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The study aimed to develop and validate a tool to recognize the presence and to evaluate the level of self-neglect in community-dwelling older people. The cross-sectional study included 2,894 face-to-face interviews with randomly selected individuals from among the general population, social service users, and hospital patients. In addition, specially trained interviewers assessed the physical appearance and standards of living. Reliability, content, and construct validity were assessed. The Item Response Theory was used. The following scales were developed: the Self-Reported Self-Neglect Scale (SRSNS), the Objective Assessment of the Level of Self-Neglect–Physical Appearance (OALSN-PA) scale, concerning physical health risks based on the appearance of an individual, and the Objective Assessment of the Level of Self-Neglect–Standards of Living Arrangements (OALSN-SLA) scale, which assesses the physical and personal living conditions. The brevity of the scales makes them useful for the daily practice of health care and social care professionals.

Little is known about how retirement and the time use redistribution that comes with it relate to experiential wellbeing, especially in low- and middle-income countries (LAMICs). This study aims to determine whether there are differences in experiential wellbeing between retired and working older adults; whether time use accounts for a portion of these differences; and whether these potential relationships differ across LAMICs and high-income countries. We used data from 2 multicountry studies conducted in countries at different levels of economic development: SAGE (China, Ghana, India, Mexico, and South Africa) and COURAGE in Europe (Finland, Poland, and Spain), focusing on participants aged 50+ (N = 21,000). Retirement was significantly associated with higher experiential wellbeing in both surveys, and time use accounted for more than 40% of the total effect. Retirees were higher in experiential wellbeing than working older adults, and differences in how individuals spend their day accounted for part of this relationship. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A healthy lifestyle is related to physical and mental health. The aim of this study was to assess whether different healthy lifestyle behaviours are associated with experiential and evaluative well-being.A total of 10,800 participants from Finland, Poland and Spain were interviewed in 2011-2012. Physical activity, fruit and vegetable consumption, smoking, alcohol use, and sleep quality were self-reported. Life satisfaction was measured with the Cantril Self-Anchoring Striving Scale. Positive and negative affect were assessed using an abbreviated version of the Day Reconstruction Method. Multivariate regression analyses were performed.Healthy lifestyle behaviours (consumption of five or more servings of fruit and vegetables per day, moderate or high physical activity, being a non-daily smoker, and having a good sleep quality) were positively associated with evaluative well-being (ß=0.23 p0.001; ß=0.16, p0.001; ß=0.26, p0.001; ß=0.23, p0.001, respectively), after controlling for confounding variables such as health and depression. Good sleep quality was related with higher positive affect (ß=0.29, p0.001), lower negative affect (ß=-0.15, p0.001) and higher life satisfaction (ß=0.23, p0.001), after adjusting for those confounding variables.A healthy lifestyle is an important correlate of well-being independently of its effects on health. Healthy lifestyles could be considered when developing strategies to improve not only the physical health, but also the well-being of the population.Un estilo de vida saludable está relacionado con la salud física y mental. El objetivo de este trabajo fue evaluar si diferentes comportamientos de estilo de vida saludable estaban asociados con el bienestar subjetivo.Se entrevistó a un total de 10.800 participantes de Finlandia, Polonia y España en 2011-2012. La actividad física, el consumo de frutas y verduras, el tabaco, el alcohol y la calidad del sueño fueron autoinformados. La satisfacción con la vida se midió con la Cantril Self-Anchoring Striving Scale. El afecto positivo y negativo se evaluaron utilizando una versión abreviada del Método de Reconstrucción del Día. Se llevaron a cabo análisis de regresión múltiple.Las conductas de estilo de vida saludable (consumo de cinco o más frutas y verduras al día, actividad física moderada o alta, no fumar a diario y tener una buena calidad del sueño) se asociaron positivamente con el bienestar evaluativo (ß=0,23, p0,001; ß=0,16, p0,001; ß=0,26, p0,001; ß=0,23, p0,001, respectivamente), después de controlar por variables de confusión como la salud y la depresión. La buena calidad del sueño se relacionó con mayor afecto positivo (ß=0,29, p0,001), menor afecto negativo (ß=-0,15, p0,001) y mayor satisfacción con la vida (ß=0,23, p0,001), después de ajustar por dichas variables de confusión.Un estilo de vida saludable se correlaciona de manera importante con el bienestar, independientemente de sus efectos en la salud. Los estilos de vida saludables podrían ser considerados a la hora de desarrollar estrategias que mejoren no solo la salud física, sino también el bienestar de la población.

Objective:This study aims to generate country-specific norms for two episodic memory tasks and a verbal fluency test among middle-aged and older adults using nationally representative data from nine low-, middle-, and high-income countries.Method:Data from nine countries in Africa, Asia, Europe, and Latin America were analyzed (n = 42,116; aged 50 years or older). Episodic memory was assessed with the word list memory (three trials of immediate recall) and word list recall (delayed recall). Verbal fluency was measured through the animal naming task. Multiple linear regression models with country-specific adjustments for gender, age, education, and residential area were carried out.Results:Both age and education showed high influence on test performance (i.e. lower cognitive performance with increasing age and decreasing years of education, respectively), while the effect of sex and residential area on cognitive function was neither homogeneous across countries nor across cognitive tasks.Conclusions:Our study provided sex-, age-, education-, and residential area-specific regression-based norms that were obtained from one of the largest normative study worldwide on verbal recall and fluency tests to date. Findings derived from this study will be especially useful for clinicians and researchers based at countries where cognitive norms are limited.

