Estonian Generations and Gender Survey 2020:

The primary aim of this study is to thoroughly investigate the prevalence and determinants of loneliness among older adults in the Baltic-Nordic region. Utilizing high-quality data sources and employing a methodologically rigorous approach, the study endeavors to enhance our understanding of how loneliness manifests and varies across different cultural and socio-economic contexts within these regions. By identifying key factors influencing loneliness, including demographic, social, and economic variables, the research seeks to contribute significantly to the existing body of knowledge on loneliness and inform targeted public health strategies and interventions tailored to the unique needs of older adults in the Baltic and Nordic countries. This research, centered on older adults aged 67 and above within the Baltic-Nordic region, draws upon data from the Survey of Health, Ageing and Retirement in Europe (SHARE), specifically its eighth wave conducted between June and August 2020. The demographic analysis of this study covers a diverse sample of 5,313 participants from the Baltic and Nordic regions. Specifically, the sample includes 2,377 participants from Nordic countries, namely Sweden, Denmark, and Finland, and 2,936 from the Baltic countries of Estonia, Latvia, and Lithuania. The investigation extends to the financial well-being of households, involving an analysis of 3,925 individuals, with 1,748 from Nordic countries and 2,177 from Baltic countries. Although Iceland is categorized as a Nordic country, the analysis within this study is conducted separately due to the unavailability of SHARE data for this region. Instead, the HL20 study, focusing on the health and well-being of the older adult population in Iceland, contributes data for 1,033 respondents. This methodological distinction allows for a comprehensive understanding of regional differences, highlighting the importance of specialized approaches to examine the intricate dynamics of loneliness and well-being across the Baltic-Nordic region. The study reveals significant regional variations in loneliness among older adults during the COVID-19 outbreak, with the Baltic countries (Estonia, Latvia, Lithuania) reporting a lower prevalence of loneliness compared to the Nordic countries (Sweden, Denmark, Finland). Iceland, while grouped with the Nordic countries, was analysed separately. Employment emerges as a key factor in reducing loneliness across all regions, suggesting the benefits of social interactions and structured routines. Gender and marital status significantly influence loneliness, with notable disparities in the Baltic region and smaller gaps in the Nordic countries, reflecting the impact of societal and cultural norms. Additionally, educational attainment and health status show varied associations with loneliness, highlighting the complex interplay of individual and societal factors in these regions.

Although engagement in productive activities is associated with favourable outcomes with respect to the health and well-being of older individuals, the association between such activities and depression in older populations remains relatively unexplored. The purpose of this study was to evaluate the association among five productive activities (paid work, formal volunteering, caregiving, informal helping and caring for grandchildren) with depression in older adults in 14 European countries. This cross-sectional study used the first two waves of data collected by the Survey of Health, Ageing and Retirement in Europe and analysed a total sample of 7238 relatively healthy community residents aged 60 years and older from 14 European countries. The Survey of Health, Ageing and Retirement in Europe excluded potential participants with a past history of depression, cognitive impairment and physical limitations. Depression was categorised using the EURO-D instrument, and associations with participating in productive activities were investigated. Depression was less prevalent among those individuals who were employed or self-employed and those who participated in formal volunteering or informal helping, whereas caregiving was associated with a higher risk of depression. Caring for grandchildren was not associated positively or negatively with depression. Formal volunteering and caregiving remained associated with depression after adjustment for age, sex, marital status, education, economic status, country and presence of long-term illness. Availability of formal volunteering may be important in reducing depression risk, whereas caregiving is associated with a higher risk of depression in older European adults. Further research is required to clarify the direction of causation and evaluate interventions.

This paper introduces the 'Survey of Health, Ageing and Retirement in Europe' (SHARE) to researchers on ageing. SHARE provides an infrastructure to help researchers better understand the individual and population ageing process: where we are, where we are heading to, and how we can influence the quality of life as we age, both as individuals and as societies. The baseline wave in 2004 provides data on the life circumstances of some 27,000 persons aged 50 and over in 11 European countries, ranging from Scandinavia across Western and Central Europe to the Mediterranean. SHARE has made great efforts to deliver truly comparable data, so we can reliably study how differences in cultures, living conditions and policy approaches shape the life of Europeans just before and after retirement. The paper first describes the SHARE data. In order to demonstrate its value, it then presents highlights from the three main research areas covered by SHARE, namely economics, sociology, and health.

