Survey Of Health , Ageing And Retirement In Europe Research Articles

Adverse childhood experiences and multimorbidity in adulthood: Findings from the Survey of Health, Ageing and Retirement in Europe (SHARE)

Adverse childhood experiences and multimorbidity in adulthood: Findings from the Survey of Health, Ageing and Retirement in Europe (SHARE)

Physical activity and persistence of supra-threshold depressive symptoms in older adults: A ten-year cohort study

Few multination-based studies have examined the longitudinal association between PA (physical activity) and persistence of supra-threshold depressive symptoms (SDS). This cohort study aimed to assess the influence of PA on persistence of SDS. Data were obtained from the Population Survey of Health, Ageing and Retirement in Europe (SHARE). The cohort was composed of individuals with SDS at baseline. Depressive symptoms were ascertained using the EURO-D scale, with a value over 4 indicatives of SDS. The study included 6,631 participants with SDS. After adjusting for nine different covariates at baseline and the changes of PA level during the follow-up period, compared to very low PA, moderately high (OR=0.82; 95 %CI: 0.69–0.98; p = 0.03), and high (OR=0.80; 95 %CI: 0.66–0.95; p = 0.01) PA levels were associated with significantly reduced persistence of depressive symptoms. In a propensity score analysis, matching low and high PA level for baseline scores of EURO-D, people with high PA levels reported a lower EURO-D of 0.53 points (p < 0.0001). In conclusion, among adults with depression, higher levels of PA were associated with a reduced persistence of depression. These real-world data complement evidence on efficacy of exercise as a treatment for depression and can inform clinical guidelines.

Material and social deprivation associated with public health actual causes of death among older people in Europe: longitudinal and multilevel results from the Survey of Health, Ageing and Retirement in Europe (SHARE).

Adverse socioeconomic conditions at the individual and regional levels are associated with an increased risk of mortality. However, few studies have examined this relationship using multilevel analysis and, if so, only within a single country. This study aimed to examine this relationship using data from several European countries. Individual-level data were obtained from Waves 5 to 9 of the Survey of Health, Ageing and Retirement in Europe, while regional-level data were obtained from the Luxembourg Income Study Database. Cox regression analysis with gamma-shared frailty and a random intercept for country of residence was used to examine the association between individual mortality from all causes, cancer, heart attack, and stroke and measures of socioeconomic deprivation at the individual level, including material and social deprivation indices, and at the area level, including the Gini index. The risk of mortality from all causes was increased for respondents with material deprivation (hazard ratio (HR) = 1.77, 95% CI = [1.60, 1.96]) and social deprivation (HR = 7.63, 95% CI = [6.42, 9.07]) compared with those without. A similar association was observed between individual deprivation and the risk of mortality from cancer, heart attack, or stroke. Regional deprivation had a modest contextual effect on the individual risk of death from all causes and cancer. However, when individual-level deprivation was included in the models, no contextual effects were found. The results indicate that individual socioeconomic conditions significantly predict causes of death in older European adults, with those with material deprivation and social deprivation having a higher risk of death from all causes, including cancer, heart attack, and stroke, while the Gini index has a minimal effect, although the Gini index reflects regional disparities across Europe.

Impact of retirement on physical activity in older adults: a longitudinal analysis from SHARE