Objectives The growing number of chronic conditions and functional limitations resulting from demographic changes and the aging of the population poses several challenges for health care and public health. Consequently, it plays a role in the assessment of the impact of diagnostic and treatment effects on patient satisfaction. The study aims to assess older patients’ overall satisfaction with the medical care and healthcare system in Poland and to verify such factors as patient-doctor interactions, access to health care and other sociodemographic characteristics as possible determinants of patient satisfaction at the later stage of life. Methods The survey data represent the polish part of the cross-sectional COURAGE in Europe study. Satisfaction with hospital care, outpatient care, and the healthcare system in Poland was assessed. The indices for the psychosocial dimension of the patient-doctor relationships and access to hospital/outpatient care were developed based on patients’ experiences as the possibility of talking about private matters, the clarity of explanations, the involvement in decision-making process, being treated respectfully, the duration of waiting and the ease of access to a preferred doctor or other healthcare professional. The ordered probit regression models were used. Results The psychosocial dimension of patient-doctor relationships was associated with the satisfaction with both hospital and outpatient care. Being treated with respect (very good experience vs. bad odds ratio [OR] = 8.1, 95% confidence interval [CI]: [1.9, 34.4]) and the possibility to talk about private matters with medical team (very good experience vs. bad OR = 3.5, 95% CI: [1.1, 10.4]) during the last stay in hospital were reflected in the higher satisfaction with the healthcare system. By contrast, the involvement of patients in the decision-making process (very good experience vs. bad OR = 3.6, 95% CI: [1.8, 6.7]) or access to outpatient health care (based on developed index OR = 1.02, 95% CI: [1.01, 1.02]) were found to be significant determinants of satisfaction with the healthcare system in Poland. Other factors associated with satisfaction with hospital stay were gender and changes in health conditions, whereas achieving the expected outcome was related to satisfaction with outpatient care, and the expenditure for medicines and medical services – to satisfaction with the heathcare system. Conclusion The investigation confirms an important role of doctor-patient communication skills in improving older patient satisfaction and highlights the need for identifying the psychosocial dimension of patient-doctor relationships as an important part of health care.

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.

Objectives Healthy ageing (HA) is a key concept and highly desirable phenomenon in every ageing and already old societies. The aim of our study was to evaluate the influence of socio-economic conditions as well as life-style and other health-related factors on the WHO definition of HA. Design, Setting, Participants The study used cross-sectional data of the PolSenior Project — nationwide research evaluating different aspects of ageing in Poland — which included 4’653 respondents aged 65 years and over. Measurements Data were collected by trained interviewers in respondents’ homes. Three definitions of HA including or not the participants’ chronic conditions were analyzed. Results The prevalence of HA appeared as high as 17.6% if none or 1 chronic disease was present and 42.8% if no information about chronic diseases was taken into account. The association between known health predictors (age, marital status, education, income) and HA was observed. Moreover, HA appeared in relation with indicators of physical functioning and lifestyle. There was a strong concordance between HA and the fair self-rated health (OR = 1.87; 1.99, and 2.74 for the 1st, 2nd and 3rd definitions, respectively) and opposite relation with self-reported need for help (OR = 0.15; 0.15; and 0.13, respectively). Conclusions The HA definition based on no functional activity limitations, no cognitive impairment, no depressive symptoms, no more than one disease and being socially active seems to be a useful approach of HA.. Electronic Supplementary Material Supplementary material is available for this article at 10.1007/s12603-019-1243-5 and is accessible for authorized users.

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.

Objectives An increased burden of chronic diseases in the working age population is observed across high income countries. Persons with chronic diseases (PwCDs) are less likely to maintain or return to work due to several constraints they experience. The purpose of the study was to assess the preferences and needs of PwCDs regarding 6 areas of flexibility at the workplace. It was assessed whether there were any personal characteristics associated with higher or lower expectations and needs. Material and methods This was a part of a large multicenter international project, i.e., the PArticipation To Healthy Workplaces And inclusive Strategies in the Work Sector (PATHWAYS) project, aimed to contribute to the development of innovative approaches to promote professional integration and reintegration of PwCDs into the work sector. In Poland, 59 respondents diagnosed with different chronic diseases were identified through advocacy groups. An on-line survey was conducted to collect information on their needs and expectations. A cluster analysis was performed to reveal some expectation types which differentiated individuals across 6 analyzed domains, along with a multivariable logistic regression to identify some characteristics associated with a special expectation type. Results Workplace facilitator items were generally scored as needed ("rather conductive" and "very conductive" groups identified). The factors positively associated with higher needs in this domain were education, and a hindering type of the disease. Unrestricted working hours were very conductive or indifferent, and were positively associated with education. Legal solutions were more conductive for older people. Medical support, access to training, and supervisors' knowledge were needed in general, with no associations with the personal characteristics identified. Conclusions Persons with chronic diseases report several facilitators which are needed for them to maintain or return to work, but they are not satisfied with the existing economy in Poland. These needs should be taken into consideration in the effective policy development. Int J Occup Med Environ Health. 2020;33(4):427-44.

