Search

Later-life loneliness is increasingly recognized as an important public health issue. In this study, we examine whether having more children and grandchildren is protective against later life loneliness in a group of Eastern and Western European countries. Drawing on data from the Generation and Gender Surveys, we estimated logistic regression models of the likelihood of being lonely among men and women aged 65 and older. The results showed a negative association between number of children and loneliness among men and women in both Eastern-European and Western-European countries. A mediation analysis performed using the KHB decomposition method showed that grandparenthood status partly explained differences in the loneliness risks of childless women, mothers with one child and those with two or more children. Among men, the mediating role of grandparenthood was significant in Eastern Europe and marginally significant in Western countries. Given the relatively strong reliance of older people on the family in Eastern Europe, we expected that the protective effects of offspring on loneliness would be stronger in Eastern-European countries than in Western-European countries. This hypothesis was supported only in part by our results. The protective effect of having four or more children was larger in the East than in the West. Overall, our findings indicate that having close family members, including more children and at least one grandchild, has a protective effect against later-life loneliness in both country clusters considered., Einsamkeit im Alter wird zunehmend als ein wichtiges Thema der öffentlichen Gesundheit anerkannt. In dieser Studie untersuchen wir anhand einer Gruppe von ost- und westeuropäischen Ländern, ob das Vorhandensein von mehr Kindern und Enkelkindern vor Einsamkeit im späteren Leben schützt. Anhand von Daten aus dem Generation and Gender Survey schätzen wir logistische Regressionsmodelle zur Wahrscheinlichkeit von Einsamkeit bei Männern und Frauen ab 65 Jahren. Sowohl in ost- als auch in westeuropäischen Ländern zeigen die Ergebnisse einen negativen Zusammenhang zwischen der Anzahl der Kinder und der Einsamkeit von Männern und Frauen. Eine Mediatoranalyse nach der KHB-Methode ergibt, dass der Status der Großelternschaft teilweise Unterschiede in den Einsamkeitsrisiken von kinderlosen Frauen, Müttern mit einem Kind und solchen mit zwei oder mehr Kindern erklärt. Bei den Männern ist die mediierende Rolle der Großelternschaft in Osteuropa signifikant und in den westlichen Ländern marginal signifikant. Angesichts des relativ großen Vertrauens älterer Menschen in die Familie in Osteuropa erwarten wir, dass Protektionseffekte von Nachkommen auf die Einsamkeit in den osteuropäischen Ländern stärker ist als in den westeuropäischen Ländern. Diese Hypothese wird nur teilweise durch unsere Ergebnisse bestätigt. Der Protektionseffekt von vier oder mehr Kindern ist im Osten größer als im Westen. Insgesamt deuten unsere Ergebnisse darauf hin, dass enge Familienmitglieder, darunter mehrere Kinder und mindestens ein Enkelkind, eine protektive Wirkung hinsichtlich Einsamkeit im Alter in beiden untersuchten Ländergruppen haben.

A growing body of evidence suggests that reproductive history influences post-reproductive mortality. A potential explanation for this association is confounding by socioeconomic status in the family of origin, as socioeconomic status is related to both fertility behaviours and to long-term health. We examine the relationship between age at first birth, completed parity, and post-reproductive mortality and address the potential confounding role of family of origin. We use Swedish population register data for men and women born 1932-1960, and examine both all-cause and cause-specific mortality. The contributions of our study are the use of a sibling comparison design that minimizes residual confounding from shared family background characteristics and assessment of cause-specific mortality that can shed light on the mechanisms linking reproductive history to mortality. Our results were entirely consistent with previous research on this topic, with teenage first time parents having higher mortality, and the relationship between parity and mortality following a U-shaped pattern where childless men and women and those with five or more children had the highest mortality. These results indicate that selection into specific fertility behaviours based upon socioeconomic status and experiences within the family of origin does not explain the relationship between reproductive history and post-reproductive mortality. Additional analyses where we adjust for other lifecourse factors such as educational attainment, attained socioeconomic status, and post-reproductive marital history do not change the results. Our results add an important new level of robustness to the findings on reproductive history and mortality by showing that the association is robust to confounding by factors shared by siblings. However it is still uncertain whether reproductive history causally influences health, or whether other confounding factors such as childhood health or risk-taking propensity could

