| 1. |
- Agahi, Neda, et al.
(författare)
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Alcohol consumption in very old age and its association with survival : A matter of health and physical function
- 2016
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Ingår i: Drug And Alcohol Dependence. - : Elsevier BV. - 0376-8716 .- 1879-0046. ; 159, s. 240-245
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Tidskriftsartikel (refereegranskat)abstract
- Background: Alcohol consumption in very old age is increasing; yet, little is known about the personal and health-related characteristics associated with different levels of alcohol consumption and the association between alcohol consumption and survival among the oldest old. Methods: Nationally representative data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD, ages 76-101; n=863) collected in 2010/2011 were used. Mortality was analyzed unti12014. Alcohol consumption was measured with questions about frequency and amount. Drinks per month were calculated and categorized as abstainer, light-to-moderate drinker (0.5-30 drinks/month) and heavy drinker (>30 drinks/month). Multinomial logistic regressions and Laplace regressions were performed. Results: Compared to light-to-moderate drinkers, abstainers had lower levels of education and more functional health problems, while heavy drinkers were more often men, had higher levels of education, and no serious health or functional problems. In models adjusted only for age and sex, abstainers died earlier than drinkers. Among light-to-moderate drinkers, each additional drink/month was associated with longer survival, while among heavy drinkers, each additional drink/month was associated with shorter survival. However, after adjusting for personal and health-related factors, estimates were lower and no longer statistically significant. Conclusions: The association between alcohol consumption and survival in very old age seems to have an inverse J-shape; abstention and heavy use is associated with shorter survival compared to light-to moderate drinking. To a large extent, differences in survival are due to differences in baseline health and physical function.
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| 2. |
- Agahi, Neda, et al.
(författare)
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Alcohol Consumption Over the Retirement Transition in Sweden : Different Trajectories Based on Education
- 2022
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Ingår i: Work, Aging and Retirement. - : Oxford University Press. - 2054-4642 .- 2054-4650. ; 8:1, s. 74-81
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Tidskriftsartikel (refereegranskat)abstract
- Retirement is a major life transition that involves changes to everyday routines, roles, and habits. Previous studies suggest that retirement may influence drinking habits. Many natural inhibitors of alcohol consumption disappear with the removal of work constraints. The potential impact depends on both individual and contextual factors. Women in the cohorts undergoing retirement now have been more active on the labor market, including the occupation of higher status jobs, which indicates more financial resources as well as a larger role loss after retirement. Also, the current cohorts who retire have had more liberal drinking habits throughout their lives compared to previous cohorts. We therefore examined changes in alcohol consumption surrounding retirement in different education groups among women and men undergoing retirement using annual data from the Health, Aging and Retirement Transitions in Sweden (HEARTS) study, a longitudinal national study of 60- to 66-year-olds (n = 5,913), from 2015 to 2018. Latent growth curve models were used to estimate trajectories of alcohol consumption. Results showed that those who retired during the follow-up increased their usual weekly alcohol consumption while those who worked or were retired throughout the period had stable drinking habits. Those who were retired reported the highest alcohol consumption. The increase surrounding retirement was driven by people with higher education. Women with tertiary education and men with intermediate or tertiary education increased their weekly alcohol intake after retirement, while those with low education had unchanged drinking habits. Mechanisms and motivations that may fuel increased alcohol intake among people with higher education should be further investigated.
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| 3. |
- Dabergott, Filip, 1987-
(författare)
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The widowhood effect : Studies on mortality among Swedish widows and widowers
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Spousal loss is a common experience associated with old age, and a major life-event that entails a period of intense suffering for most individuals. In addition to emotional shock and grief, the period after spousal loss is often characterized by vast changes in many areas of the surviving spouse’s life, from everyday habits to financial security. Accordingly, several studies have shown that those who have lost a spouse suffer from a greater risk of dying themselves, compared to their married counterparts. This thesis explores different aspects of the association between widowhood and mortality (often referred to as the widowhood effect) using data from Swedish population registers. The overarching aim is to outline how the strength of the association has changed over time and how it varies between different social and demographic groups, and thereby contribute to a more detailed understanding of the pathways between widowhood and mortality and the importance of different mediating factors. The widowhood effect may be linked to several psychological, social and material mechanisms and individuals may have different capacities to deal with stressors such as grief, social isolation and financial strain depending on factors like sex, age, socioeconomic status and their social environment. In addition, how a specific factor influences the association between widowhood and mortality may in turn often depend on a combination of other factors.The empirical part of the thesis consists of three separate studies, focusing on i) the changing demography of widowhood, ii) the widowhood effect as it differs for men and women according to socioeconomic status and iii) period trends in the widowhood effect, with focus on the importance of education and duration of widowhood. The results show that the widowhood effect increased over the last five decades, especially among women and in younger age groups. During the same period, the relative number of women and younger individuals in the widowed population decreased, which partly offset the total observed effect of this trend. Higher socioeconomic status amplifies the widowhood effect for men, while the association for women remains ambiguous. Between the 1990s and the 2010s, the difference in excess mortality between those who had lost their spouse recently and those who had been widowed a longer period became somewhat larger. No systematic change in the association between socioeconomic status and excess mortality was evident during the same period.
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| 4. |
- Duntava, Aija, 1985-
(författare)
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A View on the Invisible : A Study of Relationships between Different Aspects of Health in Populations
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis studies relationships between different aspects of health. Health is a multi-faceted concept consisting of various aspects: most commonly morbidity, functional limitation, subjective health, and mortality. The relationships between these aspects, however, are not fully understood, so this thesis aims at contributing to our knowledge on the topic. Three studies are included, each with a particular aim within the general objective.The first study is a systematic review of the articles that have attempted to study more than two aspects of health in one model. The review maps out the field of study, presenting and summarising the results of the articles selected to review, thereby also highlighting gaps in the research. One of its conclusions is that studies approaching health as one interconnected system are rare and that the relationships between the different aspects of health do not consistently show significant effects on each other. Additionally, many population groups in terms of age and place of residence are understudied. The findings from the systematic review have largely guided the scientific curiosity of the following two empirical studies.The second study proposes and tests a parsimonious model of health structure consisting of morbidity, functional limitation, and subjective health on the adult respondents of European Social Survey (n=32,679) using structural equation modelling. The findings suggest that, in general, the proposed model holds true but there are age and gender differences in the health structure.The third study explores the variations in the health structure of the adult population in 17 countries in three European regions (North, East, and West). The results show that the model does not apply in all the studied groups across the regions. Clear gender difference in health structure exist in the Western and Northern parts of Europe but not in the East. As to age groups, the analyses show that young adults are similar in their health structure across the regions while there are regional differences between the other two age groups.This thesis shows that it is necessary to study the relationships between different aspects of health as one interconnected system. Furthermore, when health is at centre of scientific inquiry its multiple dimensions as well as age, gender, and regional variations should be acknowledged and taken into account.
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| 5. |
- Focacci, Chiara Natalie, et al.
