [ABSTRACT FROM AUTHOR]

Background The past 30 years have seen major changes in the living arrangements of older people and in long-term care policy in England and Wales. Co-resident family care and institutional care can be alternatives for seriously disabled older people, so changes in the availability of either may affect demands for the other. Aims To analyse changes in older people's living arrangements in three successive decades in England and Wales and compare the subsequent mortality of older people living with relatives, those living alone or with a spouse, and those living in institutions. Methods Cross-sequential analysis of household circumstances at the beginning and end of three decades using multinomial logistic regression of data from the Office for National Statistics Longitudinal Study. Poisson regression analysis of subsequent mortality. Results Risks of moving to an institution in 1991–2001 relative to living alone or in a couple were lower than in 1981–1991 for women and men and also lower in comparison with living with relatives for women. Chances of living with relatives rather than alone or in a couple showed a downward trend over time. Institutional residents had higher mortality than those living alone/in a couple or those with relatives. This excess was greater in 2001–2005 than in previous periods; even so, 26% of male and 36% of female institutional residents in 2001 survived 3 years. Conclusion Policy changes are important influences on use of institutional care. The health status of older people living with relatives and those in institutions is not equivalent. [ABSTRACT FROM PUBLISHER]

In this paper we examine associations between the fertility histories of older British women and men and their quality of life using data on a sample of 6,374 men and women born between 1923 and 1949 drawn from the British Household Panel Survey (BHPS). Quality of life in 2001 was measured using scores from the four subscales of the CASP-19 questionnaire: control, autonomy, pleasure and self-realisation. Fertility histories were derived using information on the births of children collected in all waves of the BHPS. The aspects of fertility history investigated were number of children born and parents' ages at birth of first and last child. Age, education, marital status, tenure status, smoking, co-residence with one or more children, perceived social support and health limitations were included as covariates. The results suggested that early entry to parenthood and to some extent high parity were related to poorer quality of life. These associations were mostly mediated by socio-economic, social support and health factors. Compared to women with two children, nulliparous women expressed a higher level of autonomy, and both nulliparous women and those with four or more children a higher level of self-realisation. Low parity was related to a lower level of pleasure, especially among men, but this relationship appeared weaker and among women was not significant when background factors were controlled. [ABSTRACT FROM AUTHOR]

In this paper we examine associations between the fertility histories of older British women and men and their quality of life using data on a sample of 6,374 men and women born between 1923 and 1949 drawn from the British Household Panel Survey (BHPS). Quality of life in 2001 was measured using scores from the four subscales of the CASP-19 questionnaire : control, autonomy, pleasure and self-realisation. Fertility histories were derived using information on the births of children collected in all waves of the BHPS. The aspects of fertility history investigated were number of children born and parents' ages at birth of first and last child. Age, education, marital status, tenure status, smoking, co-residence with one or more children, perceived social support and health limitations were included as covariates. The results suggested that early entry to parenthood and to some extent high parity were related to poorer quality of life. These associations were mostly mediated by socio-economic, social support and health factors. Compared to women with two children, nulliparous women expressed a higher level of autonomy, and both nulliparous women and those with four or more children a higher level of self-realisation. Low parity was related to a lower level of pleasure, especially among men, but this relationship appeared weaker and among women was not significant when background factors were controlled. [ABSTRACT FROM AUTHOR]

Abstract: The relationship between women''s reproductive histories and later all-cause mortality has been investigated in several studies, with mixed results. Some studies have also considered cause-specific mortality and some have included men, but none has done both. We analyse associations between parity and age of first birth for women and men across 11 cause-of-death groupings using Norwegian register data for complete cohorts born 1935–1968 whose mortality was observed 1980–2003 (i.e. at ages 45–68). Age, period, educational level, marital status, region of residence and population size of municipality were included as co-variates. In total, there were 63,000 deaths. Results showed that relative to parents of two children, childless men and women and those with one child had higher mortality risks for nearly all cause of death groupings. High parity (4+ children) was associated with raised male mortality from accidents and violence and higher mortality from cancer of the cervix among women. For other cause and gender groupings there was either little difference between those with two children and those of higher parities or an overall negative association between parity and mortality. Among men with the lowest level of education, however, high parity was positively associated with mortality from circulatory diseases. For all causes except female breast cancer, there was an inverse association between age at first birth and mortality risk. Similarities observed across cause groups and for women and men suggest that much of the fertility–mortality relationship is a result of selection or effects of reproductive behaviour on lifestyle. The latter may include both beneficial effects and harmful stress responses. However, physiological mechanisms are most probably important for some causes of death for women. Research on associations between parenting histories, health related behaviours, social support exchanges and reported or measured stress is needed to clarify mechanisms underlying the associations reported here. [Copyright &y& Elsevier]