Abstract Background With ageing populations experiencing longer post-retirement years, understanding the influence of major life transitions on health behaviours such as physical activity (PA) is crucial. This study assesses how retirement affects PA levels by analysing longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Methods This analysis utilised longitudinal data from 2004 to 2020, categorising PA according to WHO guidelines adapted to individual-level data from successive waves of SHARE. The study examined the relative risks (RR) of being physically active, using generalised estimating equation models to compare periods before and after retirement. Results The cohort consisted of 8,998 individuals aged 50 and older who were employed at baseline and retired during the study period. Initially, 83.6% of participants were categorised as physically active. A noticeable decline in PA was observed post-retirement, with RR decreasing from 1.08 (95%CI 1.07-1.10) more than 10 years before retirement to 0.90 (95%CI 0.88-0.93) more than 10 years after retirement, compared to the year of retirement. Previously inactive individuals often increased their PA levels, peaking 3 to 4 years post-retirement (RR increased from 0.79, 95%CI 0.70-0.88, to 1.49, 95%CI 1.36-1.63), suggesting a temporary boost in moderate-intensity PA during the so-called “honeymoon phase”. Conclusions Retirement can serve as a window of opportunity for enhancing leisure-time PA, particularly among those previously inactive. Sustained increases in PA are less common, highlighting the need for targeted interventions to support continued engagement in PA among retirees. The variations in PA trends suggest that interventions should be tailored to individual characteristics such as age at retirement, previous job type, and educational background to maximise public health impact. This study underscores the challenges of ensuring long-term health benefits through PA. Key messages • Retirement significantly alters physical activity patterns, highlighting an opportunity for targeted health interventions. • Longitudinal data reveals critical periods post-retirement that could benefit from public health strategies to maintain or increase physical activity among older adults.

Hospital satisfaction among older adults by European Union health system clusters

Abstract Background Health systems are influenced by political, historical, cultural and socio-economic factors and differ across countries. Classification of EU health systems into 5 clusters has allowed for international comparison and policy recommendations. This study is based on the Andersen’s Behavior Model, that predicts that a sequence of predisposing, enabling and need factors influence satisfaction and utilization of healthcare services. Aim Examine the nature and relationship of predisposing, enabling and need factors associated with hospital satisfaction of older adults across EU nations by health system classification clusters. Methods Data from Wave 9, of the Survey of Health, Ageing and Retirement in Europe (SHARE) were examined using a sample of older adults from 10 EU countries. Analysis: Non-parametric one-way ANOVA (Kruskal- Wallis test) and Multinominal Logistics regression were performed to test the null hypothesis that (1) hospital satisfaction is equal across all clusters, and (2) predisposing, enabling, and need factors, are not predictors of hospital satisfaction. Findings There was a statistically significant difference in hospital satisfaction by cluster [Chi Square= 231.44, df = 21; p&amp;lt; .001]. Age, mental health, technology and chronic disease are predictors of healthcare facilities satisfaction. [Chi Square 50.94, df = 3, p&amp;lt; .001], Among those that reported to be highly unsatisfied with healthcare facilities, [chronic disease (Beta = -2.64) and mental health (Beta = -4.41) df = 1 p&amp;lt; .001] significantly predicted hospital satisfaction. Implications for Policy and Practice: Initiatives for the care of older adults should not only aim to increase access to care but also provide targeted services for sub populations such as older adults with mental health and chronic diseases. Further, significant investment is required in technology infrastructure within hospitals and technological assistance or training should be provided to older adults. Key messages • Older adults satisfaction with hospitals varies by health system clusters and is predicted by age, mental health, use of technology and chronic disease. • Chronic disease and mental health are strong predictors of hospital dissatisfaction among older adults.

Factors that influence the need for mental health services for older adults in Europe

Abstract Background Mental health is an integral component of health, and affects close to a 100 million Europeans. Little is known about the predictors of older adult’s mental health demand among health systems in European countries. This study is based on the Andersen’s Behavior Model, that predicts that predisposing characteristics, enabling factors, and behavioral factors, influence need or demand factors of healthcare services. Aim This study has two overall objectives: (i) to investigate the determinants of older adults’ mental health services demand; and (ii) examine the relationship between predisposing characteristics, and enabling resources, with services demand. Methods Data from Wave 9, of the of the cross-national panel dataset of the Survey of Health, Ageing and Retirement in Europe (SHARE) were examined using a sample of 47, 345 older adults. Analysis: The Omnibus test was used to evaluate the fit model and Multinomial Logistics Regression were performed to test the null hypothesis that predisposing characteristics, enabling resources, and behavioral factors are not predictors of need or demand. Findings Predisposing characteristics such as gender (b=-.43, s.e.=.017, p&amp;lt;.001) and age (b=-1.96, s.e.=2.2, p&amp;lt;.001), and enabling factors such as homecare (b = 2.40, s.e.=0.1, p&amp;lt;.001), social support (b=-.26, s.e.=0.012, p&amp;lt;.001), financial support receiving (b=.51, s.e.=.086, p&amp;lt;.001), income (b=.09, s.e.=.009, p&amp;lt;.001), and behavioral factors such as use of technology are predictors of mental health services need or demand [Chi-Square= 3319.58, df = 15 and p &amp;lt;.001]. Implications for Policy and Practice Initiatives for the care of older adults should not only aim to increase access to care services for sub populations such as older adults with mental health but also consider enabling resources such as financial and social support and behavioral factors such as use of technology. Key messages • Demand for mental health services for older adults are influenced by predisposing, enabling and behavioral factors. • Investing in financial services, social support and technology may reduce the demand for mental health services among older adults.