(författare)
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The value of pension reforms for late working life: evidence from Sweden
- 2023
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Ingår i: International journal of sociology and social policy. - : EMERALD GROUP PUBLISHING LTD. - 0144-333X .- 1758-6720. ; 43:13/14, s. 79-89
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Tidskriftsartikel (refereegranskat)abstract
- PurposeDriven by the aim to increase the participation of older people in the labour force and to extend peoples working lives, the Swedish Parliament passed a bill in 1998 to increase the pension eligibility age from 60 to 61 years and establish a notional defined-contribution (NDC) plan. In this article, the authors investigate the impacts towards the prolongation of working lives expected from such an intervention.Design/methodology/approachThe authors apply a multinomial probabilistic model based on Swedish registry data on the birth cohorts 1937-1938 (n = 102,826) and observe differences in exit behaviour between eligible and non-eligible individuals.FindingsThe authors find that the cohorts eligible to the pension reform exit the labour market at a later age compared to non-eligible cohorts at the 61-years cut-off. The authors also find that the effect persists in the long term. Furthermore, the authors find that both men and women are equally struck by the reform.Originality/valueWhile there exist many descriptive reports and theoretical analyses on the costs and benefits of pension reforms, this study is the first one to empirically analyse the effect of the first European NDC pay-as-you go pension plan on the potential exclusion of old-aged workers.
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| 6. |
- Kelfve, Susanne, et al.
(författare)
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Alcohol Consumption among the Oldest Old in Sweden – Trends Over Time and Methodological Challenges
- 2012
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Ingår i: The Gerontologist. - : Oxford University Press (OUP). - 0016-9013 .- 1758-5341.
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Konferensbidrag (refereegranskat)abstract
- The overall aim of this study is to describe trends in the frequency of alcohol consumption among the oldest old population in Sweden over the last 20 years. In addition, the methodological challenges involved will be analyzed and discussed. Data from a nationally representative survey of the oldest old population in Sweden (SWEOLD) from 1992, 2002 and 2010/2011 will be used. SWEOLD provides a unique longitudinal database that represents a very high proportion of the population aged 77+ in Sweden. By including institutionalized persons, using proxy interviews and achieving a high response rate, individuals are represented regardless of their health, possible cognitive impairments or place of residence. The prevalence patterns show significant increases in alcohol consumption in all age groups, both in men and women, even when controlling for health status. More individuals are consumers and those who consume drink more often. Less frequent alcohol consumption was associated with high age, women, institutionalized individuals, proxy interviewed persons and those requiring extra effort to recruit. By excluding persons living in institutions or requiring a proxy interview – groups sometimes not represented in surveys – or accepting a lower response rate, the total prevalence of alcohol consumers is likely to be overestimated. A higher percentage of upcoming elderly cohorts in Sweden consume alcohol than previous cohorts. This has been associated with increasing health and financial problems. This emphasizes the importance of including elderly people in research on alcohol consumption and of finding solutions to the methodological challenges posed in surveying the oldest old.
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| 7. |
- Kelfve, Susanne, et al.
(författare)
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Äldres materiella förhållanden
- 2017
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Ingår i: Vem är den äldre. - Stockholm : Nationell Kvalitetsplan för Äldreomsorgen. ; , s. 15-24
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 8. |
- Kelfve, Susanne, et al.
(författare)
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Bias in estimates of alcohol use among older people : selection effects due to design, health, and cohort replacement
- 2015
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is a growing awareness of the need to include the oldest age groups in the epidemiological monitoring of alcohol consumption. This poses a number of challenges and this study sets out to examine the possible selection effects due to survey design, health status, and cohort replacement on estimates of alcohol use among the oldest old. Methods: Analyses were based on three repeated cross-sectional interview surveys from 1992, 2002 and 2011, with relatively high response rates (86 %). The samples were nationally representative of the Swedish population aged 77+ (total n = 2022). Current alcohol use was assessed by the question How often do you drink alcoholic beverages, such as wine, beer or spirits? Alcohol use was examined in relation to survey design (response rate, use of proxy interviews and telephone interviews), health (institutional living, limitations with Activities of Daily Living and mobility problems) and birth cohort (in relation to age and period). Two outcomes were studied using binary and ordered logistic regression; use of alcohol and frequency of use among alcohol users. Results: Higher estimates of alcohol use, as well as more frequent use, were associated with lower response rates, not using proxy interviews and exclusion of institutionalized respondents. When adjusted for health, none of these factors related to the survey design were significant. Moreover, the increase in alcohol use during the period was fully explained by cohort replacement. This cohort effect was also at least partially confounded by survey design and health effects. Results were similar for both outcomes. Conclusions: Survey non-participation in old age is likely to be associated with poor health and low alcohol consumption. Failure to include institutionalized respondents or those who are difficult to recruit is likely to lead to an overestimation of alcohol consumption, whereas basing prevalence on older data, at least in Sweden, is likely to underestimate the alcohol use of the oldest old. Trends in alcohol consumption in old age are highly sensitive for cohort effects. When analysing age-period-cohort effects, it is important to be aware of these health and design issues as they may lead to incorrect conclusions.
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| 9. |
- Kelfve, Susanne, et al.
(författare)
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Do postal health surveys capture morbidity and mortality in respondents aged 65 years and older? A register-based validation study
- 2015
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 43:4, s. 348-355
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Non-response to population surveys is a common problem in epidemiological and public health research. Systematic non-response threatens the validity of results. Researchers rarely evaluate the magnitude of systematic non-response because of limited access to population data. This study explores how well morbidity and mortality in postal survey respondents aged 65 years and older represented that of the target population. Methods: The 2010 Stockholm Public Health Survey and the Swedish Population Register were linked to the Cause of Death Register and the National Patient Register in Sweden. Differences were analysed between the response group and the corresponding population in mortality, hospital admission, days spent in hospital and number of diagnoses. Finally, data were weighted for non-response to see if this improved generalizability. Results: Non-response increased with age, and this increase was more pronounced among women than men. Respondents were marginally less often admitted to hospital, hospitalized fewer days and had slightly fewer diagnoses than the population, in particular after age 80. Significantly fewer women died in the response group than in the population as a whole. In terms of mortality among men and in terms of hospitalizations for most age groups, the respondents represented the population fairly well. Non-response weighting adjustment did not improve generalizability. Conclusions: Postal questionnaires are likely to capture morbidity (hospitalization) among women and men aged 65-80 years old and mortality among men, while morbidity after age 80 and mortality in women are likely to be underestimated.
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| 10. |
- Kelfve, Susanne, et al.
(författare)
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Educational differences in long-term care use in Sweden during the last two years of life
- 2023
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 51:4, s. 579-586
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Tidskriftsartikel (refereegranskat)abstract
- Background: In old age, many people experience a period of functional decline and require long-term care. Sweden has a universal largely tax-financed health and social care system that is used by all societal groups. However, few studies have investigated if educational groups use publicly paid long-term care equitably. The aim of this study was to explore educational differences in the use of long-term care, including both home care and institutional care, during the last two years of life in Sweden. Methods: We used linked register data on mortality and long-term care use, including all adults aged ⩾67 years who died in Sweden in November 2015 (N=6329). We used zero-inflated negative binomial regression models to analyse the number of months with long-term care by educational level, both crude and adjusted for age at death and cohabitation status. Men and women were analysed separately. Results: People with tertiary education died more commonly without using any long-term care compared to primary educated people (28.0% vs. 18.6%; p<0.001). In the adjusted model, educational differences in the estimated number of months with long-term care disappeared among men but remained significant among women (primary educated: odds ratio=17.3 (confidence interval 16.8–17.7); tertiary educated: odds ratio=15.8 (confidence interval 14.8–16.8)). Conclusions: Older adults spend considerable time in their last two years of life with long-term care. Only minor educational differences in long-term care use remained after adjustment for cohabitation status and age at death. This suggest that Sweden’s publicly financed long-term system achieves relatively equitable use of long-term care at the end of life.
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| 11. |
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| 12. |
- Kelfve, Susanne, et al.