MUCH OF THE research on life-course determinants of later life health has focused on cumulated effects of socioeconomic disadvantage (Ben-Shlomoand Kuh 2002; Luo and Waite 2005). Family life courses also involve differential exposures to stresses and supports and interact with other health relevant domains including socioeconomic status, health-related behaviors, and social support (Barban 2013; Grundy and Read 2015). The transition to parenthood is a pivotal life-course event whose timing and context may have implications for subsequent family and socioeconomic trajectories and for health (Knoester and Eggebeen 2006; Mirowsky 2002). Numerous studies of contemporary Western populations indicate that an early age at entry to parenthood is associated with poorer health and higher mortality inlater life.
Several processes are hypothesized to underlie this association between early parenthood and poorer later health. For women, pregnancy, parturition, and lactation present physiological challenges that may be greater for young mothers (Pirkle et al. 2014). Young mothers and fathers may also be less resilient in the face of the physical, emotional, and economic stresses involved in raising children and have fewer stress-buffering resources (Barban 2013). Additionally, early parenthood may disrupt educational and career progression and increase the chances of divorce and of high completed family size, all factors associated with socioeconomic disadvantage, health-damaging stress, and poorer later life health (Ermisch andPevalin 2005; Grundy and Read 2015; Hofferth et al., 2001). Apart from these potential causal mechanisms, an additional, or alternative, explanation for associations is deprivation experienced earlier in life, given that childhood disadvantage is associated with increased chances of early parenthood and with poorer socioeconomic outcomes and poorer health in later years (Henretta 2007; Hobcraft 2008; Maughan and Lindelow 1997; Pudrovska an

We consider how exchanges of support between parents and adult children vary by demographic and socio-economic characteristics and examine evidence for reciprocity in transfers and substitution between practical and financial support. Using data from the UK Household Longitudinal Study 2011–19, repeated measures of help given and received are analysed jointly using multivariate random effects probit models. Exchanges are considered from both a child and parent perspective. In the latter case, we propose a novel approach to account for the correlation between mother and father reports and develop an efficient Markov chain Monte Carlo algorithm suitable for large datasets with multiple outcomes.

Many charities rely on donations to support their work addressing some of the world’s most pressing problems. We conducted a meta-review to determine what interventions work to increase charitable donations. We found 21 systematic reviews incorporating 1339 primary studies and over 2,139,938 participants. Our meta-meta-analysis estimated the average effect of an intervention on charitable donation size and incidence: r = 0.08 (95% CI [0.03, 0.12]). Due to limitations in the included systematic reviews, we are not certain this estimate reflects the true overall effect size. The most robust evidence found suggests charities could increase donations by (1) emphasising individual beneficiaries, (2) increasing the visibility of donations, (3) describing the impact of the donation, and (4) enacting or promoting tax-deductibility of the charity. We make recommendations for improving primary research and reviews about charitable donations, and how to apply the meta-review findings to increase charitable donations.

Families extend well beyond households. In particular, connections between parents and their adult offspring are often close and sustained, and transfers may include financial assistance, practical support, or both, provided by either generation to the other. Yet this major engine of welfare production, distribution, and redistribution has only recently become the focus of research. Who are the beneficiaries and to what extent are the patterns of exchange socially stratified? This article discusses findings from a programme of research analysing data from two nationally representative longitudinal studies, the British Household Panel Study and its successor Understanding Society, which record help given by, and received by, respondents through exchanges with their non-coresident parents and offspring in the UK. Some families exhibit a high tendency to provide mutual support between generations; these tendencies persist over time. Financial and practical support are generally complementary rather than substitutes. Longer travel time between parents and their offspring makes the provision of practical help less likely, whilst social class, social mobility, and ethnicity exhibit complex patterns of association with intergenerational exchanges. The resulting conclusion is that exchanges within families are an important complement to formal welfare institutions in the UK and that social policies should be designed to work with the grain of existing patterns of exchange, enabling family members to continue to provide help to one another, but ensuring that those who are less well supported by intergenerational assistance can access effective social protection.

Exchanges of practical or financial help between people living in different households are a major component of intergenerational exchanges within families and an increasingly important source of support for individuals in need. Using longitudinal data, bivariate dynamic panel models can be applied to study the effects of changes in individual circumstances on help given to and received from non-coresident parents and the reciprocity of exchanges. However, the use of a rotating module for collection of data on exchanges leads to data where the response measurements are unequally spaced and taken less frequently than for the time-varying covariates. Existing approaches to this problem focus on fixed effects linear models for univariate continuous responses. We propose a random effects estimator for a family of dynamic panel models that can handle continuous, binary or ordinal multivariate responses. The performance of the estimator is assessed in a simulation study. A bivariate probit dynamic panel model is then applied to estimate the effects of partnership and employment transitions in the previous year and the presence and age of children in the current year on an individual’s propensity to give or receive help. Annual data on respondents’ partnership, employment status and dependent children, and data on exchanges of help collected at 2- and 5-year intervals are used in this study.

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.