Loneliness in Baltic-Nordic Older Adults Amid COVID-19

Abstract Background The study investigates loneliness among older adults in the Baltic-Nordic region, particularly in the context of the COVID-19 pandemic. It aims to understand how loneliness varies across cultural and socio-economic contexts in these areas, which is critical for developing public health strategies tailored to the specific needs of older populations. Methods We employed a comprehensive comparative analysis, leveraging data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and the HL20 study from Iceland, focusing on individuals aged 67 and above. The study encompassed a diverse sample from Sweden, Denmark, Estonia, Lithuania, Finland, Latvia, and Iceland, totaling 5,313 participants. This research is part of a bilateral EEA FM2021/23 initiative to enhance methodological approaches to analyzing older populations by coding and standardizing variables for comparability across different countries. Results Significant regional differences in loneliness were observed. The Baltic regions reported a higher prevalence of loneliness compared to the Nordic countries, which displayed lower levels, attributed to strong social welfare systems and community engagement. Factors such as employment, marital status, and educational attainment varied across regions, affecting loneliness levels. Conclusions The findings highlight the importance of considering regional cultural and social contexts in public health interventions aimed at reducing loneliness among older adults. The study underscores the need for targeted strategies that address the unique social dynamics of the Baltic and Nordic regions. Innovative public health actions, such as community engagement programs and policy development, are recommended to alleviate loneliness in these populations. Key messages • Significant regional differences in loneliness in the Baltic-Nordic region underscore the need for tailored public health interventions. • Employment and social welfare are key factors in mitigating loneliness among older adults, highlighting the importance of socio-economic support systems.

Residential Mobility in Childhood and Union Dissolution Later in Life

The limited existing literature studying the effects of childhood residential mobility suggests that it influences a range of life outcomes, at least in young adulthood. Little is known about how the frequency of moving in childhood is related to later-life demographic behaviour in Europe. Drawing on residential and partnership histories from the Survey of Health, Ageing and Retirement in Europe (SHARE), this paper examines whether moving in childhood relates to union dissolution in adulthood. It empirically addresses two theoretical explanations underlying the potential association: First, according to the confounding hypothesis, effects of childhood residential mobility differ by family background and resources. Second, the family stress model suggests that the accumulated stress and conflicts associated with frequent residential mobility disrupt the family and child’s social ties, resulting in worse relationship skills in later life (mediation hypothesis). Applying discrete-time event history analysis to individuals born between 1945 and 1965 in Sweden, Denmark, and Finland, we find a significant association between childhood moves (prior to age 17) and adult union dissolution. The effect’s strength varies based on the number of childhood moves, demonstrating a clear gradient. Notably, adults with three or more childhood moves exhibit a 55% higher likelihood of union dissolution compared to non-movers. These associations persist even after accounting for childhood background factors, while family stress mediates the link partially. Our findings shed light on the role of spatial mobility in shaping demographic outcomes and underscore its potential contribution to the accumulation and reproduction of life disadvantages.

Graded association of muscle strength with all-cause and cause-specific mortality in older adults with diabetes: Prospective cohort study across 28 countries.