(författare)
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Getting better all the time? Selective attrition and compositional changes in longitudinal and life course studies
- 2017
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Ingår i: Longitudinal and Life Course Studies. - : Bristol University Press. - 1757-9597. ; 8:1, s. 104-119
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Tidskriftsartikel (refereegranskat)abstract
- Longitudinal surveys are valuable tools for investigating health and social outcomes across the life course. In such studies, selective mortality leads to changes in the social composition of the sample, but little is known about how selective survey participation affects the sample composition, in addition to the selective mortality. In the present paper, we followed a Swedish cohort sample over six waves 1968-2011. For each wave we recalculated the distribution of baseline characteristics in the sample among i) the sample still alive and ii) the sample still alive and with complete follow-up. The results show that the majority of the compositional changes in the cohort were modest and driven mainly by mortality. However, for some characteristics, class in particular, the selection was considerable and in addition, was substantially compounded by survey non-participation. We suggest that sample selections should be taken into account when interpreting the results of longitudinal studies, in particular when researching social inequalities.
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| 13. |
- Kelfve, Susanne, et al.
(författare)
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Going web or staying paper? The use of web-surveys among older people
- 2020
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Ingår i: BMC Medical Research Methodology. - : Springer Science and Business Media LLC. - 1471-2288. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Web-surveys are increasingly used in population studies. Yet, web-surveys targeting older individuals are still uncommon for various reasons. However, with younger cohorts approaching older age, the potentials for web-surveys among older people might be improved. In this study, we investigated response patterns in a web-survey targeting older adults and the potential importance of offering a paper-questionnaire as an alternative to the web-questionnaire. Methods We analyzed data from three waves of a retirement study, in which a web-push methodology was used and a paper questionnaire was offered as an alternative to the web questionnaire in the last reminder. We mapped the response patterns, compared web- and paper respondents and compared different key outcomes resulting from the sample with and without the paper respondents, both at baseline and after two follow-ups. Results Paper-respondents, that is, those that did not answer until they got a paper questionnaire with the last reminder, were more likely to be female, retired, single, and to report a lower level of education, higher levels of depression and lower self-reported health, compared to web-respondents. The association between retirement status and depression was only present among web-respondents. The differences between web and paper respondents were stronger in the longitudinal sample (after two follow-ups) than at baseline. Conclusions We conclude that a web-survey might be a feasible and good alternative in surveys targeting people in the retirement age range. However, without offering a paper-questionnaire, a small but important group will likely be missing with potential biased estimates as the result.
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| 14. |
- Kelfve, Susanne, 1974-
(författare)
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Gotta survey somebody : Methodological challenges in population studies of older people
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Conducting representative surveys of older people is challenging. This thesis aims to analyze a) the characteristics of individuals at risk of being underrepresented in surveys of older people, b) the systematic errors likely to occur as a result of these selections, and c) whether these systematic errors can be minimized by weighting adjustments. In Study I, we investigated a) who would be missing from a survey that excluded those living in institutions and that did not use indirect interviews, b) how prevalence rates would be affected by these exclusions, and c) whether post-stratifying the data by sex and age (weighting adjustment) would correct for any systematic measurement error.In Study II, we compared mortality and hospitalization rates in those who responded to a postal questionnaire with rates in the target population. In addition, we tested whether a weighting variable created with a number of auxiliary variables could correct for the differences. In Study III, we followed a longitudinal cohort sample for 43 years. By recalculating baseline characteristics at each follow-up, we investigated how the sample changed after a) selective mortality and b) survey non-participation.In Study IV, we investigated whether the systematic non-participation that is likely to occur in surveys of older people affects the association between education and health.In sum, the results of these four studies show that people in the oldest age groups, women, those of low socioeconomic position, and those with the poorest health tend to be underrepresented in surveys of older people. This systematic underrepresentation might lead to an underestimation of poor health and function, a bias that is unlikely to be corrected by weighting adjustments, and to an underestimation of health inequality between educational groups. The results also show that the selective mortality that occurs in longitudinal samples might be compounded by selective non-participation among the most disadvantaged groups.
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| 15. |
- Kelfve, Susanne, et al.
(författare)
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Increased alcohol use over the past 20 years among the oldest old in Sweden
- 2014
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Ingår i: Nordic Studies on Alcohol and Drugs. - : SAGE Publications. - 1455-0725 .- 1458-6126. ; 31:3, s. 245-260
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Tidskriftsartikel (refereegranskat)abstract
- AIMS - Increased alcohol consumption among old people, reported in many countries, will likely present a major challenge to public health and policy in the future. In Sweden, current knowledge about old people's alcohol consumption is incomplete because of limited historical data and a dearth of nationally representative studies. We describe the frequency of alcohol consumption among the oldest old in Sweden over a 20-year period by sex, age, education, living situation, mobility and Activities of Daily Living. METHODS - We used repeated cross-sectional survey data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), conducted in 1992, 2002 and 2011. The samples were nationally representative of the Swedish population aged 77+, with response rates of 95.4%, 84.4% and 86.2% (total n = 2007). Self-reported consumption frequency was measured with the question How often do you drink alcoholic beverages, such as wine, beer or spirits? RESULTS - Frequency of alcohol consumption increased among the oldest old from 1992 to 2011. The proportion reporting no or less-than-monthly alcohol consumption decreased, whereas the proportion reporting weekly consumption increased. This was true for men, women and most age and educational groups. The period change in consumption frequency was not explained by changes in demographic factors, living situation or functional capacity during the study period. CONCLUSIONS - Alcohol use increased among the oldest old in Sweden during the 20-year study period. More liberal attitudes toward alcohol could contribute to the increased use. The increase in weekly alcohol consumers suggests an increase in the number of older risk consumers.
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| 16. |
- Kelfve, Susanne, et al.
(författare)
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Is the level of education associated with transitions between care settings in older adults near the end of life? A nationwide, retrospective cohort study
- 2018
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Ingår i: Palliative Medicine. - : SAGE Publications. - 0269-2163 .- 1477-030X. ; 32:2, s. 366-375
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Tidskriftsartikel (refereegranskat)abstract
- Background: End-of-life transitions between care settings can be burdensome for older adults and their relatives. Aim: To analyze the association between the level of education of older adults and their likelihood to experience care transitions during the final months before death. Design: Nationwide, retrospective cohort study using register data. Setting/participants: Older adults (65 years) who died in Sweden in 2013 (n = 75,722). Place of death was the primary outcome. Institutionalization and multiple hospital admissions during the final months of life were defined as secondary outcomes. The decedents' level of education (primary, secondary, or tertiary education) was considered as the main exposure. Multivariable analyses were stratified by living arrangement and adjusted for sex, age at time of death, illness trajectory, and number of chronic diseases. Results: Among community-dwellers, older adults with tertiary education were more likely to die in hospitals than those with primary education (55.6% vs 49.9%; odds ratio (OR) = 1.21, 95% confidence interval (CI) = 1.14-1.28), but less likely to be institutionalized during the final month before death (OR = 0.83, 95% CI = 0.76-0.91). Decedents with higher education had greater odds of remaining hospitalized continuously during their final 2 weeks of life (OR = 1.12, 95% CI = 1.02-1.22). Among older adults living in nursing homes, we found no association between the decedents' level of education and their likelihood to be hospitalized or to die in hospitals. Conclusion: Compared with those who completed only primary education, individuals with higher educational attainment were more likely to live at home until the end of life, but also more likely to be hospitalized and die in hospitals.
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| 17. |
- Kelfve, Susanne, 1974-, et al.