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: Pain is a common symptom, often associated with neurological and musculoskeletal conditions, and experienced especially by females and by older people. The aims of this study are to evaluate the temporal variations of pain rates among general populations for the period 1991-2015 and to project 10-year pain rates. Methods: We used the harmonized dataset of ATHLOS project, which included 660,028 valid observations in the period 1990-2015 and we applied Bayesian age-period-cohort modeling to perform projections up to 2025. The harmonized Pain variable covers the content "self-reported pain experienced at the time of the interview", with a dichotomous (yes or no) modality. Results: Pain rates were higher among females, older subjects, in recent periods, and among observations referred to cohorts of subjects born between the 20s and the 60s. The 10-year projections indicate a noteworthy increase in pain rates in both genders and particularly among subjects aged 66 or over, for whom a 10-20% increase in pain rate is foreseen; among females only, a 10-15% increase in pain rates is foreseen for those aged 36-50. Conclusions: Projected increase in pain rates will require specific interventions by health and welfare systems, as pain is responsible for limited quality of subjective well-being, reduced employment rates and hampered work performance. Worksite and lifestyle interventions will therefore be needed to limit the impact of projected higher pain rates., 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.

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 Current demographic trends, such as society aging, the spreading of chronic diseases, as well as early retirement choices, lead to the dwindling labor market population. Taking into consideration the foregoing tendencies and their consequences, the issue of the shrinking labor force resources seems to be the most important challenge for the labor market. In response to it, this paper identifies individual and institutional causes of withdrawal from the labor market, and explores the views of Polish stakeholders on existing strategies for the occupational re-integration of persons with chronic diseases (PwCDs). Material and methods Polish results of 2 European projects: "Participation to Healthy Workplaces and Inclusive Strategies in the Work Sector" (the PATHWAYS project) and "The Collaborative Research on Aging in Europe" (COURAGE in Europe) complemented each other. The cross-sectional population data and data from stakeholders' interviews were used. Results The authors identified several causes which could encourage people to withdraw from the labor market before attaining the official retirement age at 3 different levels: individual, occupational, and institutional. Although research has shown that the macro-level situation is crucial to staying occupationally active, in Poland stakeholders have reported the lack of effective coordination in the implementation of policies for the occupational re-integration of PwCDs. Conclusions A decision to cease work prematurely reflects a combination of many different factors, such as individual determinates, work characteristics, personal convictions, and systemic solutions. The study demonstrated that, despite the awareness of the dwindling resources of labor force, the employment-related challenges faced by PwCDs as well as people who are close to the retirement age remain unaddressed. Int J Occup Med Environ Health. 2019;32(5):695-721.

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

Cohort Profile : The Ageing Trajectories of Health - Longitudinal Opportunities and Synergies (ATHLOS) project

Depression and loneliness act in a synergistic way among older adults. We tested two indicators of the perceived neighborhood built environment (BE) as moderators of the association between these conditions in older European adults. Positive perceptions of neighborhood BE were related to lower levels of loneliness but not to major depressive disorder (MDD). Reporting low BE usability was significantly related to a higher likelihood of feeling lonely except for those suffering from MDD, whereas reporting low BE walkability was significantly related with a high likelihood of loneliness particularly among those with MDD. Therefore, improving neighborhood BE and, specifically, its walkability, might result in a reduction in the prevalence of loneliness.

Background and ObjectivesNeglect of older adults is a complex and important social problem which is difficult to detect. The aim of this review is to explore and categorize different characteristics of elder neglect, to facilitate a uniform conceptualization and provide recommendations for identification of the phenomenon.Research Design and MethodsArticles published between January 1990 and February 2019, both from developed and developing countries, were taken into consideration. The literature search was performed in PubMed, Web of Science, and CINAHL using keywords related to elder abuse and neglect. Articles regarding the concept of elder neglect, identifying or measuring this phenomenon were reviewed. The identified indicators were presented according to the Maslow’s hierarchy of needs.ResultsFrom 7,207 articles found in the initial search, 63 relevant studies were selected for the final analysis. Indicators most frequently used by researchers (functionality, physical appearance and health, social and psychological background, mental health, and environment) correspond to different aspects of needs. Caregiver’s responsibility, satisfaction of needs, and risk of harm are the core elements to consider in identification of neglect.Discussion and ImplicationsThe identified elements and categories of indicators provide the framework for developing standard definitions and measures of elder neglect. The proposed diagram demonstrates gaps in identification and can be useful in detecting potential neglect in various categories of needs. Further research on perceptions and prevalence of elder neglect in different countries would be helpful for cross-country analysis as well as for adaptation of the instruments to cultural specifics.

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.