OBJECTIVES: To investigate associations between level and changes in social isolation and in memory in older men and women. METHODS: The sample included 6,123 women and 5,110 men aged 50+ from the English Longitudinal Study of Aging (ELSA). Extended latent change score models from six measurement occasions every 2 years from 2002 were used to investigate associations between social isolation and memory. Models were adjusted for age, socioeconomic position, and health. RESULTS: Social isolation increased and memory decreased over time. Among men an initially high level of social isolation was associated with a somewhat greater decrease in memory. Among women a greater increase in social isolation predicted a greater decrease in memory and a larger change in social isolation was associated with further larger changes in isolation, although when social isolation reached a higher level it subsequently decreased. CONCLUSIONS: Results suggest that the association between social isolation and memory decline arises because social isolation is associated with increased memory decline rather than poor memory leading to increases in social isolation. Men with high levels of social isolation and women with accumulated social isolation over time are especially affected as these patterns of isolation were associated with more profound memory decline.

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.

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.

Objective: We investigate the association between parent-child contact frequency and changes in older parents’ depressive symptoms in Bulgaria, Georgia and Russia. These are countries in which societal transformations may mean that psychological feelings of security engendered by having children in close contact may have particularly important implications for the mental health of older parents. Methods: We analysed data from two waves of the Generation and Gender Surveys conducted three years apart and took account of relationships with more than one child. Analyses were performed using OLS regression models, adjusted for depressive symptoms at baseline. Results: Among mothers increases in depressive symptoms were greater for those who lacked at least weekly contact with any child than for those with frequent contact with at least one child (b = 0.64; p<0.01). Increases in depressive symptoms were associated with infrequent contacts with children, even after controlling for relationship quality (b = 0.55; p<0.05). Among unpartnered fathers, less than weekly meetings with children were associated with increases in depressive symptoms. Conclusions: Among mothers and unpartnered fathers changes in depressive symptoms varied by parent-child contact. The adverse effect of not having a partner on fathers’ mental health was reduced, but not eliminated, by having frequent contacts with adult children.

Background: Urbanization and ageing have important implications for public mental health and well-being. Cities pose major challenges for older citizens, but also offer opportunities to develop, test, and implement policies, services, infrastructure, and interventions that promote mental well-being. The MINDMAP project aims to identify the opportunities and challenges posed by urban environmental characteristics for the promotion and management of mental well-being and cognitive function of older individuals. Methods: MINDMAP aims to achieve its research objectives by bringing together longitudinal studies from 11 countries covering over 35 cities linked to databases of area-level environmental exposures and social and urban policy indicators. The infrastructure supporting integration of this data will allow multiple MINDMAP investigators to safely and remotely co-analyse individual-level and area-level data. Individual-level data is derived from baseline and follow-up measurements of ten participating cohort studies and provides information on mental well-being outcomes, sociodemographic variables, health behaviour characteristics, social factors, measures of frailty, physical function indicators, and chronic conditions, as well as blood derived clinical biochemistry-based biomarkers and genetic biomarkers. Area-level information on physical environment characteristics (e.g. green spaces, transportation), socioeconomic and sociodemographic characteristics (e.g. neighbourhood income, residential segregation, residential density), and social environment characteristics (e.g. social cohesion, criminality) and national and urban social policies is derived from publically available sources such as geoportals and administrative databases. The linkage, harmonization, and analysis of data from different sources are being carried out using piloted tools to optimize the validity of the research results and transparency of the methodology. Discussion: MINDMAP is a novel resea

We investigate how daughters’ feelings of loneliness are impacted when widowed parents develop health limitations, and when daughters take on personal care tasks in response. Using longitudinal data from daughters of widowed parents drawn from the French Family and Intergenerational Relationships Study (ERFI, 1485 observations nested in 557 daughters), we assess (a) whether health limitations of widowed parents are associated with daughters’ feelings of loneliness regardless of whether or not daughters provide personal care and (b) whether there is an effect of care provision on loneliness that cannot be explained by parental health limitations. Fixed effect regression analyses show that widowed parents’ health limitations were associated with raised feelings of loneliness among their daughters. No significant additional effect of providing personal care to a widowed parent was found. Prior research on the impact of health limitations of older parents on the lives of their adult–children has focused mostly on issues related to informal caregiving. Our findings suggest that more attention to the psychosocial impact of parental health limitations—net of actual caregiving—on adult children’s lives is warranted

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.