(författare)
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Kvantitativ datainsamling
- 2020
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Ingår i: Metoder för forskning i socialt arbete. - Malmö : Gleerups Utbildning AB. - 9789151101620 ; , s. 57-75
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Finns det något samband mellan ungdomskriminalitet och antalet fritidsgårdar i en kommun? Är socialsekreterare mer stressade i dag än för tio år sedan? Är pojkar oftare utsatta för våld än flickor? Hur har ungdomars alkoholvanor förändrats över tid? Det här är exempel på frågeställningar som är relevanta för socialt arbete, och där vi behöver använda kvantitativa forskningsmetoder för att kunna besvara dem, eftersom det i samtliga fall handlar om kvantitet, frekvens och om relationen mellan mätbara faktorer.
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| 18. |
- Kelfve, Susanne, et al.
(författare)
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Length of the period with late life dependency : Does the age of onset make a difference?
- 2023
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Ingår i: European Journal of Ageing. - : SPRINGER. - 1613-9372 .- 1613-9380. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- There is a gap in knowledge about factors associated with the duration of late life dependency. In this study, we measured how the age at onset of late life dependency relates to the time spent with late life dependency. Using Swedish register data, we identified people 70 + who entered the period of late life dependency (measured by entering long-term care for help with PADLs) between June and December 2008. We followed this cohort (n = 17,515) for 7 years, or until death. We used Laplace regression models to estimate the median number of months with late life dependency by age group, gender, level of education and country of birth. We also calculated the crude percentiles (p10, p25, p50, p75 and p90) of month with late life dependency, by age group, gender and cohabitation status. Results show that the majority spent a rather long period with dependency, the median number of months were 40.0 (3.3 years) for women and 22.6 (1.9 year) for men. A higher age at entry was associated with a shorter duration of dependency, an association that was robust to adjustment for cohabiting at baseline, gender, education and country of birth. Our results suggest that older adults who postpone the start of dependency also compress the time with dependency, this lends support to the ambitions of public health initiatives and interventions targeting maintained independence in older adults.
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| 19. |
- Kelfve, Susanne, et al.
(författare)
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Length of the period with late life dependency: Does the age of onset make a difference?
- 2023
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Ingår i: European Journal of Ageing. - : SPRINGER. - 1613-9372 .- 1613-9380. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- There is a gap in knowledge about factors associated with the duration of late life dependency. In this study, we measured how the age at onset of late life dependency relates to the time spent with late life dependency. Using Swedish register data, we identified people 70 + who entered the period of late life dependency (measured by entering long-term care for help with PADLs) between June and December 2008. We followed this cohort (n = 17,515) for 7 years, or until death. We used Laplace regression models to estimate the median number of months with late life dependency by age group, gender, level of education and country of birth. We also calculated the crude percentiles (p10, p25, p50, p75 and p90) of month with late life dependency, by age group, gender and cohabitation status. Results show that the majority spent a rather long period with dependency, the median number of months were 40.0 (3.3 years) for women and 22.6 (1.9 year) for men. A higher age at entry was associated with a shorter duration of dependency, an association that was robust to adjustment for cohabiting at baseline, gender, education and country of birth. Our results suggest that older adults who postpone the start of dependency also compress the time with dependency, this lends support to the ambitions of public health initiatives and interventions targeting maintained independence in older adults.
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| 20. |
- Kelfve, Susanne, et al.
(författare)
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Sampling and non-response bias on health-outcomes in surveys of the oldest old
- 2013
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Ingår i: European Journal of Ageing. - : Springer Science and Business Media LLC. - 1613-9372 .- 1613-9380. ; 10:3, s. 237-245
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Tidskriftsartikel (refereegranskat)abstract
- Surveys of the oldest old population are associated with several design issues. Place of residence and possible physical or cognitive impairments make it difficult to maintain a representative study population. Based on a Swedish nationally representative survey among individuals 77+, the present study analyze the potential bias of not using proxy interviews and excluding the institutionalized part of the population in surveys of the oldest old. The results show that compared to directly interviewed people living at home, institutionalized and proxy interviewed individuals were older, less educated and more likely to be female. They had more problems with health, mobility and ADL, and a significantly increased mortality risk. If the study had excluded the institutionalized part of the population and/or failed to use proxy interviews, the result would have been severely biased and resulted in underestimated prevalence rates for ADL, physical mobility and psychologic problems. This could not be compensated for weighting the data by age and sex. The results from this study imply that accurate population estimates require a representative study population, in which all individuals are included regardless of their living conditions, health status, and cognitive ability.
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| 21. |
- Kelfve, Susanne
(författare)
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Underestimated Health Inequalities Among Older People-A Consequence of Excluding the Most Disabled and Disadvantaged
- 2019
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Ingår i: The journals of gerontology. Series B, Psychological sciences and social sciences. - : Oxford University Press (OUP). - 1079-5014 .- 1758-5368. ; 74:8, s. e125-E134
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The present study analyzed whether estimates of health inequalities in old age are sensitive to the exclusion of people living in institutions and nonuse of proxy interviews. Method: Pooled data from the 2004 wave (n = 1,180, aged 69-100, primarily interviewed over the phone) and the 2011 wave (n = 931, aged 76-101, primarily interviewed face-to-face) of the Swedish Panel Study of Living Conditions of the Oldest Old were used to compare absolute and relative differences in disability and mortality between people with compulsory education and people with more than compulsory education. Results: Both absolute and relative health inequalities would have been underestimated in a survey that excluded institutionalized people and proxy-interviewed community dwellers. The same patterns were found in men and women and regardless of the mode of data collection (telephone or face-to-face interview). The degree of underestimation was lower in those 85 years and older than in those 69 to 84 years. Discussion: A survey that only includes people who live in the community and can participate without the help of a proxy might give the impression that those with low levels of education have less extensive health disadvantages than they actually have.
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| 22. |
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| 23. |
- Kåreholt, Ingemar, 1960-, et al.
(författare)
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History of Job Strain And Risk of Late-Life Dependency : A Nationwide Swedish Registerbased Study
- 2022
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Ingår i: Innovation in Aging. - : Oxford University Press. - 2399-5300. ; 6:Supplement 1, s. 502-503
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Tidskriftsartikel (refereegranskat)abstract
- There is substantial evidence that work plays a significant role in post-retirement health. Yet little is known about its role in when late-life dependency may occur. We examined associations between job strain and the risk of entering late-life dependency. Individually linked nationwide Swedish registers were used to identify people 70+ alive in January 2014, and who did not experience the outcome (late-life dependency) during two months prior to the start of the follow-up. Late-life dependency was operationalized as use of long-term care. Information about job strain was obtained via a job exposure matrice and matched with job titles. Cox regression models with age as time-scale (adjusted for living situation, educational attainment, country of birth, and sex) were conducted to estimate hazard ratios (HR) for entering late-life dependency during the 24 months of follow-up (n=993,595). Having an initial high starting point of job strain followed by an increasing trajectory throughout working life implied a 23% higher risk of entering late-life dependency at a younger age, compared with the reference group (low starting point with a decreasing trajectory). High initial starting point followed by a stable trajectory implied a 12% higher risk of entering late-life dependency at a younger age. High initial starting point followed by a decreasing trajectory implied a 10% risk reduction, and a low starting point with a stable trajectory implied a 22% risk reduction, of entering late-life dependency at a younger age. Reducing stressful jobs across working life may contribute to postponing late-life dependency.
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| 24. |
- König, Stefanie, et al.