The worldwide prevalence of diabetes is increasing, particularly among older adults. Understanding the association between muscle strength and mortality in this population is crucial for developing targeted exercise recommendations. To assess the prospective association of muscle strength with mortality in older adults with diabetes. From the Survey of Health, Ageing and Retirement in Europe (SHARE) study, spanning 28 countries, we included 16 149 diabetic adults aged 50 years and older (mean age 68.2 [standard deviation, SD, 9.2] years). Participants fulfilled two criteria: (1) diabetes diagnosis (ever) and (2) current use of diabetes medication. Muscle strength was assessed using handgrip dynamometry (unit: kg). Using time-varying Cox regression with restricted cubic splines, we determined the prospective association of muscle strength with all-cause and cause-specific mortality, controlling for various confounders. Over a mean follow-up of 5.9 years (SD 3.8), 2754 participants died (17%). Using the median level of muscle strength as reference (30 kg), lower and higher levels were associated in a curvilinear fashion with higher and lower all-cause mortality risk, respectively. The 10th percentile of muscle strength (17 kg) showed a hazard ratio (HR) of 1.65 (95% confidence interval (CI) 1.53-1.79). The 90th percentile (47 kg) of muscle strength showed a HR of 0.55 (95% CI 0.49-0.63). A somewhat similar pattern, with varying strength of associations, was seen for mortality due to cardiovascular disease (CVD), respiratory disease, severe infectious disease, digestive system disease and cancer. Muscle strength is gradually and inversely associated with all-cause and cause-specific mortality risk in older adults with diabetes. As muscle strength is highly adaptable to resistance training at all ages, the present findings highlight the importance of improving muscle strength in older adults with diabetes.

Association of Muscle Strength With All-Cause Mortality in the Oldest Old: Prospective Cohort Study From 28 Countries.

Ageing is associated with a gradual loss of muscle strength, which in the end may have consequences for survival. Whether muscle strength and mortality risk associate in a gradual or threshold-specific manner remains unclear. This study investigates the prospective association of muscle strength with all-cause mortality in the oldest old. We included 1890 adults aged ≥ 90 years (61.6% women, mean age 91.0 ± 1.5 years) from 27 European countries and Israel participating in the Survey of Health, Ageing and Retirement in Europe (SHARE) study. Muscle strength was assessed using handgrip dynamometry (unit: kilogram). Using time-varying Cox regression with restricted cubic splines, we determined the prospective association of muscle strength with mortality, controlling for age, sex, smoking, BMI, marital status, education, geographical region and self-perceived health. Over a mean follow-up of 4.2 ± 2.4 years, more than half of the participants died (n = 971, 51.4%). The mean handgrip strength was 20.4 ± 8.0 kg for all participants, with men (26.7 ± 7.5 kg) showing significantly higher strength than women (16.4 ± 5.4 kg) (p < 0.001). Using the median level of muscle strength as reference (18 kg), lower and higher levels were associated in a gradual and curvilinear fashion with higher and lower mortality risk, respectively. The 10th percentile of muscle strength (10 kg) showed a hazard ratio (HR) of 1.27 (95% CI 1.13-1.43, p < 0.001). The 90th percentile (31 kg) showed an HR of 0.69 (95% CI 0.58-0.82, p < 0.001). Stratified for sex, the median levels of muscle strength were 26 kg for men and 16 kg for women. The 10th percentile of muscle strength showed HRs of 1.33 (95% CI 1.10-1.61, p < 0.001) at 15 kg for men and 1.19 (95% CI 1.05-1.35, p < 0.01) at 10 kg for women. The 90th percentile of muscle strength showed HRs of 0.75 (95% CI 0.59-0.95, p < 0.01) at 35 kg for men and 0.75 (95% CI 0.62-0.90, p < 0.001) at 23 kg for women. Sensitivity analyses, which excluded individuals who died within the first 2 years of follow-up, confirmed the main findings. Rather than a specific threshold, muscle strength is gradually and inversely associated with mortality risk in the oldest old. As muscle strength at all ages is highly adaptive to resistance training, these findings highlight the importance of improving muscle strength in both men and women among the oldest old.

