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Background There is substantial evidence on the importance of voluntary activities for the health of middle-aged and older adults. Evidence on the effects of health and well-being on volunteering is more limited. This study examines reciprocal longitudinal associations between voluntary and/or charity activities and 21 indicators related to physical health, well-being, cognitive impairment and daily life functioning among middle-aged and older adults. Methods Longitudinal data were collected between 2011 and 2020 from a sample of 19 821 middle-aged and older adults from 15 countries participating in the Survey of Health, Ageing and Retirement in Europe. An outcome-wide analysis and an exposure-wide analysis were applied and generalized estimating equations were used. Robustness analyses were conducted. Results Voluntary and/or charity activities almost every week or more often were prospectively associated with greater emotional well-being, reduced risks of limitations in activities of daily living and of being diagnosed with Alzheimer's disease at a 6-year follow-up. Positive reverse associations were found from emotional well-being to volunteering. Limitations in daily life activities, increased loneliness, high blood cholesterol, hypertension and chronic lung disease were found to impede participation in voluntary and/or charity activities over time. Feedback loops between voluntary and/or charity activities and well-being and limitations in daily activities may exist. Conclusion Understanding the reciprocal nature of the relationship between volunteering and health and well-being can help identify strategies to encourage volunteering among middle-aged and older adults with specific health conditions and to target health promotion efforts towards volunteers. [ABSTRACT FROM AUTHOR]

Background As populations age, the possible consequences of increased frailty are a major concern for the health sector. Here, we investigate how life expectancy with and without frailty has changed during a 10–11-year-period across Europe. Methods The Sullivan method was used to investigate changes in life expectancy with and without frailty in 10 European countries. Frailty status (non-frail, pre-frail and frail) was determined by use of the Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI). Data on frailty prevalence was obtained from 21 698 individuals in wave 1 (2004–05) and 38 859 individuals in wave 6 (2015) of the SHARE. Information on mortality was obtained from the Eurostat Database. Results In 2015, women aged 70 spent 25.0% (95% CI: 24.0–26.1) of their remaining life expectancy in a frail state, and the number for men was 11.5% (95% CI: 10.7–12.3). Southern Europeans spent 24.2% (95% CI: 22.9–25.4) of their remaining life expectancy in a frail state and the numbers for Central Europeans and Northern Europeans were 17.0% (95% CI: 16.0–17.9) and 12.2% (95% CI: 10.9–13.5), respectively. From 2004–05 to 2015, life expectancy increased by 1.1 years (from 15.3 to 16.4 years) for 70-year-old Europeans. Similarly, non-frail life expectancy increased by 1.1 years (95% CI: 0.8–1.4), whereas no significant changes in life expectancy in frail states were observed. Conclusions This study suggests that Europeans today spend more years in a non-frail state than Europeans did 10–11 years ago. Our findings reflect a considerable inequality by gender and region. [ABSTRACT FROM AUTHOR]

Background Frailty is a geriatric condition associated with adverse health outcomes. As physical inactivity, low protein intake and poor social network are known risk factors, we aimed to assess the influence of these parameters and their interaction in an 11-year follow-up study on a Europe-wide level. Methods Data from the Study on Health, Ageing and Retirement in Europe were used, including 22 226 community-dwelling robust and prefrail persons aged ≥50 years, from 11 countries. Frailty was assessed with the 'Frailty Instrument for Primary care of the Survey of Health, Ageing and Retirement in Europe'. Additionally, self-reported physical activity (PA), protein intake and satisfaction with social network were assessed. The impact of these parameters on the development of frailty was calculated using multivariate cox regressions. Results Performing no regular PA, was associated with higher hazards ratio (HRs) for frailty compared with performing regular PA [men: 1.90 (95%CI: 1.50–2.42); women: 1.65 (95%CI: 1.25–2.18)]; HRs for low protein intake were 1.16 (95%CI: 0.93–1.46) for men and 1.05 (95%CI: 0.80–1.37) for women. And HR for poor social network were 0.92 (95%CI: 0.74–1.15) for men and 1.72 (95%CI: 1.31–2.27)] for women. In general, persons with a combination of two of the assessed risk factors had a higher risk for frailty compared with those with no or only one of the risk factors. However, no significant synergy index could be found. Conclusion The results illustrate the importance of PA, but also of nutritional and social network to prevent frailty. [ABSTRACT FROM AUTHOR]