(författare)
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Development of healthcare use across contemporary retirement pathways : results from a register based cohort study
- 2022
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Ingår i: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 50:4, s. 440-447
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Tidskriftsartikel (refereegranskat)abstract
- Aim: We aimed to understand the interplay between retirement pathways and healthcare use in the postponed and structurally changing context of retirement.Methods: Based on Swedish register data on income and healthcare use, we applied combined sequence and cluster analysis to identify typical pathways into retirement and analysed their relation to healthcare use developments.Results: We detected five distinct pathways into retirement. Level of healthcare use was significantly higher for the pathway via disability pensions. We saw an overall increase in healthcare use across the retirement process that was related to age rather than to the different pathways.Conclusions: Level of healthcare use at the beginning of the retirement process may be related to selection into different pathways of retirement. We did not find clear evidence across several healthcare measures that different pathways lead to different developments in healthcare use.
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| 25. |
- Lennartsson, Carin, et al.
(författare)
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Data Resource Profile : The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD)
- 2014
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Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 43:3, s. 731-738
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Tidskriftsartikel (refereegranskat)abstract
- As the number and proportion of very old people in the population increase, there is a need for improved knowledge about their health and living conditions. The SWEOLD interview surveys are based on random samples of the population aged 77+years. The low non-response rates, the inclusion of institutionalized persons and the use of proxy informants for people unable to be interviewed directly ensure a representative portrayal of this age group in Sweden. SWEOLD began in 1992 and has been repeated in 2002, 2004 and 2011. The survey is based on another national survey, the Swedish Level of Living Survey (LNU), started in 1968 with 10-year follow-up waves. This longitudinal design provides additional data collected when SWEOLD participants were in middle age and early old age. The SWEOLD interviews cover a wide range of areas including health and health behaviour, work history, family, leisure activities and use of health and social care services. Socio-economic factors include education, previous occupation and available cash margin. Health indicators include symptoms, diseases, mobility and activities of daily living (ADL). In addition to self-reported data, the interview includes objective tests of lung function, physical function, grip strength and cognition. The data have been linked to register data, for example for income and mortality follow-ups. Data are available to the scientific community on request. More information about the study, data access rules and how to apply for data are available at the website (www.sweold.se).
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| 26. |
- Marcusson, Jan, et al.
(författare)
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Proactive healthcare for frail elderly persons : study protocol for a prospective controlled primary care intervention in Sweden
- 2019
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:5
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Tidskriftsartikel (refereegranskat)abstract
- Introduction The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction.Methods and analysis In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire.Ethics and dissemination Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.
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| 27. |
- Meinow, Bettina, et al.
(författare)
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Long -Term Care Use During the Last 2 Years of Life in Sweden : Implications for Policy to Address Increased Population Aging
- 2020
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier. - 1525-8610 .- 1538-9375. ; 21:6, s. 799-805
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo map out the total use of long-term care (LTC; ie, home care or institutional care) during the last 2 years of life and to investigate to what extent gender differences in LTC use were explained by cohabitation status and age at death.DesignThe National Cause of Death Register was used to identify decedents. Use of LTC was based on the Social Services Register (SSR) and sociodemographic factors were provided by Statistics Sweden.Setting and ParticipantsAll persons living in Sweden who died in November 2015 aged ≥67 years (n = 5948).MethodsZero inflated negative binomial regression was used to estimate the relative impact of age, gender, and cohabitation status on the use of LTC.ResultsWomen used LTC to a larger extent [odds ratio (OR) 2.17, 95% confidence interval (CI) 1.92-2.50] and for a longer period [risk ratio (RR) 1.14, 95% CI 1.11-1.18] than men. When controlling for age at death and cohabitation status, gender differences in LTC attenuated (OR 1.47, 95% CI 1.28-1.72) and vanished in regard to the duration. In the controlled model, women used LTC for 15.6 months (95% CI 15.2-16.0) and men for 14.1 months (95% CI 13.7-14.5) out of 24 months. The length of stay in institutional care was 7.2 (95% CI 6.8-7.5) and 6.2 months (95% CI 5.8-6.6), respectively.Conclusions and ImplicationsA substantial part of women's greater use of LTC was due to their higher age at death and because they more often lived alone. Given that survival continues to increase, the association between older age at death and LTC use suggests that policy makers will have to deal with an increased pressure on the LTC sector. Yet, increased survival among men could imply that more women will have access to spousal caregivers, although very old couples may have limited capacity for extensive caregiving at the end of life.
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| 28. |
- Meinow, Bettina, et al.
(författare)
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Trends over two decades in life expectancy with complex health problems among older Swedes : implications for the provision of integrated health care and social care
- 2022
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Ingår i: BMC Public Health. - London, United Kingdom : Springer Science and Business Media LLC. - 1471-2458. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Due to population aging, it is essential to examine to what extent rises in life expectancy (LE) consist of healthy or unhealthy years. Most health expectancy studies have been based on single health measures and have shown divergent trends. We used a multi-domain indicator, complex health problems (CHP), indicative of the need for integrated medical and social care, to investigate how LE with and without CHP developed in Sweden between 1992 and 2011. We also addressed whether individuals with CHP more commonly lived in the community in 2011 compared to earlier years.Methods: CHP were defined as having severe problems in at least two of three health domains related to the need for medical and/or social care: symptoms/diseases, cognition/communication, and mobility. The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), a nationally representative survey of the Swedish population aged >= 77 years with waves in 1992, 2002 and 2011 (n approximate to 2000), was used to estimate the prevalence of CHP. Age- and gender-specific death rates were obtained from the Human Mortality Database. The Sullivan method was deployed to calculate the remaining life expectancy with and without CHP. The estimates were decomposed to calculate the contribution of changes from morbidity and mortality to the overall trends in LE without CHP.Results: Between 1992 and 2011, both total LE (+ 1.69 years [95% CI 1.56;1.83] and LE without CHP (+ 0.84 years [-0,87;2.55]) at age 77 increased for men, whereas LE at age 77 increased for women (+ 1.33 [1.21;1.47]) but not LE without CHP (-0.06 years [-1.39;1.26]). When decomposing the trend, we found that the increase in LE with CHP was mainly driven by an increase in the prevalence of CHP. Among individuals with CHP the proportion residing in care homes was lower in 2011 (37%) compared to 2002 (58%) and 1992 (53%).Conclusions: The findings, that an increasing number of older people are expected to live more years with CHP, and increasingly live in the community, point towards a challenge for individuals and families, as well as for society in financing and organizing coordinated and coherent medical and social services.
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| 29. |
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| 30. |
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| 31. |
- Motel-Klingebiel, Andreas, Prof. Dr. phil. habil. 1964-, et al.
(författare)
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Exclusion and Inequality in Late Working Life
- 2021
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Ingår i: European Sociological Association's Research Network on Ageing in Europe (RN01) Midterm conference 2021. - Jyväskylä.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 32. |
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| 33. |
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| 34. |
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| 35. |
- Motel-Klingebiel, Andreas, Prof. Dr. phil. habil. 1964-, et al.
(författare)
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Late work during the COVID-19 pandemic in Sweden
- 2021
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Ingår i: Gemeinsamer Kongress der Deutschen Gesellschaft für Soziologie (DGS) und der Österreichischen Gesellschaft für Soziologie (ÖGS). - Vienna.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 36. |
- Motel-Klingebiel, Andreas, Prof. Dr. phil. habil. 1964-, et al.