Experiencing Cerebrovascular Diseases like Stroke and Fear of Falling: Longitudinal Results from the Survey of Health, Ageing and Retirement in Europe.

Objective: The aim of this study was to clarify the link between experiencing cerebrovascular diseases (strokes as an explicit example) and fear of falling (FOF) among middle-aged and older adults in Europe. Methods: Longitudinal data were used from wave 5 to wave 7 of the representative Survey of Health, Ageing and Retirement in Europe (SHARE). Self-reported tools were used to quantify the key variables. Fear of falling was similarly assessed using a dichotomous yes or no question, "For the past six months at least, have you been bothered by any of the health conditions on this card", with fear of falling being one of the options. It was adjusted for various sociodemographic and health-related factors. In particular, to account for unobserved heterogeneity, conditional fixed effect regressions (FE) were used. Accordingly, change in an individual's FOF status over the included waves was analysed and correlated with the reported change of all the included time-varying independent variables within the same individual, including experiencing stroke or other cerebrovascular diseases. The final analytical sample equalled n = 22.071 observations. Results: Conditional logistic FE regressions showed that the onset of a stroke or other forms of cerebrovascular disease was not associated with an increased likelihood of experiencing fear of falling (OR = 1.25, p = 0.095). However, stratified by sex, such an association was present in men (OR = 1.79, p = 0.006), though not in women (OR = 0.94, p = 0.732). Conclusions: The onset of a stroke or other cerebrovascular diseases was associated with an increased likelihood of experiencing FOF in men but not women. Efforts are required to assist older men in avoiding FOF after the onset of stroke or other cerebrovascular pathologies.

Healthcare use among cancer survivors during the COVID-19 pandemic: results from the SHARE COVID-19 Survey

PurposeTo estimate the association between a previous cancer diagnosis and healthcare use during the COVID-19 pandemic among Europeans and Israelis individuals.MethodsThis cross-sectional study was based on data from the Survey of Health, Ageing and Retirement in Europe (SHARE), including the SHARE COVID-19 Survey, which was conducted in the summer of 2020, in 27 countries. Cancer survivors (CS, n = 6409) were country-, sex-, age-, and education-matched (1:2) to non-cancer individuals (NC). Adjusted odds ratios (OR) and 95% confidence intervals (95%CI) were computed using logistic regression.ResultsOverall, CS were more likely to refer that they forwent medical appointments due to fear of COVID-19 (OR = 1.29, 95%CI 1.19–1.41) than NC, particularly those who lived with their partner and other relatives (OR = 1.79, 95%CI 1.39–2.30). Likewise, CS had their medical appointments postponed more often (OR = 1.54, 95%CI 1.44–1.64); this association was stronger among CS who lived with their partner and other relatives (OR = 1.96, 95%CI 1.63–2.36) who reported higher economic difficulties (OR = 1.73, 95%CI 1.50–2.00) and those with no multimorbidity (OR = 1.85, 95%CI 1.62–2.11). CS were also more likely to refer that they were unable to book an appointment (OR = 1.43, 95%CI 1.26–1.63), particularly those who reported that a person close to them died due to COVID-19 (OR = 2.72, 95%CI 1.47–5.01).ConclusionCS were more likely to forgo medical treatment, report healthcare postponements, and be unable to book an appointment than NC, which highlights the importance of closely monitoring the long-term impact of the COVID-19 pandemic along the cancer care continuum.

Confinement policies: controlling contagion without compromising mental health

ABSTRACT A growing literature shows that confinement policies used by governments to slow COVID-19 transmission have negative impacts on mental health, but the differential effects of individual policies on mental health remain poorly understood. We used data from the COVID-19 questionnaire of the Survey of Health, Ageing and Retirement in Europe (SHARE), which focuses on populations aged 50 and older, and the Oxford COVID-19 Government Response Tracker for 28 countries to estimate the effects of eight different confinement policies on three outcomes of mental health: insomnia, anxiety and depression. We applied robust machine learning methods to estimate the effects of interest. Our results indicate that closure of schools and public transportation, restrictions on domestic and international travel, and gathering restrictions did not worsen the mental health of older populations in Europe. In contrast, stay at home policies and workplace closures aggravated the three health outcomes analysed. Based on these findings, we close with a discussion of which policies should be implemented, intensified, or relaxed to control the spread of the virus without compromising the mental health of older populations.