Background: Research using nonmigrant samples indicates that having a partner and children is protective against loneliness. Such beneficial effects may be weaker for migrants with partners and/or children living in different countries. Objective: We assess how feelings of loneliness among Polish migrants in the Netherlands compare to levels among the general Dutch population and how migrants’ feelings of loneliness vary by presence and location of partners and offspring. Methods: We used weighted data from the Families of Poles in the Netherlands survey (n=1,129). Wald tests were used to compare levels of loneliness among Polish migrants with scores reported in a different study for the general Dutch population. Linear regression was used to estimate how presence and location of partners and children were associated with loneliness. Results: Polish migrants in the Netherlands were lonelier than the general Dutch population. Among men, those who had been in the Netherlands for longer were lonelier than those who had more recently arrived. Unpartnered men and men with a partner living abroad were lonelier than men with a partner living in the Netherlands. For women, no effects of presence and location of a partner were found. Presence and location of children made little difference. Conclusions: Although loneliness is often considered a problem for older individuals, feelings of loneliness are also strong among working-age Polish migrants. Consistent with studies on nonmigrant samples, we found that men with a partner were less lonely than unpartnered men, but only when the partner also resided in the Netherlands.

Both coresidence patterns and the reported well-being of older people vary widely across Europe for a variety of economic, cultural, and historical factors. We investigate how far 2 indicators of well-being, happiness and life satisfaction, vary according to whether or not older women live with their children and, in particular, with son(s) or daughters(s). We compare outcomes for women who are unpartnered widows, the great majority of whom will have had children, so those with and without coresident children may be compared. We use data for 34 countries in Europe by combining 7 waves of the European Social Survey for the period 2002–2014 (N = 18,500). We control for a range of other variables known to be associated with well-being including health status, socioeconomic position, and social support. Results show that widows living with a child were happier than those living without a child (generally alone) but that in Eastern and Southern Europe it was only living with a daughter that had this positive effect. Older age was associated with higher levels of happiness and life satisfaction. Other associations, and regional differences, were as expected with lower levels of happiness in Eastern Europe and for those with poorer health and fewer social resources. These findings indicate the important influence of contextual factors on associations between living arrangements and the well-being of older people and a need for further work on possible negative impacts of living alone on the well-being of older Europeans

Poorer people are more likely to have a poorer health. Socioeconomic inequality in health extends worldwide and remains persistent in Europe despite increases in wealth, educational attainment, proportions of working in non-manual jobs, and expenditure on health services. All age groups are affected. We reviewed the evidence on health inequalities in Europe, focusing on older people, a group which is growing fast and is vulnerable to adverse socioeconomic circumstances.

Research funders across the world are implementing data management and sharing policies to maximize openness of data, transparency and accountability of the research they support. This guide aims to cover guidance on how to plan your research using a data management checklist, how to format and organize data, and how to publish and cite data. This is a useful guide for students and researchers on a topic of increasing importance, writes Emily Grundy.

Background: The MODEM project (A comprehensive approach to MODelling outcome and costs impacts of interventions for DEMentia) explores how changes in arrangements for the future treatment and care of people living with dementia, and support for family and other unpaid carers, could result in better outcomes and more efficient use of resources. Methods: MODEM starts with a systematic mapping of the literature on effective and (potentially) cost-effective interventions in dementia care. Those findings, as well as data from a cohort, will then be used to model the quality of life and cost impacts of making these evidence-based interventions more widely available in England over the period from now to 2040. Modelling will use a suite of models, combining microsimulation and macrosimulation methods, modelling the costs and outcomes of care, both for an individual over the life-course from the point of dementia diagnosis, and for individuals and England as a whole in a particular year. Project outputs will include an online Dementia Evidence Toolkit, making evidence summaries and a literature database available free to anyone, papers in academic journals and other written outputs, and a MODEM Legacy Model, which will enable local commissioners of services to apply the model to their own populations. Discussion: Modelling the effects of evidence-based cost-effective interventions and making this information widely available has the potential to improve the health and quality of life both of people with dementia and their carers, while ensuring that resources are used efficiently.

We analyse effects of parental deaths on the health of women and men aged 18–59 in 2004–2008, indicated by purchases of prescription medicines. Register data covering the entire Norwegian population were used, and fixed-effects models were estimated to control for unobserved time-invariant individual factors. A parent's death seemed to have immediate adverse consequences in both main age groups considered (18–39, 40–59), although effects were lower in the older group. Some results suggested that this health disadvantage widened with increasing time since the parent's death. However, effects were weak: the annual number of different medicines purchased was only increased by 1–7% as a result of losing a parent. Death of a parent was associated with an immediate increase in purchases of medication for mental diseases, and there were indications of a physical response as well. As time since the parental death increased, there was a decline in the purchase of medication for mental diseases, but an opposite trend with respect to medication for other diseases. On the whole, maternal and paternal deaths had the same impact, and effects on daughters and sons were of the same magnitude.