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 selfreported 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. [ABSTRACT FROM AUTHOR]

Objectives. To investigate the influence of country of residence on depression and well-being among older Europeans, after establishing the between-country measurement invariance of both constructs. Methods. We used data from a cross-sectional nationally representative population-based sample of older Europeans, the Survey of Health, Ageing, and Retirement in Europe (SHARE). The analysis sample comprised 13,498 older Europeans from nine countries. The EURO-D was used to measure depression, and a well-being outcome was derived from self-report items available in SHARE. The between-country measurement invariance of both mental health outcomes was established using modern psychometric modeling techniques. Results. After adjustment for demographic characteristics and the presence of chronic illness, Spain was the country scoring highest on depression and Denmark highest on well-being. Optimal mental health was associated with higher educational attainment and being married. Discussion. There is considerable between-country heterogeneity in later-life mental health in Europe. The Scandinavian countries, the Netherlands, and Austria, do best (low depression/high well-being), followed by Germany and France, whereas residents of Spain, Italy, and Greece report the worst mental health. [ABSTRACT FROM PUBLISHER]

Abstract: The idea that personality traits may influence longevity is based on the observation that many of the leading risk factors for mortality are behavioural tendencies such as diet, exercise, or smoking patterns. We employed data from the 1984/85 Health and Lifestyle Survey (HALS). Mortality follow-up was based on the June 2005 update of the HALS death and cancer data files. A structural equation modelling approach to survival analysis was employed for the first time in mortality research. This allowed us to investigate the direct as well as indirect links via variables that lie on the causal pathway of the association between extraversion, neuroticism and mortality. Psychological distress, alcohol consumption, smoking and somatic health were entered in the model as possible mediators. Neuroticism was indirectly associated with an increased risk of all cause mortality among women and men, mostly via somatic health and psychological distress, and to a lesser extent via smoking, whereas in women only, neuroticism had a protective role (directly). Extraversion was to a lesser extent associated with mortality risk with most of the effect being mediated by smoking. It appears that neuroticism and extraversion have a more complex association with all cause mortality than previously suggested. [Copyright &y& Elsevier]

The article presents comparative result from studies on women's fertility and mortality in exploring the effects on their reproductive behavior and mortality in Africa. The findings suggests that in populations in which fertility control is usual, factors that influence the relative costs and benefits if childbearing may influence associations between fertility histories and later mortality. The result also indicates that teenage childbirth was associated with higher mortality risk.

Objective: to identify socio-psychological predictors of mortality during a 20-year follow-up period among people aged 65 to <85 and 85+ at baseline interview. Study design and setting: elderly people living at home in East London and mid-Essex, who responded to surveys of successful survival in older age in the late 1980s; their mortality was traced through the National Health Central Registry. Results: adjusted analyses show that, as expected, the hazard rate for mortality over a 20-year follow-up was reduced for younger respondents and increased for less functionally able respondents. The hazard ratio for males was almost one and a half times that of females. The hazard rate was also reduced with each categorical increase in life satisfaction and was consistently reduced for those who undertook crafts, social visiting and activities regularly. There was some variation by age and sex. Conclusion: the results show that social participation is associated with lower risks of death, particularly among people aged 65 to <85, and that life satisfaction is also protective, particularly among females and people aged 85+, even when health status and socio-demographic circumstances are controlled. The study thus provides support for the hypothesised influence of social participation and subjective well-being on survival in older age. [ABSTRACT FROM AUTHOR]