In the present study, we aimed to update the data of frailty status in the European community-dwelling population of older adults, based on the latest data released (wave 6) of the Survey of Health, Aging and Retirement in Europe database, and to study the impact of each criterion on frailty assessment. Frailty status was assessed applying a version of the Fried phenotype operationalized for the Survey of Health, Aging and Retirement in Europe. We included all participants who answered all the questions used in a frailty assessment and who disclosed their sex and, furthermore, who were aged ≥50 years. Our final sample was 60 816 individuals. Of these, the mean age was 67.45 ± 9.71 years; 38 497 (56.4%) were women. The overall prevalence of pre-frailty was 42.9% (ranging from 34.0% in Austria to 52.8% in Estonia), and frailty was 7.7% (ranging from 3.0% in Switzerland to 15.6% in Portugal). Pre-frailty and frailty prevalence increased along with age, and were more frequent among women. Regarding the five criteria considered on frailty assessment, exhaustion seems to be the criterion that contributes most to frailty status, followed by low activity, weakness, loss of appetite and slowness. With this work, we showed that >50% of the European population aged >50 years are pre-frail/frail, which must be considered when designing interventions to reduce/postpone/mitigate the progression of this condition, thus reducing the burden associated with it. Geriatr Gerontol Int 2019; 19: 723-729.

A large variety of information of respondents’ physical and mental health has been collected within the context of the Survey of Health, Ageing and Retirement in Europe(SHARE) from its first wave in 2004 on. Despite their undisputable value, self-reported and subjective health indicators turned out not to be unproblematic in international comparative analyses. The collection of biometric data contributes to remedying such problems. This research paper presents analyses with measures of isometric grip-strength – one of the biometric measures already available in SHARE to date. Further, the authors discuss the inclusion of other biometric measures (especially via blood samples) into the investigational program of the longitudinally designed SHARE. Relevant sociological problems and questions (e. g. the importance of biomarkers for analyses of the correlation between socio-economic status and health) as well as experiences with biometric data in studies comparable to SHARE (especially from Anglo-Saxon countries) are described.

Parkinson's disease (PD) significantly reduces quality of life (QoL), particularly due to its complex interplay of motor and nonmotor symptoms. While personality traits influence QoL in chronic diseases, their longitudinal effects in people with PD (PwPD) remain underexplored. This study evaluates the longitudinal predictive influence of neuroticism, conscientiousness, and openness on QoL in PwPD over two waves of the Survey of Health, Aging, and Retirement in Europe (SHARE). This study utilized longitudinal data from 100 PwPD participants in waves 7 and 8 of the Survey of Health, Aging, and Retirement in Europe (SHARE). QoL was assessed using the CASP-12 scale, while personality traits were measured with the Big Five Inventory (BFI-10). Linear regressions and generalized estimating equations (GEE) were used to examine cross-sectional and longitudinal associations between personality traits and QoL, controlling for sociodemographic, psychosocial, and health-related variables. Neuroticism was consistently associated with lower QoL across all analyses. Cross-sectional results showed neuroticism as the strongest predictor of QoL decline in wave 7 (beta = -0.33, p < 0.001), and longitudinal GEE analyses confirmed its predictive effect (beta = -0.03, p = 0.007). Conscientiousness and openness showed limited and inconsistent associations with QoL. Beyond personality traits, depressive symptoms and mobility limitations were found to substantially impact QoL, influencing the effects of neuroticism. Neuroticism plays a pivotal role in predicting QoL decline in PwPD, highlighting its utility as a target for psychological interventions aimed at emotional regulation and resilience building. While depressive symptoms and mobility limitations also contribute, integrating personality assessments into care strategies may improve outcomes. These findings advocate for a multidimensional approach to managing PD that addresses both clinical and psychological factors.