Perceived Health Status Predicts Resilience after Hip Fracture in Older People.

Background and Objectives: Perceived health status (PHS) is associated with various health outcomes in older adults, but its relationship with resilience in the context of events with a major impact on functional status (FS), such as hip fracture, has not been explored. Our objective was to evaluate whether older adults who report good PHS before a hip fracture have a higher probability of returning to their baseline physical performance (PP) and personal independence. Materials and Methods: We analyzed data from waves 1 and 2 of the Survey of Health, Ageing and Retirement in Europe (SHARE) study, enrolling patients ≥ 65 years who experienced a hip fracture between these two waves. As study outcomes, we analyzed changes in PP and functional abilities (FAs). Results: We included 149 participants with a mean age of 75.7 years (SD: 6.5); women comprised 66%. The incidence of loss of PP was 51.7% among participants with good PHS and 59.6% among those with poor PHS. FA worsened in 40% of participants with good PHS and 58.4% in those with poor PHS. Relative risk (RR) for loss of FA in people with good PHS was 0.68 (95% CI: 0.48-0.98), which did not change after an adjustment for age, gender, baseline FA, depression, number of comorbidities, education, income, and social support, despite it not reaching statistical significance. After adjustment, the risk of worsening PP in participants with good PHS was reduced by 34% (95% CI: 0.41-1.06). Conclusions: A simple question on PHS may predict the resilience of older adults after an acute stressor. A systematic evaluation of PHS can help identify patients with a higher probability of regaining function after a hip fracture and thus provide useful information for resource allocation.

Association of handgrip strength weakness and asymmetry with later life pain risk in middle-aged and older individuals: Results from four prospective cohorts.

The burden of pain in middle-aged and older adults is considerable and significantly increases healthcare expenditures. We aimed to investigate the roles of handgrip strength (HGS) weakness and asymmetry in predicting pain across four nationally representative cohorts. This longitudinal study utilized data from four major surveys: the Health and Retirement Study (HRS); the English Longitudinal Study of Ageing (ELSA); the Survey of Health, Ageing and Retirement in Europe (SHARE); and the China Health and Retirement Longitudinal Study (CHARLS). Multivariable cubic regression splines were employed to visually explore the nonlinear associations between HGS and pain in each cohort. The Cox proportional hazard model was applied to analyze the independent and combined relationship between HGS weakness and asymmetry and pain risk. We included 41,171 participants in the final analysis, with a mean follow-up period of 4.68 ± 2.61 years (50.7% female, mean age 64.3 ± 9.3 years). No nonlinear relationship was found between HGS and pain incidence (nonlinear p < 0.05 in ELSA and SHARE; >0.05 in CHARLS and HRS). After adjustment, the highest quartile groups had a significantly reduced risk of pain compared to the lowest quartile groups across all cohorts, with hazard ratios of 0.81 (0.74, 0.89) in CHARLS, 0.86 (0.77, 0.97) in HRS, 0.88 (0.77, 0.98) in ELSA, and 0.78 (0.73, 0.84) in SHARE. Participants with normal HGS had approximately 20% lower risk of pain compared to those with weak HGS. Each 5 kg increase in HGS was associated with decreased hazard ratios for pain: 0.95 (0.93, 0.97) in CHARLS, 0.97 (0.94, 0.99) in HRS, 0.96 (0.94, 0.99) in ELSA, and 0.94 (0.92, 0.95) in SHARE. The association between HGS asymmetry and pain risk was significant only in a few cohorts (HRS at 10%, 1.10 (1.03, 1.18); SHARE at 30%, 1.12 (1.05, 1.21)). No interaction effect between HGS weakness and asymmetry on pain risk was observed (all p-values for interaction >0.05). Our findings suggest that HGS can be used as an independent predictor of pain in middle-aged and older European, American, and Chinese populations. However, our results do not support the use of HGS asymmetry as an independent predictor of pain risk. It is necessary to establish appropriate criteria for HGS asymmetry across different populations. The use of both weak HGS and asymmetry as predictors of health outcomes requires further validation in more diverse populations.

