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Introduction: Healthy life expectancy is higher among individuals with higher socioeconomic standing. However, it is unclear whether such advantage is attributable to longer (i.e., mortality advantage) or to healthier (morbidity advantage) lifespans across different health conditions. Objective: Estimate the contribution of mortality and morbidity components in differences in condition-free life expectancies (CFLE) and life expectancy with conditions (LEWC) for five major groups of conditions by sex and educational attainment, instead of using a global indicator of morbidity. Methods: Using the Sullivan Method, we computed remaining life expectancies at age 40 and 65, CFLE, and LEWC and applied a stepwise decomposition technique, using national health surveys along with mortality data, in a cross-sectional analysis. Results: An educational gradient was present in almost all conditions, with different intensities. For females, morbidity was the main contributor to educational differences in health expectancies, but mainly in the older age groups. For males, the drivers behind higher health expectancies for high-educated males were evenly distributed across mortality and morbidity between ages 40 and 65, but after that, the mortality gradient vanished between high-educated and middle-educated individuals. Discussion: The changing contribution of the mortality and morbidity gradient for different conditions across age-groups brings evidence to adequately plan health policies to mitigate health gaps and improve quality of life of the populations in a lower social standing. [ABSTRACT FROM AUTHOR]

Population care needs are dynamic. They change throughout individuals’ life courses and are related to the population structure. These needs are particularly demanding during population ageing and may vary depending on how societies cope with them. In this study, we explored the unmet social care needs of individuals in twelve European countries with different social care systems. We used data from the seventh wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) to conduct a cross-sectional study of individuals aged 65 and over with care needs (n = 7136). Unmet care needs were measured from an absolute approach. We fitted binomial regression models to explain the relative importance of individuals’ characteristics, health status and different social care systems on unmet needs. The absolute measure shows that 53.02% of the analytical sample faced unmet care needs as they reported limitations and did not receive help. The prevalence of unmet care needs is higher for men than women and for younger than older individuals. Furthermore, we found that individuals living in Mediterranean social care systems have the highest prevalence of these unmet needs. This analysis contributes to the ongoing debate about the challenges posed by ageing populations and their relationship with care. [ABSTRACT FROM AUTHOR]

Changes in population and family structures are altering the provision of care for dependent older people. In Southern European countries like Spain, such care is still largely provided by family, typically spouses and adult daughters. However, an increasing proportion of women have entered the labour force, thereby affecting their availability. To study the demand and supply balance of informal care and to quantify the need for formal care when there is a deficit, we have developed a mixed microsimulation–agent-based model (ABM). Based on nuptiality, fertility and mortality levels of cohorts born at ten-year intervals between 1908 and 1968, the model starts with a microsimulation of the lifecycle of individuals and their close relatives until death. The ABM then determines the amount of time available or needed to care for family members, starting from age 50. Estimates are derived from Spanish survey data on employment, disability and time of care received. Surprisingly, results show that the family care deficit was greater in the older cohorts due to higher mortality and thus a greater impact of widowhood. However, for future elderly persons, we foresee that persistent below-replacement fertility and, paradoxically, the prolongation of the lifespan of couples will increase the demand for formal care as there will be more couples with both members incapacitated but without children to take care of them. [ABSTRACT FROM AUTHOR]

Life expectancy in Spain is among the highest in the world. Nevertheless, we do not know if improvements in health conditions at older ages have followed postponements of death. Previous studies in Spain show a stable trend in years lived in ill health in the past. In this paper we investigate changes between 2006, 2012 and 2017 in life expectancy with and without disease at age 65 in Spain and, for the first time, in Spanish regions, which have autonomous powers of health planning, public health and healthcare. Results show that, at the country level, disease-free life expectancy reduced between 2006 and 2017 in Spain. This was explained by an expansion of most diseases except for some cardiovascular and respiratory chronic conditions. However, at the regional level the evolution was different, especially regarding each disease and sex. First, regional differences reduced between 2006 and 2012 but largely widened in 2017, suggesting that not all regions had the same ability to recover after the 2008 financial crisis that caused government cuts to health services. Second, regional analysis also highlighted diverging trends by sex. While men experienced expansion of morbidity in most regions, women experienced a compression in about half of them, ending up with women showing higher disease-free life expectancies than men in 9 out of the 17 regions considered. This study, then, calls attention to the importance of focusing the analysis of health surveillance to more disaggregated levels, more in accordance with the level of health management, as regional trends showed heterogeneity in the prevalence of diseases and different progresses in the relationship between sexes. [ABSTRACT FROM AUTHOR]

This study analyses whether care providing strategies for non-institutionalized older adults have changed in the context of a new system of long-term care that emanated from the 2006 "Dependency Act", and a lingering economic crisis. The Spanish sample of the Survey of Health, Ageing and Retirement in Europe (waves 2006 and 2013) is employed to analyse how different individual and household factors affect care strategies, distinguishing between informal (co-resident and non-resident) carers, formal carers and combined formal and informal care, using descriptive statistics and multinomial logit regression. Results show that availability, co-residence and the proximity of children are the main determinants of informal care provision to elders in need. Some externalization of informal care from the domestic domain also took place between 2006 and 2013 as well as an increase in multiple-care arrangements. In the discussion, we comment on why the new Spanish care system that was developed during the economic boom but implemented during the bust years may have consolidated informal care through the economic compensation of mainly family carers. Future research should investigate whether the increase in combined formal and informal care is because of preferences of potential family caregivers or due to a lack of alternatives. [ABSTRACT FROM AUTHOR]

The increasing proportion of persons living alone has come to be emblematic in many ways of modern Western societies because it represents the importance conceded to the individual and to individual goals at the expense, basically, of the family. Solo living has been interpreted within the context of changing values and preferences, changing personal and conjugal realities, and the changing work contexts so often associated with the Second Demographic Transition. We know little about patterns and trends in living alone over the life course in much of the world because most research to date has concentrated on regional and national portrayals or on living arrangements in later life. This study provides a systematic look at the differences in living alone by age and sex in 113 countries. Our aim is to understand the extent to which behavior differs around the world and the implications this has for society. We also examine the relationship between trends in living alone and levels of human development. Results are taken from three massive datasets: census and survey microdata from IPUMS‐international, Demographic Health Surveys, and EU‐Labor Force Surveys. [ABSTRACT FROM AUTHOR]

Graph Table 1 Disease-free life expectancy (HLE) with 95% confidence intervals and annual percentage change (APC) in the percentage of HLE at age 65, by sex and region in Spain 2006, 2012 and 2017. (PDF) Reference 1 Zueras P, Rentería E (2020) Trends in disease-free life expectancy at age 65 in Spain: Diverging patterns by sex, region and disease. [Extracted from the article]