The articles in this special issue of the European Journal of Ageing are based upon papers that were first presented in a symposium held within the framework of the 63rd Annual Scientific Meeting of the Gerontological Society of America in November, 2010, in New Orleans. The GSA’s annual meeting is one of the leading global venues for the presentation of cutting-edge gerontological research. The theme for the 2010 annual meeting—Transitions of Care: Across the Ageing Continuum—provided a singularly appropriate opportunity to organize the first GSA symposium to be based upon research papers drawn from the database of SHARE—The Survey of Health, Ageing and Retirement in Europe. This was because the SHARE database includes a rich range of topics that uniquely allow for the examination of trends and associations in the realm of care for older people. The current issue of EJA is devoted to the papers that emanated from this symposium. SHARE is a multi-disciplinary cross-national longitudinal infrastructure for the enumeration and analysis of key aspects of ageing in some 20 countries. Initiated in 2004, the SHARE survey has now completed four waves of data collection, including a retrospective life history, from over 30,000 respondents aged 50 and older. Further information on the SHARE enterprise and its importance for the generation of policy-relevant information is provided in the review article in this collection by Axel Borsch-Supan. The papers in the SHARE-based GSA symposium utilized the unique capacity of the SHARE data to examine the context of health and care for the older population and their varying configurations and effects in different countries. The paper by George Ploubidis, Caroline Dale and Emily Grundy identifies country-level differences in somatic health as a function of the level of egalitarianism that exists in the various countries. Florence Jusot, Zeynep Or and Nicolas Sirven examine a country-specific effect on the probability of preventive health care utilization, after controlling for individual-level characteristics. The article by Joanna Geerts and Karel Van den Bosch considers the correlates of transitions across formal and informal care in the respective SHARE countries. Tina Schmid, Martina Brandt and Klaus Haberkern look specifically at the influence of contextual structures on inter-generational support in European countries and the effects of these features on gender inequality. Keren Ladin points, in her article, to the higher utilization of care services among depressed persons, regardless of national setting. Finally, the review article by Axel Borsch-Supan, the founding coordinator of SHARE, considers the papers in this collection in a policy perspective, focusing on the extent to which the identified contextual factors are amenable to change and the mechanisms which may bolster health and the delivery of care in ageing societies. We are pleased to be able to make these papers available to the general public, after their having passed strict academic review by numerous reviewers who, by convention, must remain unnamed. The reviewers’ timely and thoughtful comments were most helpful in bringing the papers to publication, and are warmly appreciated. Thanks are due, also, to the two Editors-in-Chief of the European Journal of Ageing—Dorly Deeg and Hans-Werner Wahl— who kindly gave their agreement to allow publication of the papers in EJA, along with providing critical reviews of their content. The result, we hope, will constitute an important contribution to the literature on the health and care of older people in Europe. H. Litwin (&) Israel Gerontological Data Center, The Hebrew University, 91905 Jerusalem, Israel e-mail: howie.litwin@huji.ac.il

To examine the association between overweight/obesity and several self-reported chronic diseases, symptoms and disability measures. Data from eleven European countries participating in the Survey of Health, Ageing and Retirement in Europe were used. 18,584 non-institutionalised individuals aged 50 years and over with BMI > or = 18.5 (kg/m2) were included. BMI was categorized into normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9) and obesity (BMI > or = 30). Dependent variables were 13 diagnosed chronic conditions, 11 health complaints, subjective health and physical disability measures. For both genders, multiple logistic regressions were performed adjusting for age, socioeconomic status and behaviour risks. The odds ratios for high blood pressure, high cholesterol, diabetes, arthritis, joint pain and swollen legs were significantly increased for overweight and obese adults. Compared to normal-weight individuals, the odds ratio (OR) for reporting > or = 2 chronic diseases was 2.4 (95% CI 1.9-2.9) for obese men and 2.7 (95% CI 2.2-3.1) for obese women. Overweight and obese women were more likely to report health symptoms. Obesity in men (OR 0.5, 95% CI 0.4-0.6), and overweight (OR 0.5, 95% CI 0.4-0.6) and obesity (OR 0.4, 95% CI 0.3-0.5) in women, were associated with poorer subjective health (i.e. a decreased risk of reporting excellent, very good or good subjective health). Disability outcomes were those showing the greatest differences in strength of association across BMI categories, and between genders. For example, the OR for any difficulty in walking 100 metres was non-significant at 0.8 for overweight men, at 1.9 (95% CI 1.3-2.7) for obese men, at 1.4 (95% CI 1.1-1.8) for overweight women, and at 3.5 (95% CI 2.6-4.7) for obese women. These results highlight the impact of increased BMI on morbidity and disability. Healthcare stakeholders of the participating countries should be aware of the substantial burden that obesity places on the general health and autonomy of adults aged over 50.