Objectives: To investigate direct and stress-buffering associations between social support from family and the mental health of older people in Iran, a country which has recently undergone an exceptionally fast fertility transition and is consequently experiencing rapid population ageing. Method: A cross-sectional stratified random survey of 800 people aged 60+ years resident in Tehran was conducted. In total, 644 people responded. The SPS and the GHQ were used to measure perceived social support and mental health respectively. Multilevel mixed-effects models were used to examine the hypotheses. Results: The findings supported the hypothesis of a direct association between perceived and received social support and mental health. However, we did not find strong evidence to suggest that social support buffered the effects of stress arising from limitations of physical functioning. Lack of help doing paperwork was associated with worse mental health for women but not men. Source of support did not seem to be important. Conclusion: Our results indicated that in Tehran, as in Western settings, social support is important for the mental well-being of older people. Recommendations for policy and further research priorities based on the study findings were provided.

Socioeconomically disadvantaged children are more likely to be of shorter stature and overweight, leading to greater risk of obesity in adulthood. Disentangling the mediatory pathways between socioeconomic disadvantage and childhood size may help in the development of appropriate policies aimed at reducing these health inequalities. We aimed to elucidate the putative mediatory role of birth weight using a representative sample of the Scottish population born 1991–2001 (n = 16,628). Estimated height and overweight/obesity at age 4.5 years were related to three measures of socioeconomic disadvantage (mother’s education, Scottish Index of Multiple Deprivation, synthetic weekly income). Mediation was examined using two approaches: a ‘traditional’ mediation analysis and a counterfactualbased mediation analysis. Both analyses identified a negative effect of each measure of socioeconomic disadvantage on height, mediated to some extent by birth weight, and a positive ‘direct effect’ of mother’s education and Scottish Index of Multiple Deprivation on overweight/obesity, which was partly counterbalanced by a negative ‘indirect effect’. The extent of mediation estimated when adopting the traditional approach was greater than when adopting the counterfactual-based approach because of inappropriate handling of intermediate confounding in the former. Our findings suggest that higher birth weight in more disadvantaged groups is associated with reduced social inequalities in height but also with increased inequalities in overweight/obesity.

Background. Marital and partnership history is strongly associated with health in midlife and later life. However, the role of health behaviours as an explanatory mechanism remains unclear. The aim of this study was to investigate prospective associations between life-course partnership trajectories (taking into account timing, non-marital cohabitation, remarriage and marital transitions) and health behaviours measured in midlife. Methods. We analysed data from the British National Child Development Study, a prospective cohort study that includes all people born in 1 week of March 1958 (N=10 226). This study included men and women with prospective data on partnership history from age 23 to 42–44 and health behaviours collected at ages 42–46 (2000–2004). Latent class analysis was used to derive longitudinal trajectories of partnership history. We used multivariable regression models to estimate the association between midlife health behaviours and partnership trajectory, adjusting for various early and young adult characteristics. Results. After adjustment for a range of potential selection factors in childhood and early adulthood, we found that problem drinking, heavy drinking and smoking were more common in men and women who experienced divorce or who had never married or cohabited. Women who married later had a lower prevalence of smoking and were less likely to be overweight than those who married earlier. Overall marriage was associated with a higher body mass index. Individuals who never married or cohabited spent less time exercising. Conclusions. Some aspects of partnership history such as remaining unpartnered and experiencing divorce are associated with more smoking and drinking in midlife, whereas marriage is associated with midlife weight gain. Despite these offsetting influences, differences in health behaviours probably account for much of the association between partnership trajectories and health found in previous studies.

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.

A growing body of evidence suggests that reproductive history influences post-reproductive mortality. A potential explanation for this association is confounding by socioeconomic status in the family of origin, as socioeconomic status is related to both fertility behaviours and to long-term health. We examine the relationship between age at first birth, completed parity, and post-reproductive mortality and address the potential confounding role of family of origin. We use Swedish population register data for men and women born 1932-1960, and examine both all-cause and cause-specific mortality. The contributions of our study are the use of a sibling comparison design that minimizes residual confounding from shared family background characteristics and assessment of cause-specific mortality that can shed light on the mechanisms linking reproductive history to mortality. Our results were entirely consistent with previous research on this topic, with teenage first time parents having higher mortality, and the relationship between parity and mortality following a U-shaped pattern where childless men and women and those with five or more children had the highest mortality. These results indicate that selection into specific fertility behaviours based upon socioeconomic status and experiences within the family of origin does not explain the relationship between reproductive history and post-reproductive mortality. Additional analyses where we adjust for other lifecourse factors such as educational attainment, attained socioeconomic status, and post-reproductive marital history do not change the results. Our results add an important new level of robustness to the findings on reproductive history and mortality by showing that the association is robust to confounding by factors shared by siblings. However it is still uncertain whether reproductive history causally influences health, or whether other confounding factors such as childhood health or risk-taking propensity could

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 cognition 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.

