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The article has several objectives. First, it aims to discuss, based on the international literature analysis, theoretical models and factors influencing early retirement decisions, and limiting work ability and employability of older people. Second, the concept of (and the factors related to) work ability as well as the role of age management in improving employability and sustaining work activity of older adults are analyzed against the backdrop of the Polish context. Cultural (ageism) and organizational (e.g., a lack of appropriate age management in companies) factors influencing work activity in the oldest age groups are taken into account. Third, the authors present some solutions and recommendations coming from the international Participation To Healthy Workplaces And inclusive Strategies in the Work Sector (PATHWAYS) project. Finally, theoretical models, concepts and solutions are integrated into a model elucidating the conditions (cultural, social, organizational, individual) influencing work ability of older adults. The model aims to take into account theories and factors identified in the literature review and grouped into several categories. The analysis highlights the role of appropriate age management in companies in the process of sustaining work ability of older employees. Int J Occup Med Environ Health. 2022;35(5):509-26.

The study explores the direct and indirect associations (i.e., through the extent of the level of loneliness and perceived social support) between internet use for instrumental purposes and the quality of life (QoL) among elderly females and males in Poland.The analysis was based on 2001 face-to-face interviews performed among randomly selected individuals aged ≥65 years from the general population. The collected data was weighted to generalize the study sample for the reference population. The analysis was conducted using multiple linear regression models. The mediation effect was tested according to the Baron and Kenny approach.The obtained results indicate that internet use for instrumental purposes is directly related to a better QoL of elderly Polish males. This positive effect among men also occurs indirectly, through the decrease in loneliness levels as well as the increase in social support scores. It has also been shown that among elderly females, the effect of internet use for instrumental purposes is not related to a better QoL, either directly or indirectly.Internet use for instrumental purposes seems to be important in enhancing a successful life among elderly male adults. However, these technologies are not associated with better QoL among females. Practitioners should be aware of these gender differences. The study adds to the previous studies by demonstrating that the feeling of loneliness and social support mediates the relationship between internet use for instrumental purposes and QoL among elderly males, whereas among elderly females this effect does not occur. Int J Occup Med Environ Health. 2022;35(2):169-85.

Socioeconomic status (SES) relates to life satisfaction in old age, although the underlying mechanisms remain unclear. Health and subjective social status have shown to be related to both SES and life satisfaction. This study aims to test the mediating role of health and subjective social status in old age, and to analyze if these potential mediations vary among three European countries with different socioeconomic characteristics and welfare regimes.The sample comprised 7,272 participants aged 50+ from COURAGE in Europe study, a household survey carried out in 2011-2012 on nationally representative samples from Finland, Poland, and Spain. A Multiple Indicators, Multiple Causes approach based on multi-group Structural Equation Modeling was implemented to test mediating effects.The structural invariance model showed an adequate fit (CFI = 0.971, RMSEA = 0.061). Health and subjective social status invariantly mediated the relationship between SES and life satisfaction across countries with different socioeconomic characteristics and welfare regimes. SES direct effects explained 0.83-0.85% of life satisfaction variance, whilst indirect effects explained 2.29-2.36% of life satisfaction variance via health, 3.30-3.42% via subjective social status, and 0.06% via both mediating variables.Policies aimed at increasing the SES of the older adults may entail multiple benefits, resulting in better subjective social status, health, and life satisfaction outcomes, thus fostering healthy aging of the population.

The present article aims to highlight methodological aspects related to understanding and conceptualising social capital for the purposes of population research as well as describing the key challenges in the harmonisation process of indicators of social capital. The study was conducted in the frame of the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project. After a review of social capital theories developed in social science and a subsequent review of the documentation of 18 international cohorts, decision trees of the harmonisation of social variables were developed. The known-group validity was verified. The results focused on generalised trust, civic engagement and social participation are presented. The summary of the availability of any indicators of these concepts is classified in seven domains (generalised trust, political participation, religious participation, senior-specific participation, participation in sport groups, participation in volunteer/charity group activities, any participation) across surveys. The results of the analysis for known-group validity support the construct validity of the harmonised variables.

The study explores short-term effects of dissolution of union through divorce/separation and widowhood on physical and mental health as well as health-related quality of life (HRQoL) among females and males in Poland. Considering social selection and social causation theories, the study poses following research questions: are there differences in physical and mental health as well as health-related quality of life that are caused by a marital transition compared to remaining married/cohabiting? Do marital status transitions have different effects concerning physical and mental health and health-related quality of life among females and males? Data for the analysis were available for 1073 people (18+) who participate in the COURAGE-Poland population-based study from 2011 (baseline) and 2015–2016 COURAGE-POLFUS (follow-up). Health status was measured by the WHODAS II and the presence of depression based on the Composite International Diagnostic Interview. Health-related quality of life was assessed by WHOQOL-AGE scale. The analysis has been conducted using the analysis of variance, multinomial logistic regression and generalized liner mixed model according to the dependent variable. Results do suggest that transition out of marriage weakens mental health although the differences in physical health seemed to not be significant compared to the continuously married/cohabiting. The marital dissolution especially causes a decline in the mental health as well as health-related quality of life of males who transitioned to a widowed life. There has not been observed statistically significant change in terms of healthrelated quality of life between first and second wave of the survey among both widowed and divorced males and females.