In this paper, we examine associations between employment history and marital status and unpaid care provision among those aged 40–59 in England and Wales. We used data from a large nationally representative longitudinal study, the Office for National Statistics Longitudinal Study. Initially based on a sample drawn from the 1971 Census, in 2001 this study included data on 110 464 people aged 40–59 of whom 5% provided 20 or more hours per week of unpaid care. We analysed associations between caregiving of this intensity and current employment, employment history, employment characteristics, marital status, and employment after childbearing. Among men, caregiving was associated with a history of lower levels of employment. The small group of men with a history of least employment were 70% more likely to provide care than those with a history of most employment. Among women, caregiving was associated with a history of non-employment, but there were no differences between those with fully engaged and partially engaged labour market histories. Analyses of a subset of data on women who had a child between 1981 and 1991 showed that those who had returned to full-time paid work by 1991 were over 50% less likely to later become caregivers. Some associations between employment characteristics and propensity to provide 20 or more hours per week of care were also identified. Those in public sector jobs and those previously in employment with a caregiving dimension were 20–30% more likely than other working women to provide unpaid care. These results suggest a continuing gender dimension in care provision which interacts with marital status and employment in gender-specific ways. It also suggests that implementation of strategies to enable those in midlife to combine caregiving and work responsibilities, should they wish to do so, should be an urgent priority. [ABSTRACT FROM AUTHOR]

We investigate mortality differentials by marital status among older age groups using a database of mortality rates by marital status at ages 40 and over for seven European countries with 1 billion person-years of exposure. The mortality advantage of married people, both men and women, continues to increase up to at least the age group 85-89, the oldest group we are able to consider. We find the largest absolute differences in mortality levels between marital status groups are at high ages, and that absolute differentials are: (i) greater for men than for women; (ii) similar in magnitude across countries; (iii) increase steadily with age; and (iv) are greatest at older age. We also find that the advantage enjoyed by married people increased over the 1990s in almost all cases. We note that results for groups such as older divorced women need to be interpreted with caution. [ABSTRACT FROM AUTHOR]

Abstract: Recent years have seen a burgeoning of intergenerational programmes aiming to improve the well being of participants. However, very few programmes have been formally evaluated. In this paper we report results from a randomised controlled trial of a school-based intergenerational intervention undertaken in Brazil. Randomly selected samples of 253 adolescents and 266 elders aged 60 and over resident in the school''s catchment area were administered a questionnaire including questions on cognitive components of social capital, family relationships, and self-rated health. Participants were then randomly allocated to control and intervention groups. The intervention comprised participation in a 4 month programme of intergenerational activities in which the elders shared their memories with the students. At the end of the intervention the questionnaire was re-administered to the samples. High proportions (85–95%) of both samples completed the questionnaires but compliance with the intervention was low in the elderly group. In the analysis of results from the elderly sample, we therefore compared the control group with the group assigned to the intervention (intention to treat analysis). Results showed that adolescents in the intervention group were nearly three times more likely to rate their health as good than those in the control group, but also more likely to judge that most people were selfish. In the elderly sample, those from the intervention group were over twice as likely as those from the control group to report positively on the helpfulness of neighbours; judge most people to be honest or consider their family relationships as good. There were no significant differences between groups on other outcome measures. These results suggest that structured intergenerational activities may have positive effects on some aspects of social capital for both adolescents and elderly people, although further research is needed to elucidate the processes involved and the extent to which the findings are context specific. This study is the first to use a controlled trial design to evaluate this type of intervention and is valuable in showing that this design can be used in interventions of this kind, and also the difficulties involved. [Copyright &y& Elsevier]

Background: Only a minority of older people in England and Wales live in institutional care, but among the older of the old, this minority is large. Disability is the major driver of admissions, but socio-demographic factors are also relevant. Understanding more about the influence of these is important for planning by long-term care. Objective: To investigate effects of socio-demographic factors, including housing tenure, household type, marital status, and number of children, on the proportions of elderly people who made a transition from living in the community in 1991 to living in institutional care in 2001. Subjects and setting: Nationally representative record linkage study including 36,650 people aged 65 years and over, living in the community in England and Wales in 1991, who were still alive in 2001. Nineteen thousand women aged 75-89 years in 2001 were included in additional analyses of effects of parity (number of children borne). Methods: Bi-variate and multivariate analyses of variations in sample proportions, who by 2001 were resident in institutional care. Results: 4.3% of men and 9.3% of women in the surviving sample then aged 75 years and over, were in institutional care in 2001. Older age, living in rented accommodation, living alone in 1991 and being unmarried in 2001, as well as long-term illness, were associated with higher proportions making this transition. Women had higher risks than men. Childless women aged 64-79 years in 1991 had a 25% higher risk than women with children of being in institutional care in 2001. Conclusion: Socio-demographic factors continue to influence risks of entry to institutional care in England and Wales. [ABSTRACT FROM AUTHOR]

