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Population ageing is a topic of great concern in many countries. To counteract the negative effects of ageing, increased fertility or immigration are often proposed as demographic remedies. Changed emigration is, however, rarely mentioned. We explore whether reduced emigration could mitigate ageing in a country like Norway. Using cohort-component methods, we create hypothetical future demographic scenarios with lower emigration rates, and we present (prospective) old-age dependency ratios, population growth and shares of immigrants. We also estimate howmuch fertility and immigrationwould have to change to yield the same effects. In different scenarios, emigration is reduced for the total population and for subgroups, while also taking into account that reduced emigration of natives will entail reduced return migration. Our results show that even a dramatic 50% decrease in annual emigration would mitigate ageing only slightly, by lowering the old-age dependency ratio in 2060 from 0.54 to 0.52. This corresponds to the anti-ageing effect of 15% higher fertility, or one-quarter extra child per woman.

Vi lever stadig lenger, og i Norge som i mange andre land, er det et politisk mål at flere skal stå lenger i arbeid, men hvordan vil den økte levetiden påvirke størrelsen og sammensetningen av den framtidige potensielle arbeidsstyrken? Dette avhenger både av helsen til framtidens ‘yngre eldre’ (60–74 år), og av deres evner til og ønsker om å fortsette i arbeidslivet. Arbeidsgiveres holdninger og tilrettelegging av arbeidsforhold vil også ha stor betydning. I denne kommentarartikkelen oppsummerer vi aktuell forskning på området. Vi legger særlig vekt på mulige endringer i ‘yngre eldres’ helse og sykelighet, og ser dette i lys av befolkningsendringer og mulige endringer i arbeidsforhold.

Bakgrunn: Antall innvandrere i Norge vil øke framover, primært i de eldre aldersgruppene. I denne artikkelen utdyper vi hva som sannsynligvis vil kjennetegne framtidens eldre innvandrere i Norge, og vi drøfter implikasjoner for framtidens samfunn og særlig for de kommunale omsorgstjenestene. Metode: For å beskrive framtidens eldre innvandrere bruker vi Statistisk sentralbyrås befolkningsframskrivinger, som har tall for framtidens innvandrere etter kjønn, alder, landbakgrunn og botid. Disse tallene suppleres med anslag for utdanning, innvandringsgrunn og bruk av kommunale omsorgstjenester blant framtidens eldre innvandrere, basert på detaljerte registerdata. Resultater/konklusjon: Det kan bli fire ganger så mange innvandrere over 80 år de neste 20 årene. Innen 2060 kan det bli hele 14 ganger flere, ifølge befolkningsframskrivingene. I absolutte tall forventes det en økning fra i overkant av 10 000 i dag til 140 000 i 2060. En stor andel av framtidens eldre innvandrere vil ha et relativt lavt utdanningsnivå, noe som er sterkt forbundet med helse og dermed behovet for omsorgstjenester. Dette er noe tjenestene bør forberede seg på. På den andre siden kan innslaget av uformell omsorg være noe større, siden relativt mange er kommet som familieinnvandrere og fra land hvor familieomsorg er mer vanlig.

Abstract Background Future demographic and economic changes warrant a better understanding of older persons’ need for health-related long-term care services (LTC). LTC uptake among older people is likely to be influenced by the presence or absence of family members, but there is scarce research on the role played by partners with different caregiving potential. There is even less research on the contributions of adult children and their caregiving potential. The current study examines the extent to which transitions into LTC in older men and women differ according to the presence and caregiving potential of partners and children. Methods Linked registry data for Norway on older persons (aged 65+), their partners, and their adult children are used to examine how characteristics of these family members influence transitions into LTC from 2010 to 2016, using logistic discrete-time hazard regression models. We observed around 215,000 transitions to LTC, corresponding to around 26.3% of individuals and 5.4% of the total person-years (4.0 million). Caregiving potential is measured in terms of employment, income, health and educational attainment for partners and education and geographical proximity for children. Results Personal, partner and child(ren)’s resources are all associated with older persons’ LTC uptake. Unpartnered and/or childless older people are more likely to use LTC than those with partners and/or child(ren). Older persons with resourceful partners and children are the least likely to transition into LTC. The geographical proximity of adult children appears to have only a minor influence on LTC use among older people. Conclusions Population ageing and strained public resources will likely challenge the future provision of formal old-age care. The role of family networks in the future provision of formal old-age care is expected to become progressively important in the years to come. Inequalities in the health, care and welfare of older persons with and without resourceful family members are likely to increase.