The study aimed to verify an association between changes in body mass index (BMI) and quality of life (QoL) in a 4-year follow-up in a population-based study in Poland. The results covered data from 1557 adults from the general Polish population who participated in the follow-up survey, performed in two waves: 2011 (COURAGE in Europe); 2015/2016 (COURAGE-POLFUS). Anthropometric measurements and a structured questionnaire including the WHOQOL-AGE scale were used. Regression models were applied to verify whether the observed BMI–QoL association is linear or U-shaped. The inverse U-shaped association between BMI changes and QoL among Polish adults was found using a univariable model. This association was observed in women, whereas in men a linear relationship was found. At the population level, weight loss (BMI decrease of 5–10%) was associated with better QoL in healthy people. The reverse was true in sick people, whose weight loss was observed to be an indicator of poorer QoL. In conclusion, the study suggests an inverse U-shaped association between BMI and quality of life. Better QoL may be considered an additional benefit of public weight loss programs for healthy adults. Further studies focusing on people with some chronic diseases are needed.

We investigated the relation between alcohol drinking and healthy ageing by means of a validated health status metric, using individual data from the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project. For the purposes of this study, the ATHLOS harmonised dataset, which includes information from individuals aged 65+ in 38 countries, was analysed (n = 135,440). Alcohol drinking was reflected by means of three harmonised variables: alcohol drinking frequency, current and past alcohol drinker. A set of 41 self-reported health items and measured tests were used to generate a specific health metric. In the harmonised dataset, the prevalence of current drinking was 47.5% while of past drinking was 26.5%. In the pooled sample, current alcohol drinking was positively associated with better health status among older adults ((b-coef (95% CI): 1.32(0.45 to 2.19)) and past alcohol drinking was inversely related (b-coef (95% CI): &minus, 0.83 (&minus, 1.51 to &minus, 0.16)) with health status. Often alcohol consumption appeared to be beneficial only for females in all super-regions except Africa, both age group categories (65&ndash, 80 years old and 80+), both age group categories, as well as among all the financial status categories (all p &lt, 0.05). Regional analysis pictured diverse patterns in the association for current and past alcohol drinkers. Our results report the need for specific alcohol intake recommendations among older adults that will help them maintain a better health status throughout the ageing process.

Background: Pain is a common symptom, often associated with neurological and musculoskeletal conditions, and experienced especially by females and by older people, and with increasing trends in general populations. Different risk factors for pain have been identified, but generally from studies with limited samples and a limited number of candidate predictors. The aim of this study is to evaluate the predictors of pain from a large set of variables and respondents. Methods: We used part of the harmonized dataset of ATHLOS project, selecting studies and waves with a longitudinal course, and in which pain was absent at baseline and with no missing at follow-up. Predictors were selected based on missing distribution and univariable association with pain, and were selected from the following domains: Socio-demographic and economic characteristics, Lifestyle and health behaviours, Health status and functional limitations, Diseases, Physical measures, Cognition, personality and other psychological measures, and Social environment. Hierarchical logistic regression models were then applied to identify significant predictors. Results: A total of 13,545 subjects were included of whom 5348 (39.5%) developed pain between baseline and the average 5.2 years' follow-up. Baseline risk factors for pain were female gender (OR 1.34), engaging in vigorous exercise (OR 2.51), being obese (OR 1.36) and suffering from the loss of a close person (OR 1.88) whereas follow-up risk factors were low energy levels/fatigue (1.93), difficulties with walking (1.69), self-rated health referred as poor (OR 2.20) or average to moderate (OR 1.57) and presence of sleep problems (1.80). Conclusions: Our results showed that 39.5% of respondents developed pain over a five-year follow-up period, that there are proximal and distal risk factors for pain, and that part of them are directly modifiable. Actions aimed at improving sleep, reducing weight among obese people and treating fatigue would positively impact on pain onset, and avoiding vigorous exercise should be advised to people aged 60 or over, in particular if female or obese., The ATHLOS project (Ageing Trajectories of Health: Longitudinal Opportunities and Synergies) has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 635316

Objectives: To report prevalence estimates of 12-month suicide ideation and attempts in young-and-middle age adults and older people, as well as their respective associated factors.Methods: A total...

Objectives The main objective of this study is to examine the relationship between health and an early exit from paid employment in the Finnish, Polish, and Spanish populations. The authors have addressed the following 3 issues: who chooses not to work according to gender patterns, whether the health status is a determinant of being non-employed, and what diseases are associated with being non-employed. Material and methods The studied material consists of data from the Collaborative Research on Ageing in Europe (COURAGE in Europe) project. The analysis was based on a sample of 5868 individuals, including 1214 from Finland, 2152 from Poland and 2532 from Spain. In the paper, these data were complemented with the results of the PArticipation To Healthy Workplaces And inclusive Strategies in the Work Sector (PATHWAYS) project. Results The results of the study revealed that self-rated health was a strong predictor of being non-employed for different reasons. Chronic diseases, such as arthritis, angina, diabetes, chronic obstructive pulmonary disease, depression and hypertension, were typically associated with an increased risk of being non-employed due to health problems and early retirement. Women more frequently reported arthritis and depression, while a higher proportion of men suffered from angina and diabetes. Conclusions The results obtained by the authors highlight the importance of evaluating gender patterns in work cessation and, at the same time, the importance of gender-focused actions in terms of preventing withdrawal from the labor market. In principle, all chronic diseases have some impact on participation in the labor market. It is worth noting, however, that each of them affects workforce participation in a different manner, depending on the specific disease, country and gender. For this reason, tailored support to every individual's needs is highly recommended. Int J Occup Med Environ Health. 2020;33(3):365-84.