The Survey of Health, Ageing and Retirement in Europe (SHARE) and the Generations and Gender Survey (GGS) are two widely used European longitudinal surveys with data on sociodemographic and health topics, but their comparability has not been systematically investigated. We compared SHARE and GGS data for 50-80 year olds in seven European countries (Belgium, Estonia, France, Germany, Hungary, the Netherlands and Poland) to assess data quality and the potential for joint analyses. The results showed that information on, and distributions by, age, gender, marriage and fertility patterns were broadly similar in both sources. For some countries distributions by educational level varied between the two sources even though both reported using the International Standard Classification of Education, which may reflect variations in the timings of surveys. The wording of health questions and their placement in the questionnaire sometimes differed between the surveys. This may account to some extent for differences between them in estimates of the prevalence of poor health. We investigated what effect these variations might have on analyses of health inequalities by undertaking multivariable analysis of associations between education and marital status and two health indicators.

Objectives: Life course influences on later life depression may include parenting trajectories. We investigate associations between number and timing of births and use of antidepressant medication in late mid-life using data on the whole Norwegian population. Methods: We estimated logistic regression models to analyse variations in the purchase of antidepressants between 2004 and 2008 by timing of births and number of children among women and men aged 45–73, using Norwegian population register data. We controlled for age, education, marital and partnership status, and (in some models) family background shared among siblings. Results: Mothers and fathers of two or more children were generally less likely to purchase antidepressants than the childless. Mothers who started childbearing before age 22 were an exception, although according to sibling models they were not more likely to purchase antidepressants. All models showed that women who became mothers before age 26 and had only one child had higher odds of medication purchase than the childless. Older age at first birth was generally associated with lower risks of antidepressant purchase. Conclusion: This analysis of high-quality data for a national population indicates that early motherhood, childlessness and low parity are associated with higher usage of antidepressants in late mid-life. Our data did not allow identification of mediating pathways, and we lacked information on early mental and physical health and some other potentially important confounders not shared between siblings. Furthermore purchase of antidepressants is not a perfect indicator of depression. Those concerns aside, the results suggest complex effects of fertility on depression that merit further investigation.

The Centre for Epidemiologic Studies of Depression (CES-D) and the Euro-D are commonly used depressive symptom scales but their comparability has not been assessed to date. This article aims to contribute to the literature comparing the drivers of depression in old age across countries by examining whether CES-D (in its eight-item short version) and Euro-D are comparable. Data from the Survey of Health, Ageing and Retirement in Europe (SHARE, N=15,487) covering 13 countries was used to examine the scales’ distributional properties, systematic differences between population subgroups, sensitivity and specificity, and associations with established risk factors for depression in old age. CES-D and Euro-D were strongly correlated (r=0.6819 (p<0.000). However, agreement between the two scales was moderate. There were systematic discrepancies in scores by demographic characteristics. CES-D captures a more extreme pool of depressed individuals than Euro-D. Although associations with risk factors are always in the same direction, they are often stronger for CES-D than Euro-D. Findings highlight the need be cautious when comparing depression levels and associations with risk factors between surveys using different measures of depressive symptoms.

The health and health care needs of a population cannot be measured or met without knowledge of its size and characteristics. Demography is concerned with this and with understanding population dynamics - how populations change in response to the interplay between fertility, mortality and migration. This understanding is a pre-requisite for making the forecasts about future population size and structure which should underpin health care planning. Such analyses necessitate a review of the past. The number of very old people in a population, for example, depends on the number of births eight or nine decades earlier and risks of death at successive ages throughout the intervening period. The proportion of very old people depends partly on this numerator but more importantly on the denominator, the size of the population as a whole. The number of births in a population depends on current patterns of family building, and also on the number of women 'at risk' of reproduction - itself a function of past trends in fertility and mortality. Similarly, the number and causes of deaths are strongly influenced by age structure. Demography is largely concerned with answering questions about how populations change and their measurement. The broader field of population studies embraces questions of why these changes occur, and with what consequences. This chapter presents information on demographic methods and data sources and their application to health and population issues, together with information on demographic trends and their implications and the major theories about demographic change in order to elucidate the complex inter-relationship between population change and human health.

Objectives: Previous studies of older European populations have established that disability and morbidity vary with indicators of socio-economic position (SEP). We undertook a systematic narrative review of the literature to ascertain to what extent there is evidence of similar inequalities in the subjective health and well-being of older people in Europe. Method: Relevant original research articles were searched for using Medline, Global Health, Embase, Social Policy and Practice, Cinahl, Web of Science and IBSS. We included studies of SEP and indicators of subjective health and well-being (self-rated health; life satisfaction; quality of life) conducted since 1991 using population based samples of older people in Europe and published 1995-2013. Results: A total of 71 studies were identified. Poorer SEP was associated with poorer subjective health and well-being. Associations varied somewhat depending on the SEP measure and subjective health and well-being outcome used. Associations were weaker when social support and health related behaviours were adjusted for suggesting that these factors mediate the relationship between SEP and subjective health and well-being. Associations tended to be weaker in the oldest age groups. The patterns of associations by gender were not consistent and tended to diminish after adjusting for indicators of health and life circumstances. Conclusion: The results of this systematic narrative review of the literature demonstrate the importance of social influences on later life subjective health and well-being and indicate areas which need further investigation, such as more studies from Eastern Europe, more longitudinal studies and more research on the role of mediating factors.