(författare)
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Precarious pathways into retirement and new risks for gendered economic exclusion in Sweden, 1990-2015
- 2019
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Ingår i: Innovation in Aging. - : Oxford University Press. - 2399-5300. ; 3:Supplement_1, s. S131-S131
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Tidskriftsartikel (refereegranskat)abstract
- The ability and disposition of ageing people to maintain their labour market activity and/or to retire from work structurally depend on pension systems, activation policies, ageism, changing for labor demand and economic shifts. Structural conditions are changing, but social change does not mature homogeneously and neither do the institutional shifts induced by it. Gains in opportunities and resources do not benefit all people, groups and even societies in the same way. Changes increase insecurities and life course inhomogeneity, create unequally distributed challenges and show asynchrony in shifts and outcomes. They generate new precarity in ageing and socially structured risks for exclusion in work and retirement and refer to existing later life inequalities by cohort, gender, region, education, class and ethnicity. From this perspective of ageing and social change, the paper deals with shifts in late work and retirement patterns and later-life outcomes under changing institutional conditions, focusing on gendered risks for economic exclusion and later life precarity in Sweden. Swedish registry data comprising individual work and health histories as well as employer, regional and neighborhood information on the total population 50+ ever living in Sweden 1990-2015 is used in a cohort sequential perspective. Analyses focus on gender inequalities and concentrate on occupational activities, retirement transitions and pension revenues under changing social conditions. Models find increasingly heterogeneous preretirement and transition patterns, new gender gaps and increasing risks of economic exclusion in retirement with disadvantaged groups as forerunners in overall relative declines in later-life economic positions.
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| 37. |
- Motel-Klingebiel, Andreas, Prof. Dr. phil. habil. 1964-, et al.
(författare)
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Spätes Erwerbsleben während der COVID-19- Pandemie in Schweden
- 2021
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Konferensbidrag (refereegranskat)abstract
- Während der COVID-19-Pandemie hat sich Schweden von Anbeginn auf Empfehlungen wie Kontaktreduzierung and Abstand konzentriert, aber trotz des Verzichts auf lockdownähnliche Maßnahmen standen und stehen die Menschen wie überall vor großen Herausforderungen. Während altersbedingte Sterblichkeitsrisiken und die Rolle der stationären und ambulanten Pflege in Schweden wohlbekannt sind, ist weiterhin wenig über die Folgen insbesondere für die späte Erwerbstätigkeit bekannt. Ziel diese Beitrags ist es daher, die Auswirkungen und Pandemiefolgen in Schweden unter dem Gesichtspunkt sozialer Risiken im Bereich des Erwerbslebens und der Ungleichheit in Bezug auf Alter und Geschlecht vor den Hintergrund von Pandemie- und Gleichstellungspolitiken zu verstehen. Es werden Veränderungen und deren Bewertungen während der Pandemie und der damit verbundenen politischen Maßnahmen erörtert. Es wird vor dem Hintergrund der schwedischen Pandemiepolitiken gefragt a) Welche Veränderungen im Bereich der Erwerbsarbeit erleben Menschen unterschiedlichen Alters in Schweden? b) Wie zufrieden sind Menschen unterschiedlichen Alters mit den Veränderungen im Arbeitsleben und welches sind wichtigsten Herausforderungen? c) Hat die COVID-19-Pandemie im Hinblick auf Alter, Geschlecht einen ungleichen Einfluss auf das Erwerbsleben? Die Division Ageing and Social Change (www.ageing.se) der Linköping University , in Schweden hat hierzu eine Online-Umfrage mit bisher zwei Wellen durchgeführt (eine dritte Welle wird im Juni 2021 hinzugefügt). Die Stichprobenziehung erfolgte durch Online-Werbung in den größten Tageszeitungen Östergötlands mit 780.000 zufällig verteilten Seitenaufrufen im Juni und Dezember 2020 (n = 1.100 (617/483), 30-74 Jahre, gewichtet nach Alter, Geschlecht und Bildung). Die Studie wurde im Rahmen des Forschungsprogramms EIWO (www.eiwoproject.org; Forte dnr. 2019-01245) durchgeführt. Die Ergebnisse zeigen Ergebnisse zu Veränderungen und deren subjektive Bewertung im Verlauf der Pandemie: Ältere Arbeitnehmer sind anfangs allgemein weniger negativ von pandemiebedingten Veränderungen betroffen als jüngere. Auffallend sind hingegen starke Geschlechtsunterschiede hinsichtlich Auswirkungen und Bewertungen, die negativen Konsequenzen in der Gruppe der 65-Jährigen und Älteren sowie der Anteil und die Zusammensetzung der Gruppe, die von positiven Veränderungen berichtet.
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| 38. |
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| 39. |
- Motel-Klingebiel, Andreas, Prof. Dr. phil. habil. 1964-, et al.
(författare)
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What equality? Life course diversity and inequality In later life In changing Sweden
- 2017
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Ingår i: Innovation in Aging. - : Oxford University Press. - 2399-5300. ; 1:suppl_1, s. 845-845
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Tidskriftsartikel (refereegranskat)abstract
- This paper discusses shifts in inequality over time in Sweden, which serves as a case example of a quickly changing welfare society. Its 60+ population of today faced the golden age of capitalism, prosperity and welfare but also crises, new uncertainties, erosions and shifts in social norms and organisation of labour. These changes add to life course inhomogeneity, generate asynchronies, and create winners and losers regarding life chances and inclusion. Transformations in life courses and social institutions exacerbate the cumulation of (dis)advantage and have crucial impacts on employment, retirement transitions and later life. Aspects like gender, cohort, education, ethnicity and others moderate these dynamics. Increasing disparities between societies give rise to migration and contribute in turn to differences within countries.This study deals with changing population compositions, patterns and later-life consequences of life courses in Sweden focusing on inter- and intra-cohort disparities. By taking an international comparative perspective, Swedish trends are contrasted with those in other European societies. Based on extensive Swedish registry information and European survey data from EU-SILC, this study assesses changes in trajectories and distributions in a cohort-sequential perspective.Results of this ongoing study find significant shifts in life course patterns that are fortified by variations in population compositions, with disadvantaged groups as forerunners in overall relative declines in later-life economic positions, and increasing intra-cohort inequalities corresponding with unexpected drawbacks for many as well as new possibilities for others.
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| 40. |
- Nilsen, Charlotta, et al.
(författare)
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History of working conditions and the risk of old-age dependency : a nationwide Swedish register-based study
- 2024
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Ingår i: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 52:6, s. 726-732
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Tidskriftsartikel (refereegranskat)abstract
- Aims: There is substantial evidence that previous working conditions influence post-retirement health, yet little is known about previous working conditions' association with old-age dependency. We examined job strain, hazardous and physical demands across working life, in relation to the risk of entering old-age dependency of care. Methods: Individually linked nationwide Swedish registers were used to identify people aged 70+ who were not receiving long-term care (residential care or homecare) at baseline (January 2014). Register information on job titles between the years 1970 and 2010 was linked with a job exposure matrix of working conditions. Random effects growth curve models were used to calculate intra-individual trajectories of working conditions. Cox regression models with age as the timescale (adjusted for living situation, educational attainment, country of birth, and sex) were conducted to estimate hazard ratios for entering old-age dependency during the 24 months of follow-up (n = 931,819). Results: Having initial adverse working conditions followed by an accumulation throughout working life encompassed the highest risk of entering old-age dependency across the categories (job strain: HR 1.23, 95% CI 1.19-1.27; physical demands: HR 1.36, 95% CI 1.31-1.40, and hazardous work: HR 1.35, 95% CI 1.30-1.40). Initially high physical demands or hazardous work followed by a stable trajectory, or initially low-level physical demand or hazardous work followed by an accumulation throughout working life also encompassed a higher risk of dependency. Conclusions: A history of adverse working conditions increased the risk of old-age dependency. Reducing the accumulation of adverse working conditions across the working life may contribute to postponing old-age dependency.