Background and Objectives The purpose of the study was to create and validate a tool that could be implemented easily to recognize the presence and assess the level of neglect in community-dwelling older adults, and to provide information about the prevalence of the phenomenon in different subgroups of older adults in Poland. Research Design and Methods The cross-sectional study of elder neglect and self-neglect was conducted in Lesser Poland in 2017. It included 2,443 face-to-face interviews with randomly selected community-dwelling individuals from among the general population (1,635), social service users (280), and hospital patients (528). Classical Test Theory and Item Response Theory (IRT) were used to build the scale, and its content and construct validity and reliability were assessed. Results The Self-Reported Neglect Scale (SRNS) with a 2-factor structure (basic needs and psychological needs dimensions) was created. Results of the IRT analysis showed high item discrimination (2.7–4.8 for the first factor, 0.8–3.2 for the second). The 1-year prevalence of neglect as a percentage of nonzero values of the SRNS was estimated at 11.4%. Discussion and Implications The SRNS exhibited good psychometric properties. It may have promise as a tool for the assessment of neglect in epidemiological studies as well in the everyday practice of medical professionals and social workers.

The aim of the study was to assess the differences between rural and urban areas as regards the role of social capital and its effect on self-rated health and subjective well-being among older people in Poland. The sample was selected on the basis of multi-stage clustered design from the non-institutionalized adult population. Analysis was based on 1,299 elderly people aged 65 and over from the general Polish population who participated in the COURAGE in Europe project. Six regions of Poland were distinguished according to first level of Nomenclature of Units for Territorial Statistics (NUTS) classification . As an indicator of social capital, the COURAGE Social Network Index, the OSLO-3 Social Support Scale, and the three item UCLA Loneliness scale were used, as well as social participation and trust was assessed. Self-rated health (SRH) was measured by WHO-Europe recommended version (ranging from 'very good' to 'very bad'). Well-being was assessed by the Day Reconstruction Method.bResults:/bThe results showed that in urban areas, social network and social participation supported positive self-rated health; in rural, older residents the number of years of education and social support played the same role, while self-rated health decreased with an increasing level of loneliness. Self-rated health decreased in both groups of older people with a growing number of diseases. The multivariate linear regression model of predictors of well-being in older age also confirmed differences between urban and rural elderly residents. In rural residents, subjective well-being significantly increased with the positive effect of the social network. In both urban and rural areas, poor assessment of subjective well-being in older age increased with a higher level of loneliness and growing number of chronic diseases.

Purpose Gender-related differences in life expectancy, prevalence of chronic conditions and level of disability in the process of ageing have been broadly described. Less is known about social determinants, which may have different impacts on quality of life in men and women. The investigation aims to reveal gender-related differences in social determinants on quality of life assessed by a multi-pathway model including health, social, demographic and living place characteristics. Methods The study group consisted of 5099 participants aged 50+ representing general populations of three different European regions (Finland, Poland, Spain) who participated in COURAGE in EUROPE Project. Standardized tools were used to measure quality of life (WHOQOL-AGE) and social determinants (COURAGE Social Network Index, OSLO-3 Social Support Scale, UCLA Loneliness Scale, participation scale and trust). A multipath model considering exogenous predictors (demographic, economic), mediators (social) and endogenous outcome (QOL) was created to reveal the role of determinants. Gender-related differences were investigated across three age categories: 50–64; 65–79 and 80+. Results The model (RMSEA = 0.058; CFI = 0.939) showed the effects of all of the investigated determinants. Gender-related differences in the association between social constructs and QOL were observed for social networks in the group of 80+, for social support in the group of 50–64 and 65–79 years, and for social participation in the group of 65–79 years. Males benefited more (in QOL) from social networks and social support, and women from social participation. Conclusions The research provides valuable knowledge about the role of social determinants in QOL considering complex relations between different social constructs. Additionally, the results showed gender-related differences in the associations between social networks, social support, social participation and QOL, suggesting that men might benefit more from the interventions in the first two. Although our research did not investigate the effects of interventions, the results show directions for future investigations, how to shape social interventions at the population level to improve quality of life of older adults, and thus help achieve successful ageing. Electronic supplementary material The online version of this article (doi:10.1007/s11136-017-1530-8) contains supplementary material, which is available to authorized users.

Objectives The objective of this study is to present the barriers existing in Poland to professional integration and reintegration of people with chronic diseases, including mental health conditions, and discuss them on the basis of expert opinions and in comparison with the situation in other European countries. Material and methods The research methodology was based on a mixed-methods approach, including literature review, in-depth expert interviews, and a survey (based on a structured questionnaire) performed with experts. Results The mapping of policies, systems and services facilitating the integration and reintegration of people with chronic diseases in Poland, as well as expert opinions, made it possible to identify many barriers regarding access to support, such as an obligation to have a certificate of disability, and a system of certification by 2 institutions. There are also barriers regarding the support itself, including problems with subsidies and with professional (re)integration services. Conclusions Poland has a multi-level and multi-sector system of public institutions, which should provide support for people with disabilities and chronic diseases. Nevertheless, the research conducted in Poland indicates an insufficient implementation of the existing solutions. Int J Occup Med Environ Health. 2019;32(4):475–88