Background Cross-national comparison studies on gender differences have mainly focussed on life expectancy, while less research has examined differences in health across countries. We aimed to investigate gender differences in cognitive function and grip strength over age and time across European regions. Methods We performed a cross-sectional study including 51 292 men and 62 007 women aged 50 + participating in the Survey of Health, Ageing and Retirement in Europe between 2004–05 and 2015. Linear regression models were used to examine associations. Results In general, women had better cognitive function than men, whereas men had higher grip strength measures. Sex differences were consistent over time, but decreased with age. Compared with men, women had higher cognitive scores at ages 50–59, corresponding to 0.17 SD (95% CI 0.14, 0.20) but slightly lower scores at ages 80–89 (0.08 SD, 95% CI 0.14, 0.00). For grip strength, the sex difference decreased from 18.8 kg (95% CI 18.5, 19.1) at ages 50–59 to 8.5 kg (95% CI 7.1, 9.9) at age 90 +. Northern Europeans had higher cognitive scores (19.6%) and grip strength measures (13.8%) than Southern Europeans. Gender differences in grip strength were similar across regions, whereas for cognitive function they varied considerably, with Southern Europe having a male advantage from ages 60–89. Conclusion Our results illustrate that gender differences in health depend on the selected health dimension and the age group studied, and emphasize the importance of considering regional differences in research on cognitive gender differences. [ABSTRACT FROM AUTHOR]

Background The scope of this work was to investigate socioeconomic inequalities among European adults aged 50 or older in chronic diseases and behavioural risk factors for these diseases, namely, smoking habits, obesity and physical inactivity, between 2004 and 2015. Methods Data for this study were drawn from the Survey of Health, Ageing and Retirement (SHARE) in Europe, which is a panel database of microdata on health, socioeconomic status and social and family networks of people aged 50 years or older, covering most of the European Union. The predicted number of non-communicable diseases (NCDs) was used to estimate the concentration index and to find the contributions of determinants to socioeconomic inequalities in chronic diseases. Results The inequality disfavoured the poor in both years, but the effect was stable from 2004 (C = −0.071) to 2015 (C = −0.081). Inequality was shown to be attributed mostly to physical inactivity and obesity and this contribution increased during the study period. Among socioeconomic status (SES) determinants, education and marital status were the most concentrated in both years, while physical inactivity and obesity were the most concentrated behavioural risk factors in both years. Conclusions To prevent chronic diseases, health policy should aim not only to improve individual health behaviours in the population, but also to reduce socioeconomic inequality. Our study suggests promoting a healthy lifestyle in the most disadvantaged socioeconomic classes as a strategy to improve the health conditions of the whole population. [ABSTRACT FROM AUTHOR]

Background Mental health problems are a risk factor for loss of paid employment. This study investigates (i) the relation between depressive symptoms and different involuntary pathways of labour force exit and (ii) explores gender and geographical differences in this relation. Methods The study population consisted of 5263 individuals in paid employment aged between 50 years and the country-specific retirement age from 11 European countries participating in the longitudinal Survey of Health, Ageing and Retirement in Europe (SHARE). Self-reported depressive symptoms at baseline were assessed using the EURO-D. Employment status was derived from interviews after 2 and 4 years. Cox proportional hazards regression analyses were used to investigate the association between depressive symptoms and labour force exit via disability benefit and unemployment. Population attributable fractions (PAFs) were calculated to estimate the contribution of depressive symptoms to these pathways of labour force exit. Results Both men and women with a EURO-D score ≥4 had a >2-fold increased risk of a disability benefit (HR: 2.46, 95%CI 1.68–3.60) after adjustment for demographics and work-related characteristics. Among men depressive symptoms elevated the risk of becoming unemployed at follow-up (HR 1.55; 95%CI: 0.94–2.57). The PAF was 0.18 for disability benefit and 0.04 for unemployment, and varied across European regions. Conclusions Individuals with depressive symptoms are at increased risk of losing paid employment, which in turn may aggravate their symptoms. Targeting depressive symptoms with public health and occupational policies should be considered to reduce the burden of mental diseases in Europe. [ABSTRACT FROM AUTHOR]