The Impact of Unmet Healthcare Needs on the Perceived Health Status of Older Europeans During COVID-19.

To examine how unmet healthcare needs and the exposure to the pandemic impacted self-reported health (SRH) among individuals aged 50 and above. We use data from two waves of the Survey of Health, Ageing and Retirement in Europe (SHARE) Corona Survey collected in 2020 and 2021 in 27 European countries and Israel (N = 42,854). Three dimensions of barriers to healthcare access were investigated: healthcare forgone, postponed, and denied. Mixed-effects logistic regression analysis was employed to explore SRH deterioration during the pandemic. Findings indicate that unmet healthcare needs decreased throughout the pandemic but significantly contributed to the worsening of SRH among older adults. Mild or severe exposure to the pandemic heightened the likelihood of reporting deteriorated SRH. Additionally, the pandemic disproportionately affected females, the oldest-old, and those living alone or facing economic vulnerability. To mitigate the adverse effects on the health status of older adults, policymakers are strongly advised to prioritize addressing the healthcare needs of those who have been disproportionately affected by the pandemic.

Facilitators and barriers for working beyond statutory pension age: A prospective cohort study across 26 European countries.

The aging population of European countries highlights the need for extended working lives. This study aims to investigate facilitators and barriers for working beyond the statutory pension age (SPA). Using data from waves 1, 2, 4-9 of the Survey of Health, Ageing and Retirement in Europe (SHARE) (2004-2022), we followed 9131 workers with a mean age of 56.9 [standard deviation (SD) 3.5] years from 26 European countries until they surpassed the SPA for their respective country, sex and year of participation. Using robust Poisson regression, we modelled the prospective association of work factors, lifestyle, health, and demographics at baseline with working at least one year beyond the SPA. Participants were followed for 9.5 (SD 3.9) years. After surpassing the SPA by at least one year, 18% were still working. Among the work factors, opportunities for skill development [risk ratio (RR) 1.20, 95% confidence interval (CI) 1.07-1.34] and recognition at work (RR 1.13, 95% CI 1.01-1.26) facilitated working beyond SPA, while time pressure (RR 0.89, 95% CI 0.81-0.97) and poor prospects for job advancement (RR 0.76, 95% CI 0.70-0.83) were barriers. For the other factors, smoking was negatively associated with working beyond the SPA, while living in the northern part of Europe, higher level of education, and being divorced or separated were positively associated with working beyond the SPA. This prospective cohort study across 26 European countries identified four modifiable work factors that influenced working beyond the SPA. Addressing modifiable barriers and facilitators at the workplace and through public health initiatives could help extend working lives in Europe.

Associations Between Sleep And Cognition Among Middle-Aged And Older Adults In Europe

Abstract Background The Survey of Health, Ageing and Retirement in Europe (SHARE) is a supranational longitudinal study of community-dwelling middle-aged and older adults involving 29 countries, including all continental members of the European Union. We analysed wave 8 of SHARE (2019/2020) for associations between sleep and cognition. Methods The previously validated SHARE Cognitive Instrument (SHARE-Cog), which includes 10-word registration, verbal fluency and 10-word recall, was used to assess cognition. Together with data on impairment in activities of daily living and subjective perception of cognition, participants were divided into four groups: dementia, mild cognitive impairment (MCI), subjective memory complaint (SMC), normal cognition (NC). Survey-weighted generalised linear regression models were used to compare groups. To analyse the association between sleep duration and cognition, total hours of sleep was plotted on the x-axis and mean SHARE-Cog score on the y-axis. Results 29,450 were included (55% female; mean age 68.27), categorised as: Dementia 4%, MCI 9%, SMC 14% and NC 73%. A characteristic ‘inverted U’ shaped association was observed between sleep duration and cognition. Compared to optimal sleep duration of seven hours, mean SHARE-Cog scores declined progressively with more or less sleep. Those with cognitive impairment were significantly more likely to report recent trouble sleeping: Dementia 47%; MCI 43%; SMC 46%; NC 30% (p &amp;lt;0.001). Cognitive impairment was also significantly associated with increased use of medication to aid sleep (Dementia 17%; MCI 13%; SMC 8%; NC 4%, p &amp;lt;0.001) and with daytime napping or resting (Dementia 72%; MCI 60%; SMC 45%; NC 41%, p &amp;lt;0.001). Conclusion This analysis of a large population-based study confirmed an ‘inverted-U’ shaped association between sleep duration and cognition. Cognitive impairment was also significantly associated with increased reports of recent trouble sleeping, increased use of medication to aid sleep, and increased daytime napping or resting.