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| 41. |
- Poli, Arianna, 1987-
(författare)
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A Divided Old Age through Research on Digital Technologies
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis aims at contributing to the understanding of digital inequalities among older people, by studying the involvement of older people in research on digital technologies. Some mechanisms driving old age digital inequalities are well known. For instance, people with lower social positions tend to have lower digital skills, to face technology accessibility and affordability issues, and, thus, to engage less with digital technologies compared to their counterparts. However, less attention has been paid to issues related to research and development of digital technologies, such as the involvement of older people in research evaluating new digital technologies. Previous studies indicate that participants and non-participants in research are different one another, with the former being younger, reporting higher educational levels, having better health status than the non-participants. This may bias research outcomes and lead to incorrect conclusions on the utility of digital technologies. The objective of this thesis is to investigate the link between the involvement of older people in digital technology evaluations and the research outcomes. Healthcare is used as exemplifying context in which digital technologies are used. In Study I, participation in digital health research is conceptualised, and a research tool for identifying and measuring selective participation is developed. In Study II and III, factors associated with participation in two digital health intervention studies are analysed. In Study IV, the impact of selective participation on the research outcomes of a digital health study is identified, measured, and corrected. Thesis findings show that participation of older people in digital health research is selective by age, gender, health status, job level, and digital skills, and can indicate a mechanism for digital inequalities. Selective participation biases research outcomes by overemphasising the intervention effects of the over-represented groups over those among the under-represented groups. It can cause an overestimation of the positive effects of digital health technologies due to the under-representation of those groups who do not benefit from the intervention. This promotes digital technologies which increase exclusion risks for some groups of older people and reinforce old age digital and social inequalities. Weighting procedures can be used for mitigating the impact of this mechanism on the research outcomes of intervention studies on digital technologies.
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| 42. |
- Poli, Arianna, et al.
(författare)
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A research tool for measuring non-participation of older people in research on digital health
- 2019
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Healthcare services are being increasingly digitalised in European countries. However, in studies evaluating digital health technology, some people are less likely to participate than others, e.g. those who are older, those with a lower level of education and those with poorer digital skills. Such non-participation in research - deriving from the processes of non-recruitment of targeted individuals and self-selection - can be a driver of old-age exclusion from new digital health technologies. We aim to introduce, discuss and test an instrument to measure non-participation in digital health studies, in particular, the process of self-selection.Methods: Based on a review of the relevant literature, we designed an instrument - the NPART survey questionnaire - for the analysis of self-selection, covering five thematic areas: socioeconomic factors, self-rated health and subjective overall quality of life, social participation, time resources, and digital skills and use of technology. The instrument was piloted on 70 older study persons in Sweden, approached during the recruitment process for a trial study.Results: Results indicated that participants, as compared to decliners, were on average slightly younger and more educated, and reported better memory, higher social participation, and higher familiarity with and greater use of digital technologies. Overall, the survey questionnaire was able to discriminate between participants and decliners on the key aspects investigated, along the lines of the relevant literature.Conclusions: The NPART survey questionnaire can be applied to characterise non-participation in digital health research, in particular, the process of self-selection. It helps to identify underrepresented groups and their needs. Data generated from such an investigation, combined with hospital registry data on non-recruitment, allows for the implementation of improved sampling strategies, e.g. focused recruitment of underrepresented groups, and for the post hoc adjustment of results generated from biased samples, e.g. weighting procedures.
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| 43. |
- Poli, Arianna, 1987-, et al.
(författare)
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Does the Uneven Involvement of Older People in Digital Health Research Bias Research Results?
- 2022
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Konferensbidrag (refereegranskat)abstract
- The involvement of older people in research on digital technologies is uneven. Some groups of older people, e.g. the older ones, are less likely to participate in research which evaluates new digital technologies, compared to their counterparts. This may bias research results and produce wrong research conclusions. In this work, we aim at understanding whether and how the uneven involvement of older people in research on digital technologies has an impact on the research results. Our example is an intervention study which evaluated a web-based system for monitoring the postoperative progress of individuals after day surgery, i.e. ‘Mobile Phone in Recovery after Ambulatory Surgery’ (MIRAS). We considered a sample of 717 individuals of age 50 years and older (mean age: 65) who underwent a day surgery at one of the MIRAS recruitment sites during the recruitment timeframe. This group included both MIRAS participants and those who were not recruited byMIRAS. Based on information on age, gender, recruitment status, and intervention results, we implemented a weighting procedure to adjust the intervention results for the over-representation and the under-representation of groups of older people in the MIRAS sample by age and gender. We found that weighted and unweighted intervention results differed one another. The unweighted intervention results were over-positive with regards to the efficacy of the intervention due to the under-representation of groups of older people who were older and men. Biased results generate inaccurate conclusions which, in turn, can inform inappropriate digitalisation strategies and policies.
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| 44. |
- Poli, Arianna, 1987-, et al.
(författare)
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Old-age diversity is underrepresented in digital health research : findings from the evaluation of a mobile phone system for post-operative progress monitoring in Sweden
- 2023
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Ingår i: Ageing & Society. - : Cambridge University Press. - 0144-686X .- 1469-1779. ; 43:10, s. 2264-2286
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Tidskriftsartikel (refereegranskat)abstract
- Much research is conducted to evaluate digital-based solutions for health-care services, but little is known about how such evaluations acknowledge diversity in later life. This study helps fill this gap and analyses participation in the evaluation of a web-based mobile phone system for monitoring the post-operative progress of patients after day surgery. Participation is conceptualised as resulting from three processes: pre-screening, recruitment and self-selection. Based on field information and survey data, this study models (a) the (non-)participation in a sample of 498 individuals aged 60 and older that includes non-screened, non-recruited, decliners and participants in the evaluation, and (b) the individual decision to participate in a sample of 210 individuals aged 60 and older who were invited to take part in the evaluation. Increasing age enhances the likelihood of not being screened, not being recruited or declining the invitation. Those not recruited were most often ineligible because of technology-related barriers. Decliners and participants differed by age, gender, job, health status, digital skills, but not by social participation. Results suggest that highly specific groups of older people are more likely to be involved than others. Old-age diversity is not properly represented in digital health research, with implications for the inclusivity of new digital health technologies. This has implications for increased risks of old-age exclusion and exacerbation of social and digital inequalities in ageing societies.
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| 45. |
- Poli, Arianna, et al.
(författare)
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Prediction of (Non)Participation of Older People in Digital Health Research : Exergame Intervention Study
- 2020
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 22:6
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Tidskriftsartikel (refereegranskat)abstract
- Background: The use of digital technologies is increasing in health care. However, studies evaluating digital health technologies can be characterized by selective nonparticipation of older people, although older people represent one of the main user groups of health care.Objective: We examined whether and how participation in an exergame intervention study was associated with age, gender, and heart failure (HF) symptom severity.Methods: A subset of data from the HF-Wii study was used. The data came from patients with HF in institutional settings in Germany, Italy, the Netherlands, and Sweden. Selective nonparticipation was examined as resulting from two processes: (non)recruitment and self-selection. Baseline information on age, gender, and New York Heart Association Functional Classification of 1632 patients with HF were the predictor variables. These patients were screened for HF-Wii study participation. Reasons for nonparticipation were evaluated.Results: Of the 1632 screened patients, 71% did not participate. The nonrecmitment rate was 21%, and based on the eligible sample, the refusal rate was 61%. Higher age was associated with lower probability of participation; it increased both the probabilities of not being recruited and declining to participate. More severe symptoms increased the likelihood of nonrecruitment. Gender had no effect. The most common reasons for nonrecruitment and self-selection were related to physical limitations and lack of time, respectively.Conclusions: Results indicate that selective nonparticipation takes place in digital health research and that it is associated with age and symptom severity. Gender effects cannot be proven. Such systematic selection can lead to biased research results that inappropriately inform research, policy, and practice.