Background: Every research project faces challenges regarding how to achieve its goals in a timely and effective manner. The purpose of this paper is to present a project evaluation methodology gathered during the implementation of the Participation to Healthy Workplaces and Inclusive Strategies in the Work Sector (the EU PATHWAYS Project). The PATHWAYS project involved multiple countries and multi-cultural aspects of re/integrating chronically ill patients into labor markets in different countries. This paper describes key project’s evaluation issues including: (1) purposes, (2) advisability, (3) tools, (4) implementation, and (5) possible benefits and presents the advantages of a continuous monitoring. Methods: Project evaluation tool to assess structure and resources, process, management and communication, achievements, and outcomes. The project used a mixed evaluation approach and included Strengths (S), Weaknesses (W), Opportunities (O), and Threats (SWOT) analysis. Results: A methodology for longitudinal EU projects’ evaluation is described. The evaluation process allowed to highlight strengths and weaknesses and highlighted good coordination and communication between project partners as well as some key issues such as: the need for a shared glossary covering areas investigated by the project, problematic issues related to the involvement of stakeholders from outside the project, and issues with timing. Numerical SWOT analysis showed improvement in project performance over time. The proportion of participating project partners in the evaluation varied from 100% to 83.3%. Conclusions: There is a need for the implementation of a structured evaluation process in multidisciplinary projects involving different stakeholders in diverse socio-environmental and political conditions. Based on the PATHWAYS experience, a clear monitoring methodology is suggested as essential in every multidisciplinary research projects.

Background: Persons with chronic diseases (PwCDs) often experience work-related problems, and innovative actions to improve their participation in the labor market are needed. In the frame of the European (EU) Pathways Project, the aim of the study is to compare existing strategies (policies, systems, and services) for professional (re-)integration of PwCDs and mental health conditions available at both European and national level between different European welfare models: Scandinavian, Continental, Anglo-Saxon, Mediterranean, and “Post-Communist”. Method: The European strategies were identified by an overview of relevant academic and grey literature searched through Medline and internet searches, while national strategies were explored through questionnaires and in-depth interviews with national relevant stakeholders. Results: The mapping of existing strategies revealed that, both at European and national level, PwCDs are often considered as part of the group of “persons with disabilities” and only in this case they can receive employment support. European countries put in place actions to support greater labor market participation, but these differ from country to country. Conclusion: Strategies targeting “persons with disabilities” do not necessarily address all the needs of persons with chronic diseases. Countries should consider the importance of employment for all to achieve smart, sustainable, and inclusive growth.

Background: Research addressing the impact of a large number of factors on unemployment is scarce. We aimed to comprehensively identify factors related to unemployment in a sample of persons aged 18–64 from Finland, Poland and Spain. Methods: In this cross-sectional study, factors from different areas were considered: socio-demographic indicators, health habits, chronic conditions, health state markers, vision and hearing indicators, and social networks and built environment scores. Results: Complete data were available for 5003 participants, mean age 48.1 (SD 11.5), 45.4% males. The most important factors connected to unemployment were health status indicators such as physical disability (OR = 2.944), self-rated health (OR = 2.629), inpatient care (OR = 1.980), and difficulties with getting to the toilet (OR = 2.040), while the most relevant factor related to employment were moderate alcohol consumption (OR = 0.732 for non-heavy drinkers; OR = 0.573 for infrequent heavy drinkers), and being married (OR = 0.734), or having been married (OR = 0.584). Other factors that played a significant role included presence of depression (OR = 1.384) and difficulties with near vision (OR = 1.584) and conversation hearing (OR = 1.597). Conclusions: Our results highlight the importance of selected factors related to unemployment, and suggest public health indications that could support concrete actions on modifiable factors, such as those aimed to promote physical activity and healthy behaviors, tackling depression or promoting education, in particular for the younger.

The increasing prevalence of chronic diseases among the European working age population, as well as the implications for the individual and societal level, underline the need for policy guidelines targeting the effective inclusion of persons with chronic diseases in the workplace. The aim of the present paper was to explore the perspectives of European and National-level stakeholders on existing strategies for work re-integration of persons with chronic diseases, and to provide policy guidelines. A highly-structured interview protocol was distributed to 58 National level stakeholders (policy makers, professionals and employers) from seven European countries. Additionally, 20 European organizations concerned with health-related issues and employment completed an online survey. The findings reveal that employment-related challenges remain largely unaddressed. Both national and European stakeholders considered the existing legislative frameworks inadequate and appraised the co-ordination for the implementation of employment re-integration policies as ineffective. Policies targeting at work re-integration of persons with chronic diseases at European and national level should focus on consistent cooperation among all key stakeholders, awareness raising to staff and management, dissemination of effective strategies, developing research and evaluation standards and establishing monitoring systems on inclusive labour markets. The current study was part of the PATHWAYS project. The PATHWAYS project has received funding from the European Union’s Health Programme (2014–2020) Grant agreement n. 663474.