Fatherhood is an important domain of the lives of most men but, in contrast to extensive research into associations between marriage and health, possible effects of paternity on later life health and mortality have attracted relatively little attention. Of those studies that have been undertaken, many relate to historical or less developed country populations with high levels of fertility and much less is known about associations in contemporary developed societies. In this paper we use data from a large nationally representative record linkage study of men in England and Wales to analyse associations between aspects of paternity history and subsequent mortality and health in a sample of 20,260 mature men in long‐term first marriages. At entry to the study in 1981 sample members had a mean age of 63 and a mean duration of marriage of 38 years. Mortality was observed for a twenty three year period (1981–2004) and indicators of health status measured ten (in 1991) and twenty years (in 2001) after entry into the analysis. Paternity characteristics investigated included number of children born and, among men who were fathers, early or late paternity; experience of a particularly short or long interval between marriage and first birth; and experience of one or more short intervals between births. Socio‐economic characteristics included in the analysis were based on measures relating to educational attainment, occupational social class and housing tenure, in the latter two cases observed at more than one point of time. Contrary to our hypotheses, results showed no later life disadvantages of childlessness in this sample of men who had experienced long term first marriages. However, aspects of paternity history were associated with later life health and mortality. Most notably men who had had a child before the age of 23 had higher mortality and higher odds of poor health in 1991 and 2001 than other fathers, while men who had a child at ages 40 or over had lower mortality and lower risks of long term illness in 1991. Men who had had four or more children also appeared to have worse later life health in some of the health indicators used in this study. Limitations of the data include absence of information on contacts with children or on health related behaviours hypothesised to be associated with fatherhood. Results nevertheless suggest long‐term consequences of particular paternity pathways. [ABSTRACT FROM PUBLISHER]

The ‘sandwich generation’ has been conceptualised as those mid-life adults who simultaneously raise dependent children and care for frail elderly parents. Such a combination of dependants is in fact very unusual, and the more common situation is when adults in late mid-life or early old age have one or more surviving parents and adult but still partly dependent children. It can be hypothesised that for parents in this pivotal position, the demands from adult children and from elderly parents compete, with the result that those who provide help to one are less likely to provide help to the other. An alternative hypothesis, however, is that family solidarity has an important influence but is not universal, so that some pivotal-generation parents engage in intergenerational exchange in both directions, and there is a positive association between helping parents and helping children. To investigate this question, the paper presents an analysis of data from two broadly comparable national surveys, in Great Britain and the United States, on the care provided by women aged 55–69 years to their descendent and ascendent relatives. The results show that around one-third of the women reported providing help to members of both generations, and that around one-fifth provided support to neither. They broadly support the solidarity hypothesis, but provide some evidence that having three or more children is associated with a reduced likelihood of providing help to a parent. [ABSTRACT FROM AUTHOR]

This paper considers the processes and circumstances that create vulnerability among older people, specifically to a very poor quality of life or an untimely or degrading death. Models of ageing processes are used to define vulnerable older people as those whose reserve capacity falls below the threshold needed to cope successfully with the challenges they face. Compensatory supports may intervene to mitigate the effects of challenges and to rebuild reserve. The dimensions of reserve, challenges and compensation are discussed, with emphasis on demographic and other influences on the availability of family and social support. Policy initiatives to reduce vulnerability can focus on each part of the dynamic process that creates vulnerability, namely, ensuring that people reach later life with ‘reserve’, reducing the challenges they face in later life, and providing adequate compensatory supports. The promotion through the lifecourse of healthy lifestyles and the acquisition of coping skills, strong family and social ties, active interests, and savings and assets, will develop reserves and ensure that they are strong in later life. Some of the physical and psychological challenges that people may face as they age cannot be modified, but others can. Interventions to develop compensatory supports include access to good acute care and rehabilitation when needed, substitute professional social and psychological help in times of crisis, long-term help and income support. Our knowledge of which interventions are most effective is however limited by the paucity of rigorous evaluation studies. [ABSTRACT FROM AUTHOR]