Background: Previous research shows associations between fertility histories and later life health. The childless, those with large families, and those with a young age at entry to parenthood generally have higher mortality and worse health than parents of two or three children. These associations are hypothesised to reflect a range of biosocial influences but underlying mechanisms are poorly understood. Objectives: To identify pathways from fertility histories to later life health by examining mediation through health related behaviours, social support and strain, and wealth. Additionally to examine mediation through allostatic load –an indicator of multisystem physical dysregulation hypothesised to be an outcome of chronic stress. Methods: Associations between fertility histories, mediators and outcomes were analysed using path models. Data were drawn from the English Longitudinal Study of Ageing. Outcomes studied were a measure of allostatic load based on 9 biomarkers and self-reported long-term illness which limited activities. Results: Early parenthood (<20 for women, <23 for men) was positively associated with higher (worse) allostatic load and long-term illness. These associations were partly mediated through wealth, smoking, and physical activity. Wealth, smoking, physical activity and and social strain also mediated associations between larger family size, itself associated with early parenthood, and health outcomes. We found no significant associations between childlessness and allostatic load or long-term illness except for an assocaition between childlessness and long-term illness among women in models adjusted only for age. Conclusions: In England early parenthood and larger family size are associated with less wealth and poorer health behaviours and this accounts for much of the association with health. At least part of this operates through stress related physiological dysfunction (allostatic load).

Background It is well established that unmarried people have higher mortality from circulatory diseases and higher all-cause mortality than the married, and these marital status differences seem to be increasing. However, much remains to be known about the underlying mechanisms. Our objective was to examine marital status differences in the purchase of medication for circulatory diseases, and risk factors for them, which may indicate underuse of such medication by some marital status groups. Methods Using data from registers covering the entire Norwegian population, we analysed marital status differences in the purchase of medicine for eight circulatory disorders by people aged 50-79 in 2004-2008. These differences were compared with those in circulatory disease mortality during 2004-2007, considered as indicating probable differences in disease burden. Results The unmarried had 1.4-2.8 times higher mortality from the four types of circulatory diseases considered. However, the never-married in particular purchased less medicine for these diseases, or precursor risk factors of these diseases, primarily because of a low chance of making a first purchase. The picture was more mixed for the divorced and widowed. Both groups purchased less of some of these medicines than the married, but, especially in the case of the widowed, relatively more of other types of medicine. In contrast to the never-married, divorced and widowed people were as least as likely as the married to make a first purchase, but adherence rates thereafter, indicated by continuing purchases, were lower. Conclusion The most plausible interpretation of the findings is that compared with married people, especially the never-married more often have circulatory disorders that are undiagnosed or for which they for other reasons underuse medication. Inadequate use of these potentially very efficient medicines in such a large population group is a serious public health challenge which needs further investigati

Using data from the Russian Longitudinal Monitoring Survey, 1998–2010, we investigated the extent to which patterns of alcohol consumption in Russia are associated with the subsequent likelihood of entry into cohabitation and marriage. Using discrete-time event history analysis we estimated for 16–50 year olds the extent to which the probabilities of entry into the two types of union were affected by the amount of alcohol drunk and the pattern of drinking, adjusted to allow for social and demographic factors including income, employment, and health. The results show that individuals who did not drink alcohol were less likely to embark on either cohabitation or marriage, that frequent consumption of alcohol was associated with a greater chance of entering unmarried cohabitation than of entering into a marriage, and that heavy drinkers were less likely to convert their relationship from cohabitation to marriage.

Objective. To examine whether socioeconomic position (SEP) is associated with progression in the health-seeking process for hearing loss. Method. Logistic regression of data from a cross-sectional survey representative of noninstitutionalized, 50 years and older population of England (ELSA wave 2, 2004). Using self-reported hearing difficulty as starting point, we examined the association between SEP and health-seeking behaviors in 6 stages leading to hearing aid acquisition and use. Results. Higher SEP was associated with lower odds of self-reported hearing difficulty, adjusted odds ratio [OR] = 0.87 (95% confidence interval [CI] 0.83–0.91, p < .001). There was marginal negative association between higher SEP and receiving hearing aid recommendation (adjusted OR = 0.88, 95% CI 0.78–0.99, p = .05). SEP was not associated with any other stage of health-seeking behavior. Discussion. Among the noninstitutionalized older population of England, SEP-related inequalities exist in the prevalence of self-reported hearing loss. However, SEP is not strongly associated with progression in the remaining stages of health-seeking process during and after an individual’s contact with the health system.