BACKGROUND AND AIM: Frailty is characterized by several deficits in multiple health related domains. Although cognition is among the important components of frailty, there is lack of evidence on the role of specific neuro-cognitive dimensions. The primary aim of the present work was to evaluate the multidimensional definition of frailty, and to assess whether neuro-cognitive function is a constituent of the frailty syndrome among adults aged =50?years living in three European countries. As a secondary aim, the construct validity of the created frailty index was tested (with inpatient and outpatient hospitalization), as well as its determinants. METHODS: Data were obtained from a cross-sectional, community-based, nationally-representative survey conducted in Finland, Poland and Spain (n?=?7987 individuals aged =50?years). Socio-demographic, clinical, lifestyle and social factors were assessed using validated procedures. Cognitive function was assessed with the following tests: learning and short-term memory, working memory and verbal fluency. A frailty index was constructed based on 31 frailty attributes. Principal component analysis was used to identify the components of the frailty index. Logistic and Poisson regression analysis was also conducted. RESULTS: The factor analysis on the components of the index extracted three main dimensions for frailty (disability and daily functioning, cognitive function, chronic health conditions), confirming the multiple dimensions of frailty. Various socio-demographic (e.g., financial status, education level) and lifestyle habits (alcohol consumption) were related with frailty. The presence of frailty was associated with 3.1 times higher odds for inpatient hospitalization (95%CI 2.75 to 3.51). Frailty was also related with higher frequency of outpatient visits. CONCLUSIONS: These findings suggest that frailty is a multidimensional concept with three major dimensions. Neuro-congitive function seems to be a separate dimension of the frailty syndrome. Smoking habits and alcohol intake were positively related with frailty while inpatient and outpatient hospitalization were found to be associated to the level of frailty.

Background Turner syndrome (TS) appears in women as a result of the lack of part or the whole of one of the X chromosomes. It is characterized by the occurrence of low height, hypogonadism, numerous developmental defects, and is often accompanied by psychological disturbances. Objectives Although the phenotype characteristics of women with TS are quite well documented, the knowledge of the impact of Turner syndrome on the satisfaction with life is still insufficient. The aim of our study was to assess the impact of TS on selected variables of quality of life, and hence also life satisfaction in women with this syndrome. Material and methods The research was carried out in a group of 176 women with TS starting March 1995. The patients underwent anthropological and medical examinations, and their medical histories were taken using a questionnaire that included demographic and psychosocial items as well as issues related to selected variables of quality of life. In our research model, general life satisfaction was a dependent variable. The statistical analysis was conducted using the eta and Cramer's V correlation coefficients as well as a multidimensional logistic regression model. Results The main determinants of dissatisfaction with life in women with TS were short stature and feelings of loneliness and being handicapped. Conclusions The determinants of life satisfaction in women with Turner syndrome were closely related to the private life of the study participants, in particular self-perception and feelings concerning their health status.

Background Socioeconomic status, as measured by education, occupation or income, is associated with depression. However, data are lacking on the psychosocial, material and behavioral mediators of these associations. We have examined the association of education, occupation and income with depression and the potential mediations using community-based data. Methods A total of 7,966 older adults were interviewed in Finland, Poland and Spain. The differential associations between depression and SES, mediator variables, country of residence and cofounder variables, such as chronic physical conditions, were assessed through logistic regression models. Meditation analyses were carried out using khb method for Stata 13.1. Results Education, followed by household income, were the SES indicators most frequently significantly associated with depression. These SES markers, but not occupation, showed an independent effect in this association. Psychosocial factors and loneliness in particular showed the strongest associations with depression among mediator variables. However, material factors and, especially, financial strain had a higher mediating function in the association between SES and depression. Overall, SES markers, chronic conditions and mediation factors were more positive in Finland than in Poland and Spain. Conclusion Improving psychosocial and material dimensions as well as access to the educational system for older adults might result in a reduction in the prevalence of depression in the general population and particularly among individuals with low SES.

Purpose The purpose of this study is to characterize health status of older cancer survivors using data from the population-based PolSenior study. Methods We compared cancer survivors and non-cancer subjects according to comorbidities, functional status, mental health, and sociodemographic factors. Results There were 286 (5.8%) cancer survivors in a population of 4943 adults aged 65 years and older. The mean age of cancer survivors was 79.4 ± 8.2 years and the median time since cancer diagnosis was 8.5 years (Q1–Q3: 4–16 years). After adjustment for age, sex, education, marital status, and number of comorbidities, compared with a non-cancer population, cancer survivors were more likely to experience falls (OR = 1.38; 95% CI: 1.04–1.83), and to report poor health (OR = 1.49; 95%CI: 1.83–2.06), but cancer survivorship was not associated with impairments in instrumental activities of daily living (IADLs). Age and university education, but neither the time from cancer diagnosis nor the number of comorbidities, were associated with impairments in cancer survivors. Three or more chronic diseases were found in over 50% of cancer survivors and in 38% of the non-cancer population (p

The aim of the study was to assess the differences between rural and urban areas as regards the role of social capital and its effect on self-rated health and subjective well-being among older people in Poland.

Background: It is important to know whether the relationships between experienced and evaluative well-being and health are consistent across countries with different income levels. This would allow to confirm whether the evidence found in high income countries is the same as in low- and middle-income countries and to suggest policy recommendations that are generalisable across countries. We assessed the association of well-being with health status; analysed the differential relationship that positive affect, negative affect, and evaluative well-being have with health status; and examined whether these relationships are similar across countries.Methods: In this cross-sectional study, interviews were conducted amongst 53,269 adults from nine countries in Africa, Asia, Europe, and Latin America. Evaluative well-being was measured with a short version of the World Health Organization (WHO) Quality of Life instrument, and experienced well-being was measured with the Day Reconstruction Method. Decrements in health were assessed with the 12-item version of WHO Disability Assessment Schedule 2.0. Block-wise linear regression and structural equation models were employed.Results: Considering the overall sample, evaluative well-being was more strongly associated with health (β = −0.35) than experienced well-being (β = −0.14), and negative affect was more strongly associated with health (β = 0.10) than positive affect (β = −0.02). The relationship between health and well-being was similar across countries. Lower scores in evaluative well-being and a higher age were the factors more strongly related with a worse health.Conclusions: The different patterns observed across countries may be related to differences in the countries' gross domestic product, social protection system, economic situation, health care provision, lifestyle behaviours, or living conditions. The fact that evaluative well-being is more predictive of health than experienced well-being suggests that our level of satisfaction with our lives might be more important for our health than the actual emotions than we experience in our day-to-day lives and points out the need of interventions that improve the way people evaluate their lives.