Background We observed a lack of population-based longitudinal research examining the association of disadvantaged childhood socioeconomic circumstances (CSC) and disability [activities of daily living (ADL) and instrumental activities of daily living (IADL)] in older age, and whether socioeconomic attainments in adulthood can compensate for a poor socioeconomic start in life. Methods Data on 24 440 persons aged 50–96 in 14 European countries (Survey of Health, Ageing and Retirement in Europe) were used to measure the associations between CSC and limitations with ADL and with IADL, using mixed-effects logistic regression models. Models stratified by gender were adjusted for education during young adulthood, main occupation during middle age, ability to make ends meet during old age and potential confounding and control variables. Results Risks of ADL and IADL limitations increased with age and were different between women and men. For women, a gradient across CSC strata was observed, showing that the more disadvantaged the CSC, the higher the risk of ADL and IADL limitations in old age, even after adjustment for adult socioeconomic indicators. For men, the association between CSC and disability was mediated by the main occupation in middle age and the ability to make ends meet at older age. Conclusion Women who grew up in socioeconomically disadvantaged households were at higher risk of disability in older age and this disadvantage was not attenuated by favourable adult socioeconomic conditions. Men were more likely to make up for a disadvantaged start in adulthood. [ABSTRACT FROM AUTHOR]

Background The demographic aging of societies and the need to adapt to this trend makes it important to gain insight into the way retirement affects different forms of health, and factors that influence this relationship. Pre-retirement job characteristics have only rarely been included in this type of research. Methods The regressor variable method is applied to two waves (4 and 5) of data from the Survey of Health Ageing and Retirement in Europe, a multi-national prospective cohort study. The final sample consists of 9092 people aged 50–70 at wave 4, of whom 1257 retired voluntarily. Health is assessed through the presence of physical health problems, general self-rated health and the EURO-D scale for depressive symptoms. Results The findings indicate that retirement from jobs with high physical demands leads to a relative improvement in general self-rated health compared with those who remain at work. Retirement from a psychologically demanding job is associated with less depressive symptoms. No effects are found for health measured as the presence of physical health problems. Conclusion Different types of measures for health yield different results for outcomes of retirement; pre-retirement job demands play an important role in how retirement affects health; physical demands seem primarily related to physical health benefits, psychological demands seem primarily related to mental health benefits. [ABSTRACT FROM AUTHOR]

Demographic trends in Europe are currently being shaped by an ageing population, falling fertility rates and diverse migration flows. Fertility rates are lowest in Eastern and Southern Europe with Eastern Europe also experiencing the lowest net migration and an exodus of its working population. All regions in Europe are experiencing aging of their population with some countries having the added burden of high rates of unemployment among the working age population. The impact of these demographic changes on the current and future public health of the country depends on how countries have been preparing and adapting to demographic changes over the past years. Changes in age structure and ethnic composition will put further strain on health care and welfare systems and requires careful planning. A multi-faceted approach which goes beyond the health care system is required and countries need to look beyond their borders in search as to how countries are tackling these important issues. As Europe ages the concept of healthy aging should become an increasing priority focus for European Public Health. [ABSTRACT FROM AUTHOR]

Background: The European population is aging. The main drivers of public spending on health care for people of 65 years and older are hospital admission and admission to long-term care facilities. High quality community care can be a cost-effective and quality solution to respond to the impact of ageing populations on health-care systems. It is unclear how well countries are equipped to provide affordable and quality community care. The aim of this article is to describe and compare community care delivery with care-dependent older people in Europe. Methods: This study is conducted within the European Union-financed IBenC project [Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (FP7)] in which six European countries are involved. To compare the community care delivery with care-dependent older people in these countries, we performed a systematic comparison of macro indicators using metadata complemented with data from multinational surveys. Results: Data on the following dimensions are described and compared: population of the country, governmental expenditures on health, sources of community health services funding, governmental vision and regulation on community care, community care organisations and care professionals, eligibility criteria for and equity in receiving care and the involvement of informal care. Conclusion: Because of the variations in the European community care contexts, the growing demand for community care as a cost-effective and quality solution to the care burden of aging populations will have country-specific impacts. When learning from other countries' best practices, in addition to researchers, policy makers should take full account of local and national care contexts. [ABSTRACT FROM AUTHOR]