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| 46. |
- Poli, Arianna, 1987-, et al.
(författare)
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(Un)willingness to Participate in Digital Health Research and Self-Ageism
- 2021
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Konferensbidrag (refereegranskat)abstract
- Much research is conducted for evaluating digital-based solutions for healthcare among older people. However, some older people are less likely to be involved than others. We present an analysis of participation in the evaluation of a mobile-based system for monitoring post-operative progress after a day surgery in Sweden. We explore key factors associated with the unwillingness to participate and discuss the possible role of self-ageism in determining the decision not to participate. Based on field information and survey data, we compared participants and non-participants in a sample of 368 individuals aged 60 and older and modelled the individual decision to participate (or not) in the evaluation. Decliners and those who were willing to participate differ along the lines of (chronological) age, gender, job, health status, and digital skills. Age remains a significant factor explaining individual decision to participate even when controlling for other variables. Overall results indicate that very specific groups of older people are more likely to participate than others in digital health research. Age plays a major role in the decision to participate or not. Negative self-perception of being old with respect to digital health research could contribute to explaining the individual unwillingness to participate.
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| 47. |
- Rahman, Atiqur, et al.
(författare)
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Eldercare services for people with and without a dementia diagnosis : an analysis of Swedish registry data
- 2021
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The growing number of people living with dementia (PlwD) implies an increase in the demand for eldercare services in Sweden like in many other countries. Few studies have analyzed the use of eldercare services for PlwD. The aim of the present study is to investigate the association between demographic factors (age, sex, cohabiting status) and the use of municipal eldercare services (including both home care and residential care) for older adults with dementia compared to older adults without dementia in Sweden.Methods: This study used several nationwide Swedish registers targeting all individuals aged 65 and above living in Sweden in 2014 and still alive 31st of March 2015 (n = 2,004,409). The primary outcomes variables were different types of eldercare service, and all participants were clustered based on age, sex, cohabiting status, and dementia diagnosis. In addition to descriptive statistics, we performed multivariate logistic regression models for binary outcomes and linear regression models for continuous outcomes.Results: Results showed that (1) older age is a significantly strong predictor for the use of eldercare services, although PlwD start using eldercare at an earlier age compared with people without dementia; (2) women tend to receive more eldercare services than men, especially in older age, although men with dementia who live alone are more likely than women living alone to receive eldercare; (3) having a dementia diagnosis is a strong predictor for receiving eldercare. However, it was also found that a substantial proportion of men and women with dementia did not receive any eldercare services.Conclusions: We found that people with a dementia diagnosis use more as well as start to use eldercare services at an earlier age than people without dementia. However, further research is needed to investigate why a substantial part of people with a dementia diagnosis does not have any eldercare at all and what the policy implications of this might be.
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| 48. |
- Rahman, Atiqur, et al.
(författare)
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People Living with a Dementia Diagnosis with No Eldercare at all : Who Are They?
- 2022
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Ingår i: Journal of Aging & Social Policy. - : Informa UK Limited. - 0895-9420 .- 1545-0821. ; 34:6, s. 876-893
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Tidskriftsartikel (refereegranskat)abstract
- Dementia is a non-curable disease that progressively affects people’s ability to handle their everyday life. Still, previous Swedish research found that many people living with dementia (PlwD) do not use any eldercare. In this study, we investigated the association between not using eldercare services and key social background factors: years with dementia, hospital care, and country of birth for PlwD. We identified all people aged 65+ diagnosed with dementia between January 2006 and March 2015 (n = 43,372) using secondary data analysis of information taken from multiple Swedish nationwide registers. Results showed that not using eldercare was more common among younger age groups and men. The likelihood of having no eldercare was three times higher for those cohabiting; notably, almost a fifth of the PlwD who had the diagnosis for four years or more did not have eldercare at all. Finally, people born outside Europe used eldercare less than persons born in Sweden. Since the public dementia policy in Sweden is basically geared toward PlwD in a later stage and primarily in residential care, there has been almost no policy development around the needs and rights of PlwD in their homes. This study provides a ground for reconsidering dementia policy regardless of the ethnic and cultural backgrounds of PlwD.
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| 49. |
- Rahman, S M Atiqur, et al.
(författare)
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Long-term care use among people living with dementia : a retrospective register-based study from Sweden
- 2022
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 22
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although many people with dementia need progressive support during their last years of life little is known to what extent they use formal long-term care (LTC). This study investigates the use of LTC, including residential care and homecare, in the month preceding death, as well as the number of months spent in residential care, among Swedish older decedents with a dementia diagnosis, compared with those without a dementia diagnosis.Methodology: This retrospective cohort study identified all people who died in November 2019 in Sweden aged 70 years and older (n = 6294). Dementia diagnoses were collected from the National Patient Register (before death) and the National Cause of Death Register (death certificate). The use of LTC was based on the Social Services Register and sociodemographic factors were provided by Statistics Sweden. We performed regression models (multinomial and linear logistic regression models) to examine the association between the utilization of LTC and the independent variables.Results: Not only dementia diagnosis but also time spent with the diagnosis was crucial for the use of LTC in the month preceding death, in particular residential care. Three out of four of the decedents with dementia and one fourth of those without dementia lived in a residential care facility in the month preceding death. People who were diagnosed more recently were more likely to use homecare (e.g., diagnosis for 1 year or less: home care 29%, residential care 56%), while the predicted proportion of using residential care increased substantially for those who had lived longer with a diagnosis (e.g., diagnosis for 7 + years: home care 11%, residential care 85%). On average, people with a dementia diagnosis stayed six months longer in residential care, compared with people without a diagnosis.Conclusions: People living with dementia use more LTC and spend longer time in residential care than those without dementia. The use of LTC is primarily influenced by the time with a dementia diagnosis. Our study suggests conducting more research to investigate differences between people living with different dementia diagnoses with co-morbidities.
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| 50. |
- Rahman, S M Atiqur, et al.
(författare)
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Patterns of long-term care utilization during the last five years of life among Swedish older adults with and without dementia
- 2023
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Ingår i: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 18:10
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Tidskriftsartikel (refereegranskat)abstract
- AimsThe aims of this study were to compare the patterns of long-term care (LTC) use (no care, homecare, residential care) among people with and without dementia aged 70+ in Sweden during their last five years of life and its association with sociodemographic factors (age, gender, education, cohabitation status) and time with a dementia diagnosis.MethodsThis retrospective cohort study included all people who died in November 2019 aged 70 years and older (n = 6294) derived from several national registers. A multinomial logistic regression was conducted to identify which sociodemographic factors predicted the patterns of LTC use.ResultsResults showed that the time with a dementia diagnosis and cohabitation status were important predictors that influence the patterns of LTC use during the last five years of life. Nearly three-quarters of people living with dementia (PlwD) used residential care during the last five years of life. PlwD were more likely to reside in residential care close to death. Women who lived alone, with or without dementia, used residential care to a higher degree compared to married or cohabiting women.ConclusionsAmong people without a dementia diagnosis, as well as those who were newly diagnosed, it was common to have no LTC at all, or use LTC only for a brief period close to death. During the last five years of life, PlwD and those living alone more often entered LTC early and used residential care for a longer time compared to people without dementia and people living alone, respectively.
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