Objective The care processes directed towards institutionalized older people needs to be tailored on goals and priorities that are relevant for this specific population. The aim of the present study was (a) to describe the distribution of selected health determinants in a sample of institutionalized older adults, and (b) to investigate the impact on survival of such measures. Design Multicentre longitudinal cohort-study. Setting 57 nursing homes (NH) in 7 EU countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands) and 1 non-EU country (Israel). Participants 3036 NH residents participating in the Services and Health for Elderly in Long TERm care (SHELTER) study. Measurements We described the distribution of 8 health determinants (smoking habit, alcohol use, body mass index [BMI], physical activity, social participation, family visits, vaccination, and preventive visits) and their impact on 1-year mortality. Results During the one-year follow up, 611 (20%) participants died. Overweight (HR 0.79; 95% C.I. 0.64–0.97) and obesity (HR 0.64; 95% C.I. 0.48–0.87) resulted associated with lower mortality then normal weight. Similarly, physical activity (HR 0.67; 95% C.I. 0.54–0.83), social activities (HR 0.63; 95% C.I. 0.51–0.78), influenza vaccination (HR 0.66; 95% C.I. 0.55–0.80) and pneumococcal vaccination (HR 0.76 95% C.I. 0.63–0.93) were associated with lower mortality. Conversely, underweight (HR 1.28; 95% C.I. 1.03–1.60) and frequent family visits (HR 1.75; 95% C.I. 1.27–2.42) were associated with higher mortality. Conclusions Health determinants in older NH residents depart from those usually accounted for in younger and fitter populations. Ad hoc studies are warranted in order to describe other relevant aspects of health in frail older adults, with special attention on those institutionalized, with the ultimate goal of improving the quality of care and life.