Immigration has been a long-standing contentious issue across the globe. According to a recent report published by the International Organization for Migration (IOM) in 2015, the majority of people in the Northern and Western European countries report positive perceptions towards immigration compared to those of the Southern European countries. However, little is known about how migration affects the well-being of old aged people. The main aim of this study is to examine the association between net migration rates and the subjective and objective well-being of old-aged natives in Europe, using the Survey of Health, Ageing and Retirement in Europe during the period of 2004–2017. The estimates will also take place across different regions and across various groups such as gender, age, education level, and first- and second-generation migrants. In addition to the conventional methods, such as the ordinary least squares (OLS) used to analyse the relevant associations, we also apply an instrumental variables (IV) approach to account for possible endogeneity in migration. The results are mixed as we find a positive impact of migration on the subjective well-being and wages of natives and second-generation immigrants in the Northern/Western and Eastern European countries, and a negative impact in the Southern region.

Background: Depression is a frequently occurring mental illness that has been shown to be strongly related to important life outcomes, such as education or labor. Few studies focus on the impact of job status on the risk of depressive symptoms. Aims: We used longitudinal data from the Survey of Health, Ageing and Retirement in Europe for people aged from 50 to 64 years old across 11 countries to analyze how the type of job is related to depression. Methods: Associations between the type of job and depressive symptoms are analyzed using logistic multilevel models. Results: The risk of depressive symptoms is higher for self-employers. Among the self-employed, women are more at risk (OR: 3.22) as well as those who visit the doctor more frequently. On the other hand, people reporting a good quality of life and those living with a partner demonstrate a lower risk of depressive symptoms. These effects manifest less for employees, while the risk is also higher for women and those visiting the doctor frequently but lower for those who have a good quality of life or children. Conclusions: The stress suffered at work is related to a higher risk of depressive symptoms. The self-employed usually experience more stress at work, as this is related to a larger responsibility and, usually, less stability.

Visual dysfunction is a non-motor symptom of Parkinson disease (PD), but its prevalence is unknown as population-based data on the epidemiology of visual symptoms in PD are lacking. The objective was to determine the prevalence of visual dysfunction in PD. This was a cross-sectional analysis of data from adults ≥50years old in the Survey of Health, Ageing and Retirement in Europe (SHARE), a multinational population-based health survey of adults living in one of 27 European countries and Israel. PD diagnosis was self-reported. Impairment in overall, distance or near eyesight was defined as a score of 4 or 5 on a 1-5 scale. Adjusted logistic regression was used to determine the association between PD and self-reported vision. There were 115240 age-eligible participants in the SHARE study (mean age 64.3years, 54% female), of whom 1438 (1.25%) reported a diagnosis of PD. In adjusted logistic regression models, PD was associated with increased odds of impaired overall [odds ratio (OR) 2.67, 95% confidence interval (CI) 1.91-3.72], distance (OR 2.55, 95% CI 2.04-3.19) and near (OR 2.07, 95% CI 1.69-2.55) eyesight. Individuals with PD were also less likely to report having an eye examination within the previous 2 years (OR 0.59, 95% CI 0.38-0.92), but this did not remain statistically significant after adjusting for confounders (OR 0.76, 95% CI 0.47-1.24). Visual dysfunction is significantly more common in PD than in the general adult population. Visual symptoms are a potentially under-recognized and under-treated source of reduced quality of life in PD patients that require further attention and study.