Antall innvandrere i Norge vil øke framover, men utelukkende i de eldre aldersgruppene. I aldersgruppen 55-66 år vil det bli nesten tre ganger så mange innvandrere de neste 20 årene. Hva vil dette bety for norsk arbeids- og samfunnsliv? Vil de være i jobb? Denne artikkelen undersøker hva som vil kjennetegne de eldre innvandrerne framover – deres bakgrunn, utdanning, sysselsetting og hvor i Norge de vil bo. Våre resultater tyder på at framtidens eldre innvandrere i snitt vil ha betydelig lavere utdanningsnivå og arbeidsdeltakelse enn innfødte på samme alder. Det kan gi utfordringer både for integrerings- og seniorpolitikken.

Few producers of official population projections provide regular evaluations of past projection inaccuracies. This paper assesses deviations between the projected and registered total population for Norway (1996–2018), as well as deviations in the age structure, total fertility rate and number of births, period life expectancy at birth and number of deaths, and net international migration. Projected life expectancy was consistently lower than the real development. Few systematic deviations were observed for fertility up to 2009, but thereafter fertility has been consistently overprojected. However, the deviations between projected and realised trends in births and deaths have been relatively small as compared to those for net international migration. The projections produced between 1996–2005 underestimated long-term population growth due primarily to the unforeseen increase in immigration following EU expansion in 2004. More recent projections contain no consistent under- or overprojection of net migration and the deviations for the total population have been moderate.

Abstract Background Knowledge of mortality differentials in immigrant groups depending on their reason for migration, length of stay in host countries and characteristics of sending countries may be beneficial for policy interventions aimed to improve various immigrant groups’ health and welfare. Methods We employed discrete-time hazard regression models with time-varying covariates to compare the death risk of immigrants to those of Norwegian-born natives using linked register data on the Norwegian population aged 25–79 during 1990–2015. More than 492,000 deaths occurred in around 4.6 million individuals. All analyses were adjusted for sex, age, calendar time and sociodemographic characteristics. Results Immigrants had an 11% survival advantage overall. Those immigrating due to work or education had the lowest death risk, whereas refugees had the highest death risk (albeit lower than that of natives). Death risks increased markedly with length of stay, and were most pronounced for those having spent more than 40% of their lives in Norway. Net of reason for migration, only minor differences were observed depending on Human Development Index characteristics of sending countries. Conclusion Independent of reason for migration and characteristics of sending countries, those who immigrate to Norway in adulthood appear to be particularly healthy. The higher death risk associated with prolonged lengths of stay suggests that disadvantageous ‘acculturation’ or stress factors related to the post-migration period may play a role in the long run. The health and welfare of long-term immigrants thus warrants further research.

Married cancer patients enjoy a survival advantage, potentially attributable to better health at diagnosis, earlier contact with health personnel, and/or access to resources to ensure more optimal treatment. These mechanisms only invoke the mere presence of a partner, but partners bring varying amounts of resources into the household. It is likely that also spousal resources contribute to differentials in survival net of own resources, as gradients in survival by the latter are well documented. Our aim is to examine the combined roles of own and spouses’ socioeconomic characteristics (SES) and age for cancer survival. Almost 268,000 married patients diagnosed with a first cancer after age 50 during 1975–2007 were identified from the Norwegian Cancer Registry and other national registers. In a sequence of hazard models, differences in survival by patients' own education, income and age and the role of spouses' characteristics were assessed. Furthermore, we also assessed the importance of homogamy/heterogamy along the same dimensions. Partners’ characteristics clearly matter for survival. The relative survival of patients with highly educated partners, net of their own education, is significantly higher than that of patients with lesser-educated partners. Somewhat similar effects are observed for income, net of education. A less consistent pattern is observed for age, although non-normative heterogamy patterns in age and income appear to be associated with a survival disadvantage. The naïve perspective of only considering the presence of partners may thus conceal important differences in cancer survival. Health personnel may take advantage of such knowledge in interactions with patients and their families, and gather information on resources in immediate networks that may impact prognosis favorable and/or unfavorable and help patients utilize these resources to improve prognosis.