To explore the associations between health and how people evaluate and experience their lives.We analysed data from nationally-representative household surveys originally conducted in 2011-2012 in Finland, Poland and Spain. These surveys provided information on 10 800 adults, for whom experienced well-being was measured using the Day Reconstruction Method and evaluative well-being was measured with the Cantril Self-Anchoring Striving Scale. Health status was assessed by questions in eight domains including mobility and self-care. We used multiple linear regression, structural equation models and multiple indicators/multiple causes models to explore factors associated with experienced and evaluative well-being.The multiple indicator/multiple causes model conducted over the pooled sample showed that respondents with younger age (effect size, β = 0.19), with higher levels of education (β = -0.12), a history of depression (β = -0.17), poor health status (β = 0.29) or poor cognitive functioning (β = 0.09) reported worse experienced well-being. Additional factors associated with worse evaluative well-being were male sex (β = -0.03), not living with a partner (β = 0.07), and lower occupational (β = -0.07) or income levels (β = 0.08). Health status was the factor most strongly correlated with both experienced and evaluative well-being, even after controlling for a history of depression, age, income and other sociodemographic variables.Health status is an important correlate of well-being. Therefore, strategies to improve population health would also improve people's well-being.Étudier les associations entre la santé et la manière dont les personnes évaluent et ressentent leur vie.Nous avons analysé les données tirées des enquêtes sur les ménages représentatifs à l'échelle nationale qui ont été menées en 2011–2012 en Finlande, Pologne et Espagne. Ces enquêtes ont fourni des informations sur 10 800 adultes, dont le bien-être a été mesuré en utilisant la méthode de reconstruction de la journée et le bien-être évaluatif a été quantifié avec l'échelle de Cantril (Cantril Self-Anchoring Striving Scale). L'état de santé a été évalué par des questions dans huit domaines, y compris la mobilité et le fait de prendre soin de soi-même. Nous avons utilisé des modèles d'équation structurelle à régression linéaire multiple et des modèles à indicateurs et à causes multiples pour étudier les facteurs associés au bien-être ressenti et évaluatif.Le modèle à indicateurs et à causes multiples appliqué sur l'échantillon groupé a montré que les répondants jeunes (ampleur de l'effet [L'état de santé est un facteur de corrélation important du bien-être. Par conséquent, les stratégies d'amélioration de la santé de la population devraient également améliorer le bien-être des personnes.Examinar la relación entre la salud y cómo las personas evalúan y experimentan sus vidas.Se analizaron datos de encuestas a hogares representativos a nivel nacional realizadas inicialmente entre 2011 y 2012 en Finlandia, Polonia y España. Estas encuestas proporcionaron información sobre 10 800 adultos, para quienes el bienestar experiencial se midió con el método de reconstrucción de día y el bienestar evaluativo se midió con la escala Cantril. Se evaluó el estado de salud mediante preguntas de ocho ámbitos, que incluían la movilidad y el cuidado personal. Se emplearon modelos de regresión lineal múltiple y ecuaciones estructurales, así como modelos de causas múltiples/indicadores múltiples a fin de examinar los factores asociados con el bienestar experiencial y evaluativo.El modelo de causas múltiples/indicadores múltiples realizado en la muestra combinada mostró que los encuestados de menor edad (tamaño del efecto [El estado de salud guarda una correlación importante con el bienestar. Por lo tanto, las estrategias para mejorar la salud de la población podrían asimismo mejorar el bienestar de las personas.دراسة الارتباطات بين الصحة وطريقة تقييم الأشخاص لحياتهم وخبراتهم الحياتية.قمنا بتحليل البيانات المستمدة من دراسات استقصائية ذات عينات ممثلة على الصعيد الوطني أجريت في الأصل في عامي 2011 و2012 في فنلندا وبولندا وأسبانيا. وقدمت هذه الدراسات الاستقصائية معلومات عن 10800 شخص بالغ، تم قياس مستوى الرفاهية لديهم باستخدام طريقة إعادة بناء اليوم وتم قياس مستوى الرفاهية التقييمي باستخدام مقياس كانتريل للتحديد الذاتي للازدهار. وتم تقييم الحالة الصحية عن طريق طرح أسئلة في ثمانية مجالات شملت الانتقال والرعاية الذاتية. واستخدمنا الارتداد الخطي المتعدد ونماذج المعادلة الهيكلية ونماذج المؤشرات المتعددة/ الأسباب المتعددة لاستكشاف العوامل المرتبطة بمستوى الرفاهية الفعلي والتقييمي.أظهر نموذج المؤشرات المتعددة/ الأسباب المتعددة الذي أجري على العينة المجمعة أن المشاركين صغار السن (حجم الأثر [معامل بيتا = 0.19)، الذين يتمتعون بمستويات تعليم عالية (معامل بيتا = -0.12)، أو لديهم تاريخ من الاكتئاب (معامل بيتا = -0.17) أو يعانون من سوء الحالة الصحية (معامل بيتا = 0.29) أو سوء الوظائف الإدراكية (معامل بيتا = 0.09) أبلغوا عن مستوى رفاهية أسوأ. وكانت العوامل الإضافية المرتبطة بمستوى الرفاهية التقييمي الأسوأ هي ذكورية النوع (معامل بيتا = -0.03) وعدم العيش مع شريك (معامل بيتا = 0.07) وانخفاض المستوى المهني (معامل بيتا = -0.07) أو مستوى الدخل (معامل بيتا = 0.08). وكانت الحالة الصحية العامل الأقوى ارتباطاً بكل من مستوى الرفاهية الفعلي والتقييمي، حتى بعد ضبط متغيرات تاريخ الاكتئاب والسن والدخل وغيرها من المتغيرات الاجتماعية الديمغرافية.تمثل الحالة الصحية أحد العوامل المهمة المرتبطة بمستوى الرفاهية. ومن ثم، ستؤدي الاستراتيجيات الرامية إلى تحسين صحة السكان إلى تحسين مستوى رفاهية الأشخاص كذلك.探索健康与人们如何评价和体验其生活之间的关联。我们分析了2011-2012年最初在芬兰、波兰和西班牙进行的国家横断面家庭调查的数据。这些调查提供了10800名成年人的信息，对其使用昨日重现法（Day Reconstruction Method）衡量幸福体验，并使用坎特里尔自我定位奋斗量表（Cantril Self-Anchoring Striving Scale）衡量可评价的幸福。健康状态通过包括流动性和自我保健等八个领域的问题进行评估。我们使用多元线性回归、结构方程模型和多指标/多原因模型探索与体验和可评价幸福感相关的因素。混合样本中执行的多指标/多原因模型显示，更年轻（效应量[健康状况是幸福感的重要关联因素。因此，改善人口健康的策略也将改善民生幸福度。Изучить связь между здоровьем и тем, как люди оценивают и воспринимают свою жизнь.Мы проанализировали данные национальных репрезентативных обследований домохозяйств, первоначально проведенных в 2011—2012 годах в Финляндии, Польше и Испании. Эти обследования представили информацию о 10 800 взрослых людях, степень фактического благополучия жизни которых измерялась с использованием метода реконструкции дня, а степень оценочного благополучия — на основе шкалы самооценки Кантрила. Состояние здоровья оценивалось по ответам на вопросы в восьми областях, включая мобильность и способность к самообслуживанию. Мы использовали модели множественной линейной регрессии, модели структурных уравнений и модели множественных индикаторов/множественных причин для изучения факторов, связанных с фактическим и оценочным благополучием.Применение модели множественных индикаторов/множественных причин по совокупной выборке показало, что респонденты в более молодом возрасте (величина эффекта [Состояние здоровья является важным фактором благополучия. Поэтому стратегии по улучшению здоровья населения также ведут к улучшению его благополучия.

Purpose To comprehensively identify the determinants of quality of life (QoL) in a population study sample of persons aged 18–50 and 50+. Methods In this observational, cross-sectional study, QoL was measured with the WHOQOL-AGE, a brief instrument designed to measure QoL in older adults. Eight hierarchical regression models were performed to identify determinants of QoL. Variables were entered in the following order: Sociodemographic; Health Habits; Chronic Conditions; Health State description; Vision and Hearing; Social Networks; Built Environment. In the final model, significant variables were retained. The final model was re-run using data from the three countries separately. Results Complete data were available for 5639 participants, mean age 46.3 (SD 18.4). The final model accounted for 45% of QoL variation and the most relevant contribution was given by sociodemographic data (particularly age, education level and living in Finland: 17.9% explained QoL variation), chronic conditions (particularly depression: 4.6%) and a wide and rich social network (4.6%). Other determinants were presence of disabling pain, learning difficulties and visual problems, and living in usable house that is perceived as non-risky. Some variables were specifically associated to QoL in single countries: age in Poland, alcohol consumption in Spain, angina in Finland, depression in Spain, and self-reported sadness both in Finland and Poland, but not in Spain. Other were commonly associated to QoL: smoking status, bodily aches, being emotionally affected by health problems, good social network and home characteristics. Conclusions Our results highlight the importance of modifiable determinants of QoL, and provide public health indications that could support concrete actions at country level. In particular, smoking cessation, increasing the level of physical activity, improving social network ties and applying universal design approach to houses and environmental infrastructures could potentially increase QoL of ageing population.