Do machine learning algorithms perform better than statistical survival analysis when predicting retirement decisions? This exploratory article addresses the question by constructing a pseudo-panel with retirement data from the Survey of Health, Ageing, and Retirement in Europe (SHARE). The analysis consists of two methodological steps prompted by the nature of the data. First, a discrete Cox survival model of transitions to retirement with time-dependent covariates is compared to a Cox model without time-dependent covariates and a survival random forest. Second, the best performing model (Cox with time-dependent covariates) is compared to random forests adapted to time-dependent covariates by means of simulations. The results from the analysis do not clearly favor a single method; whereas machine learning algorithms have a stronger predictive power, the variables they use in their predictions do not necessarily display causal relationships with the outcome variable. Therefore, the two methods should be seen as complements rather than substitutes. In addition, simulations shed a new light on the role of some variables—such as education and health—in retirement decisions. This amounts to both substantive and methodological contributions to the literature on the modeling of retirement.

Using panel data extracted from wave 1, 2, 4, 5 and 6 of the Survey of Health, Ageing and Retirement in Europe, this paper investigates the impact of unemployment on health outcomes of the European elderly during the period 2004 to 2015. Various estimators with panel fixed-effects are employed to control for the time-invariant unobserved confounders. To eliminate selection bias, the study separates the impacts of plant closures and being laid off from other potentially endogenous reasons for unemployment. Most importantly, finite mixture models are used to account for unobserved heterogeneity. Results from the models using a dummy for unemployment show significant impacts on self-rated health, chronic disease, and mental health. Models with plant closures and being laid off as two exogenous variables confirm the similar impacts on mental health. The impacts of plant closures and being laid off are slightly higher for chronic disease, but only being laid off worsens self-rated health. Notably, women are more likely to get chronic disease when they lose their jobs by plant closures, even once a year. Unemployment also damages women's mental health but the marginal effects for men are even larger. The finite-mixture models separately estimate the health impacts on two latent classes and show that members of the class with more ex-post ill-health tend to suffer more health problems due to unemployment. Age, marriage, number of children, education and industry sectors jointly determine the class membership.

How survey design affects self-assessed health responses in the Survey of Health, Ageing, and Retirement in Europe (SHARE)

Background: The risk of influenza-related complications is elevated in older adults and in persons with one or more chronic diseases. Vaccination of such individuals is therefore recommended in Europe as a preventive measure. We aimed to compare between European countries 1) to what extent high-risk subgroups receive influenza vaccination and 2) how likely they are to receive vaccination compared to the non-risk group. Methods: We used data from the Survey of Health, Ageing and Retirement in Europe collected in 2004/05. Adults aged 50+ years from eleven countries (Austria, Belgium, Denmark, France, Germany, Greece, Italy, the Netherlands, Spain, Sweden, Switzerland) were asked whether they had received flu vaccination in the previous year. Using self-reported data from 16,182 individuals, we defined several high-risk subgroups (age 65+, presence of chronic lung disease [CLD], cardiovascular disease [CVD], diabetes/high glucose level). We calculated weighted and design-adjusted estimates of vaccination prevalence with 95% confidence intervals (CI) for each country. Country-specific multivariable logistic regression was used to explore associations between membership in a high-risk subgroup and vaccination uptake. Results: The prevalence of influenza vaccination in high-risk subgroups was generally highest in the Netherlands (e.g., 76.7% [95% CI: 73.6%, 79.8%] for those aged 65+ years and 74.6% [95% CI: 68.3%, 80.9%] for CLD) and was consistently lowest in Greece (26.3% [95% CI: 23.2%, 29.3%] and 18.5% [95% CI: 11.3%, 25.6%], respectively). Comparison of multivariable models suggested substantial cross-national variation in targeted influenza prevention. The adjusted odds of self-reported vaccination in those aged 65+ (versus &lt;65), for example, ranged from 2 (Austria and Germany) to more than 10 (Denmark and the Netherlands). Conclusions: Influenza vaccination coverage among high-risk subgroups varies considerably between European countries. Most countries did not achieve recommended coverage rates; some fell well below recommendations, raising questions about the effectiveness of national efforts in reaching high-risk individuals.