Aim: In order to improve patient outcomes and minimize health care costs, many Western countries are attempting to reduce the length of stay in hospitals by transferring responsibilities from specialist care to primary care. In Norway, the Coordination Reform was implemented in 2012 to enhance this development. As a result, the number of patients discharged to the municipal health care services has increased significantly. We investigate the extent to which nurses in nursing homes and home care services feel equipped to provide adequate care for patients discharged from hospitals after the reform. Data: Altogether, 1,938 nurses representing around 80% of Norwegian municipalities assessed their experiences of this reform. Results: An increase in the number of poorly functioning patients discharged to the municipality services was reported. Regardless of place of work, concerns were raised about limited resources in terms of personnel, equipment and competence, as well as an increase in hospital readmission rates. Negative reports on care provision for recently discharged patients came most frequently from nurses in municipalities which generally had low incomes, diverted limited resources to the health care sector and relied heavily on home-based care. Conclusion: Insufficient transfer of resources to the home care services may have hampered the ability to fulfil the Coordination Reform’s intentions of providing safe care to patients in their own homes as an alternative to prolonged hospital stays. Due to a marked increase in reported hospital readmissions, it is not obvious that shorter lengths of stays have reduced overall health care costs.

The role of cancer coordinators in cancer care collaboration in Norwegian municipalities Uncoordinated services represent a pronounced challenge in Norwegian health care. To enhance local cancer care, a trial project implementing cancer coordinator positions in several Norwegian municipalities was launched in 2012. We aim to assess the role cancer coordinators play in the local coordination of cancer care. In 2014, 52% of cancer coordinators in Norwegian municipalities answered a quantitative web survey concerning their role. Cancer coordinators work directly with patients and their families, but are also a resource for other service providers. Collaboration with involved parties is generally adequate, although interactions with general practitioners, NAV, schools and kindergartens could be improved. Cancer prevalence will increase due to population aging, and thus pressure municipal health services. Cancer coordinators report that they contribute positively in local cancer care. Future research should include perspectives also from patients, next-of-kin and collaborating partners, and potential differences in municipalities with and without cancer coordinators should be explored.

Background: Differences in all-cause mortality between immigrants and host populations may provide insight into health inequities that could be reduced. Objective: Death risks of adult immigrants were compared to those of the host population to assess effects of country of origin, duration of residence, calendar period, and sociodemographic characteristics, i.e., sex, education, and marital and parental status. Methods: Registry data encompassing the entire Norwegian population age 25-79 in 1990-2012 were used to compare death risks in various immigrant groups and the host population, using discrete-time hazard regression models with time-varying covariates. Results: Over 451,000 deaths occurred in around 4.4 million individuals. After adjusting for sex, age, and calendar period, immigrants had an 8Š survival advantage (odds ratio (OR) 0.92). Death-risk estimates for immigrants were lowered pronouncedly by further adjustment of sociodemographic factors (OR 0.81). The greatest survival advantage was observed among immigrants with a short duration of residence. With increasing lengths of stay, immigrants' risk of death became similar to that of the host population. The survival advantage was most pronounced for younger, unmarried, and childless immigrants. Although the survival of Central and Eastern European immigrants improved over time, none of the groups had a higher adjusted death risk than the host population. Conclusions: Immigrants have a 20Š survival advantage compared to the host population. The convergence in mortality with increasing duration of residence suggests that 'healthy migrant' and 'acculturation' effects counteract each other, and warrants further research on the health and welfare of long-term immigrants.

Cancer survivorship research includes the study of physical, psychosocial, and economic consequences of cancer diagnosis and treatment among pediatric and adult cancer survivors. Historically, the majority of cancer survivorship studies were from the United States, but survivorship issues are increasingly being addressed in other developed countries. Cross-cultural studies remain, however, scarce. The degree to which knowledge attained may or may not be transferred across cultures, countries, or regions is not known. Some important challenges for comparative research are therefore discussed in a cross-cultural perspective. Several substantive and methodological challenges that complicate the execution of cross-cultural cancer survivorship research are presented with examples and discussed to facilitate comparative research efforts in the establishment of new survivorship cohorts and in the planning and implementation of survivorship studies. Comparative research is one key to understanding the nature of cancer survivorship, distinguishing modifiable from nonmodifiable factors at individual, hospital, societal, and system levels and may thus guide appropriate interventions. Lastly, suggested future courses of action within the field of comparative cancer survivorship research are provided.

Discrete-time hazard regression models were employed to register and census data on 1.4 million Norwegian married couples from 1974-2001 to explore the probability of divorce following cancer illness. Divorce rates for around 215 000 persons diagnosed with cancer were compared to divorce rates for persons for whom all the other observed variables were the same. No overall harmful influence of a cancer diagnosis was observed. Most cancer forms resulted in small, immediate declines in divorce rates the first years following diagnosis. Exceptions were significant increases in the divorce rates for persons diagnosed with cervical and testicular cancer.