Sleep In Europe: Changes In Prevalence Of Sleep Disturbances In Middle-aged And Older Europeans

Abstract Background We analysed the prevalence of sleep-related parameters in those aged ≥50 years in 28 countries participating in waves 8 (2019/2020) and 9 (2022) of the Survey of Health, Ageing and Retirement in Europe (SHARE). Methods Overall and per country prevalence rates of subjective trouble sleeping, daytime napping/resting and use of medication to aid sleep were analysed. Survey-weighted generalised linear models were used to assess changes between waves 8 and 9. Results A total of 34,322 people were included from wave 8 (55% female; mean age 68.27) and 50,670 from wave 9 (55% female; mean age 68.77). There was no statistically significant difference in the overall prevalence of subjective trouble sleeping (both 35%), use of medication to aid sleep (both 7%) or daytime napping/resting (both 47%) between waves 8 and 9. For trouble sleeping, prevalence ranged from 20% (Greece) to 52% (Estonia) in wave 8 and from 16% (Greece) to 50% (Portugal) in wave 9. Statistically significant reductions were observed in Estonia (52% vs. 49%, p = 0.006), Poland (49% vs. 37%, p &amp;lt;0.001) and Slovenia (38 vs. 33%, p = 0.001). A statistically significant increase was observed in Spain (27% vs. 37%, p = 0.004). Similarly for sleep-related medication use, statistically significant reductions were again observed in Estonia (11% vs. 9%, p = 0.028) and Poland (10% vs. 6%, p &amp;lt;0.001) but not Slovenia (both 4%, p = 0.858). The prevalence of daytime napping/resting remained very similar between waves 8 and 9, with the only marginally significant difference being in France (38% vs. 35%, p = 0.033). Conclusion This analysis shows the prevalence of subjective trouble sleeping, use of medication to aid sleep, and daytime napping/resting among middle-aged and older adults across Europe. Trouble sleeping remains a prevalent symptom amongst middle-aged and older adults but varies significantly across countries.

Feeling discriminated means poor self-perceived health: a gender analysis using SHARE.

Most part of the literature has highlighted the detrimental effects of discrimination on health. However, the influence of past and perceived discrimination on older workers' self-assessed health has been understudied. Firstly, we aim at studying whether reported discrimination is associated with self-assessed health among adults of working ages (50-65 years of age). Secondly, we analyze the existence of differences by gender. Data was retrieved from the seventh wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) to obtain the regular panel of questions, and the third and seventh waves of the SHARELIFE questionnaire, that includes information about discrimination (n = 30,019). We develop logistic regression models to determine the relationship of discrimination on male and female workers' self-assessed health separately. Our results show that 49.0% of our sample was composed of highly discriminated women, while the remaining percentage covered men and women (42.3% males and 8.7% females) that reported lower levels of discrimination. Our estimations reveal a significant association between discrimination and poor health status, especially in the case of men ranging from OR = 1.802 (95% CI 1.502-2.163) to OR = 1.565 (95% CI 1.282-1.910). In the case of women our results range from OR = 1.728 (95% CI 1.463-2.040) to OR = 1.196 (95% CI 0.992-1.442). These findings are essential to highlight the importance of tackling discrimination as a determinant of health that negatively affects both sexes, men and women.