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 I % 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. [ABSTRACT FROM AUTHOR]

In this paper data from a nationally representative British longitudinal study are used to analyse exchanges of support between Third Age parents (aged 55–75) and their adult children. Results show that between two thirds and three quarters of parents in this age group were involved in some sort of exchange relationship with at least one of their children. Generally, more Third Age parents were providers than recipients of help, but there was a strong reciprocal element to intergenerational exchange with, for example, married parents who provided support to at least one child being twice as likely as those who did not to receive support from a child, after allowance for a range of relevant parental and child characteristics. Parental characteristics associated with higher probability of providing help included higher income, home ownership and being married or widowed rather than divorced. Higher income and home ownership were, however, negatively associated with odds of receiving help from a child, again after adjustment for other co-variates, suggesting socio-economic differences in the balance of support exchanges. Children seem responsive to parental needs in that receipt of help from a child was positively associated with older parental age and with parental disability. The paper shows that in Britain, as in the USA, the balance of intergenerational exchanges involving Third Age adults is downward rather than upward, in contravention of depictions of older adults as‘burdens’ on younger generations. Current demographic and social changes are, it is argued, likely to increase support demands from adult children to Third Age parents in coming decades. [ABSTRACT FROM AUTHOR]

Older people now constitute the majority of those with health problems in developed countries so an understanding of health variations in later life is increasingly important. In this paper, we use data from three rounds of the Health Survey for England, a large nationally representative sample, to analyse variations in the health of adults aged 65–84 by indicators of attributes acquired in childhood and young adulthood, termed personal capital; and by current social resources and current socio-economic circumstances, while controlling for smoking behaviour and age. We used six indicators of health status in the analysis, four based on self-reports and two based on nurse collected data, which we hypothesised would identify different dimensions of health. Results showed that socio-economic indicators, particularly receipt of income support (a marker of poverty) were most consistently associated with raised odds of poor health outcomes. Associations between marital status and health were in some cases not in the expected direction. This may reflect bias arising from exclusion of the institutional population (although among those under 85 the proportion in institutions is very low) but merits further investigation, especially as the marital status composition of the older population is changing.Analysis of deviance showed that social resources (marital status and social support) had the greatest effect on the indicator of psychological health (GHQ) and also contributed significantly to variation in self-rated health, but among women not to variation in taking three or more medicines and among men not to self-reported long-standing illnesses. Smoking, in contrast, was much more strongly associated with these indicators than with self-rated health. These results are consistent with the view that self-rated health may provide a holistic indicator of health in the sense of well-being, whereas measures such as taking prescribed medications may be more indicative of specific morbidities. The results emphasise again the need to consider both socio-economic and socio-psychological influences on later life health. [Copyright &y& Elsevier]

In this article we examine changes in the proportion of older widowed and divorced women in England and Wales moving from 'independent' to two kinds of 'supported' household-supported private households and institutions-during the decades 1971-81 and 1981-91. Our main aim was to see whether observed increases in institutionalisation over this period were the result of a decreased propensity to move to the households of relatives. We used the ONS Longitudinal Study, a record linkage study including individual level data from the 1971, 1981 and 1991 censuses of England and Wales. A multinomial logit model was used to investigate the correlates of transitions from independent to supported private households versus institutions among elderly widowed and divorced women. While the overall rate of transitions to join either supported private households or institutions was largely the same in the two decades, the balance between the two shifted markedly in favour of transitions to institutions. In terms of the limited range of covariates it was possible to consider, owner-occupiers were significantly more likely than tenants to move to supported private households than to institutions. [ABSTRACT FROM AUTHOR]

Examines the influence of socio-economic and health differences on the family support provided by parents to adult children. Factors affecting the provision of support; Comparison between the family support provided by British and American families; Types of help provided by family members.