Objectives To explore the joint association of depression and cognitive function with severe disability in nationally-representative samples of community-dwelling adults aged 50 years and older from Finland, Poland and Spain. Design Cross-sectional. Setting Community-based. Participants Population-based sample of 7987 non-institutionalized adults aged 50 and older. Measurements The outcome was severe disability, defined as ≥ 90th percentile of the 12-item version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0). Past 12-month DSM-IV major depressive disorder was assessed with the depression module of the WHO Composite International Diagnostic Interview (CIDI). A global cognitive function score was obtained through neuropsychological tests. Product terms between depression and cognition were introduced in multivariable logistic regression models to test for interaction. Results Lower cognitive function and depression were both significantly associated with severe disability in all countries. A significant interaction was only found in Finland where the ORs (95% CIs) of depression for severe disability at the 25th (worse), 50th, and 75th (better) percentiles of cognitive function were 7.26 (4.28–12.32), 11.1 (6.7–18.38), and 17.56 (9.29–33.2), respectively. Conclusion People with depression and cognitive decline are likely to benefit from the usual evidence-based treatments to reduce the burden of disability. However, in Finland, those with better cognitive function may benefit from more aggressive depression treatment. Future research is warranted to assess whether our results may be replicated.

Background. Population ageing challenges health care systems due to the high prevalence and impact of multimorbidity in older adults. However, little is known about how chronic conditions present in certain multimorbidity patterns, which could have great impact on public health at several levels. The aim of our study was to identify and describe multimorbidity patterns in low-, middle-, and high-income countries. Methods. We analyzed data from the Collaborative Research on Ageing in Europe project (Finland, Poland, and Spain) and the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, and South Africa). These cross-sectional studies obtained data from 41,909 noninstitutionalized adults older than 50 years. Exploratory factor analysis was performed to detect multimorbidity patterns. Additional adjusted binary logistic regressions were performed to identify associations between sociodemographic factors and multimorbidity. Results. Overall multimorbidity prevalence was high across countries. Hypertension, cataract, and arthritis were the most prevalent comorbid conditions. Two or three multimorbidity patterns were found per country. Several patterns were identified across several countries: "cardiorespiratory" (angina, asthma, and chronic obstructive pulmonary disease), "metabolic" (diabetes, obesity, and hypertension), and "mentalarticular" (arthritis and depression). Conclusions. A high prevalence of multimorbidity occurs in older adults across countries, with low-and middle-income countries gradually approaching the figures of richer countries. Certain multimorbidity patterns are present in several countries, which suggest that common underlying etiopathogenic factors may play a role. Deeper understanding of these patterns may lead to the development of preventive actions to diminish their prevalence and also give rise to new, comprehensive approaches for the management of these co-occurring conditions.

The final publication is available at Springer via http://dx.doi.org/10.1007/s10902-015-9669-x, Given the growing interest in the study of subjective well-being as a measure of social progress, instruments that produce valid and reliable scores and that can be used within and across countries are needed. The aim of the present study was to analyze the measurement equivalence of the Day Reconstruction Method in its brief version, using nationally representative samples from Finland, Poland, and Spain obtained within the COURAGE in Europe project. The goodness-of-fit of a two-correlated-factors model and the reliability of the scores obtained were assessed. Cross-country invariance was tested employing a multiple group confirmatory factor analysis, through sequential constraint imposition. In each country, measurement invariance was tested across time frames (morning, afternoon and evening) and days of the week (weekday and weekend). The results found support for the hypothesis of a two-correlated-factors (positive and negative affect) structure; the reliability of the positive, the negative and the net affect scores showed appropriate values. A high equivalence across the three national samples was found: all items except one showed strong measurement invariance indicating that respondents from Finland, Poland, and Spain attribute the same meaning to the latent construct under study, and the levels of the underlying items are equal in all three countries. Similar results were found for the measurement equivalence across time frames and days of the week. Our findings support the assumption of comparability across the different samples considered; in general, higher positive affect and lower negative affect were found in Finland, in the evening and at the weekend, The research leading to these results has received funding from the European Community’s Seventh Framework Programme (FP7/2007-2013) under grant agreement number 223071 (COURAGE in Europe), from the Instituto de Salud Carlos III-FIS research grants number PS09/00295 and PS09/01845, and from the Spanish Ministry of Science and Innovation ACI-Promociona (ACI2009-1010). The study was supported by the Instituto de Salud Carlos III, Centro de Investigación Biomédica Red de Salud Mental (CIBERSAM), and the AGES-CM Programme (AGES-S2010/BMD-2422), B.O. is grateful to the Sara Borrell postdoctoral programme (reference no. CD12/00429) supported by the Instituto de Salud Carlos III, Spain.