The relative contribution of early or later life Socio Economic Position (SEP) to later life health is not fully understood and there are alternative hypotheses about the pathways through which they may influence health. We used data from the English Longitudinal Study of Ageing with a formal approach for the identification of mediating factors in order to investigate alternative hypotheses about life course influences on biomarkers of later life health. We found that early life SEP predicts physical health at least 65 years later. However, a more complicated pattern of associations than that implied by previous findings was also observed. Age group specific effects emerged, with current SEP dominating the effect on later life physical health and fibrinogen levels in participants under 65, while early life SEP had a more prominent role in explaining inequalities in physical health for men and women over 75. We extend previous findings on mid adulthood and early old age, to old age and the beginnings of late old age. The complexity of our findings highlights the need for further research on the mechanisms that underlie the association between SEP and later life health.

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.

Background Ethnicity recording across the National Health Service (NHS) has improved dramatically over the past decade. This study profiles the completeness, consistency and representativeness of routinely collected ethnicity data in both primary care and hospital settings. Methods Completeness and consistency of ethnicity recording was examined in the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES), and the ethnic breakdown of the CPRD was compared with that of the 2011 UK censuses. Results 27.1% of all patients in the CPRD (1990–2012) have ethnicity recorded. This proportion rises to 78.3% for patients registered since April 2006. The ethnic breakdown of the CPRD is comparable to the UK censuses. 79.4% of HES inpatients, 46.8% of outpatients and 26.8% of A&E patients had their ethnicity recorded. Amongst those with ethnicity recorded on >1 occasion, consistency was over 90% in all data sets except for HES inpatients. Combining CPRD and HES increased completeness to 97%, with 85% of patients having the same ethnicity recorded in both databases. Conclusions Using CPRD ethnicity from 2006 onwards maximizes completeness and comparability with the UK population. High concordance within and across NHS sources suggests these data are of high value when examining the continuum of care. Poor completeness and consistency of A&E and outpatient data render these sources unreliable.

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.

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.

Aims: The aim of the study was to explore associations between dimensions of alcohol use in married couples and subsequent divorce in Russia using longitudinal data. Methods: Follow-up data on 7157 married couples were extracted from 14 consecutive annual rounds (1994–2010) of the Russian Longitudinal Monitoring Survey, a national population-based panel study. Discrete-time hazard models were fitted to estimate the probability of divorce among married couples by drinking patterns reported in the previous survey wave. Results: In adjusted models, increased odds of divorce were associated with greater frequency of husband and wife drinking (test for trend P = 0.005, and P = 0.05, respectively), wife's binge drinking (P = 0.05) and husband's heavy vodka drinking (P = 0.005). Couples in whom the wife drank more frequently than the husband were more likely to divorce (OR 2.86, 95% CI 1.52–5.36), compared with other combinations of drinking. The association between drinking and divorce was stronger in regions outside Moscow or St. Petersburg. Conclusion: This study adds to the sparse literature on the topic and suggests that in Russia heavy and frequent drinking of both husbands and wives put couples at greater risk of future divorce, with some variation by region and aspect of alcohol use.

Introduction: Housing is a major influence on health. Housing tenure is associated with housing conditions, affordability, and security and is an important dimension of housing. In the UK there have been profound changes in both housing conditions and the distribution of households by tenure over the past century, that is during the lifetimes of the current population. Methods: We firstly reviewed and summarise changes in housing conditions, housing policy and tenure distribution as they provide a context to possible explanations for health variations by housing tenure, including health related selection into different tenure types. We then use 2015-2021 data from a large nationally representative UK survey to analyse associations between housing tenure and self-reported disability among those aged 40-69 controlling for other socio-demographic factors also associated with health. We additionally examine changes in the association between housing tenure and selfreported disability in the population aged 25 and over in the first two decades of the 21st century and project trends forward to 2030. Results: Results show that associations between housing tenure and disability by tenure were stronger than for any other indicator of socio-economic position considered with owner-occupiers having the best, and social renters the worst, health. Differences were particularly marked in reported mental health conditions and in economic activity, with 28% of social renters being economically inactive due to health problems, compared with 4% of owneroccupiers. Rates of disability have increased over time, and become increasingly polarised by tenure. By 2020 the age standardised disability rate among tenants of social housing was over twice as high as that for owner occupiers, with projections indicating further increases in both levels, and differentials in, disability by 2030. Discussion: These results have substantial implications for housing providers, local authorities and for