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Le concept de vulnérabilité et son application aux politiques sociales.

Frailty is a core concept in understanding vulnerability and adjustment to stress in older adults. Adopting the perspective provided by the transactional model of stress and coping (Lazarus and Folkman in Stress, appraisal, and coping, Springer, New York, 1984), the present study examined three aspects of frailty in older adults: (1) the link between frailty and perceived stress exposure (PSE); (2) the link between frailty and stress-related symptoms (SRS); and (3) the role of frailty in the link between PSE and SRS. Participants were 2711 adults aged between 64 and 101 years who were taking part in the Swiss Vivre/Leben/Vivere study. As well as assessing frailty, we measured PSE and SRS during the 4 weeks preceding the administration of the questionnaires, together with the covariates age, sex, educational attainment, language of the canton, and type of canton (urban vs. rural). Regression analyses revealed higher levels of PSE in frail older adults than in non-frail older adults. In addition, frail older adults reported more SRS than non-frail older adults. As expected, the association between PSE and SRS differed as a function of the frailty status: The positive relation between PSE and SRS being stronger for frail older adults than for non-frail older adults. These results suggest that frailty is related to perceived discrepancy between resources and demands, and to ability to cope with PSE. Our findings have implications for interventions to help frail older adults manage stress.

Interest in the study of vulnerability has experienced impressive growth across various disciplines. To contribute to this major but scattered development in the study of vulnerability, this article argues for a multidisciplinary life-course framework. This framework promotes a systemic and dynamic perspective focused on three complementary research directions: multidimensional, multilevel, and multidirectional. On the basis of this life course perspective, the authors also propose a definition of vulnerability as a dynamic process of stress and resources across various domains of life (i.e., work, family, health, migration, etc.), levels (i.e., person, group, collective), and time (i.e., long-term processes). The concept of vulnerability has recently captured a lot of attention. The topic emerged without a consensual definition, and paradoxically, its vagueness is likely part of its success. In this article, we show the richness of vulnerability as a concept used and that can be developed in a multi- and hopefully interdisciplinary effort. We define vulnerability in terms of the dynamics of stress and resources across the life course and illustrate its potential through the discussion of empirical examples, notably drawn from the Swiss National Centre of Competence in Research LIVES (www.lives-nccr.ch). On this basis, we propose three research directions aiming at developing a life-course framework for understanding the systemic and dynamic properties of vulnerability: multidimensional, multilevel, and multidirectional analyses.

This issue defines vulnerability as a key interdisciplinary concept for understanding life trajectories. Moreover, it develops a life course framework to study vulnerability along three structuring axes of research: multidimensionality, multilevel, and multidirectionality.

Objectives: The present study sets out to investigate the relation of cognitive abilities to well-being and its interplay with key life course proxies of cognitive reserve and social capital in a large sample of older adults. Method: Three thousand eighty older adults served as sample for the present study. Physical well-being (EuroQoL-5D questionnaire) and psychological well-being (Satisfaction with Life Scale) as well as cognitive performance in terms of verbal abilities (Mill Hill vocabulary scale), processing speed (Trail Making Test part A), and cognitive flexibility (Trail Making Test part B) were assessed. Participants reported information on education, occupation, cognitively stimulating leisure activities, the different languages regularly spoken as well as family and close friends. Results: Moderation analyses showed that the relation of cognitive performance to physical and psychological well-being was significantly attenuated in individuals with a higher cognitive level of the first job after education, a larger number of midlife and current cognitively stimulating leisure activities, a larger number of languages regularly spoken, a larger number of significant family members and friends, and more frequent contact with and more confidence in significant family members. Conclusion: Present data suggest that the relation of low cognitive abilities to low well-being in old age is attenuated in individuals with greater cognitive reserve and greater social capital accumulated over the life course.

L'intérêt de cette recherche est de comprendre comment les personnes âgées évaluent rétrospectivement leur passé. D'une part, nous cherchons à savoir si, au sein de la population âgée, il existe des différences d'âge concernant l'effet de positivité. D'autre part, nous nous demandons si les perceptions de bonheur et de vulnérabilité liées à des souvenirs répondent à deux processus différents de rappel. Pour tester nos hypothèses, nous avons utilisé l'enquête Vivre / Leben / Vivere menée auprès d'individus de 65 ans et plus vivant en Suisse (n=4200). Les résultats montrent que le bonheur dépend des normes culturelles et sociales, alors que la vulnérabilité a un effet d'âge, confirmant l'indépendance de ces deux processus de rappel. Par ailleurs, pour le bonheur, il n'existe pas de différences d'âge, alors que c'est le cas pour la vulnérabilité: les groupes les plus âgés ont globalement moins de probabilité d'indiquer des moments de vulnérabilité pendant le parcours de vie.

This review paper investigates the potentially misleading effect of some social norms on life trajectories. Conformity to some gender norms related to the division of paid and family work becomes counterproductive for individuals who experience turning points in their life along the way. We present various empirical results mainly drawn from the Swiss National Centre of Competence in Research LIVES where conformity to social norms has detrimental effects on life trajectories. We conclude by stressing that the sensitizing concept of misleading norms contributes to a better understanding of vulnerability across the life course. Research has mainly stressed the positive aspects of individual compliance with social norms across the life course and the negative consequences of deviance from social norms. However, more attention should be paid to the vulnerability processes of conforming with established norms. One area of research in which normative conformity has been criticized concerns gender. Various studies have stressed that gender norms predispose a highly unequal accumulation of resources and specialization processes among men and women, thus delegating males and females to particular roles. We use this field of research to present misleading norms as a sensitizing concept (Blumer, 1969 Blumer, H. (1969). Symbolic interactionism. Englewood Cliffs, NJ: Prentice Hall.) and stress the mismatch between social structures and social norms as a root of individual vulnerability across the life course. Based on the framework that is proposed by Spini, Bernardi, and Oris (this issue), we develop the idea that misleading norms are reproduced under the influence of multilevel processes, from the individual, to intermediate groupings and networks, to society at large. This article focuses on one empirical example of misleading norms: the potential negative consequences for a large number, if not a majority, of individuals in contemporary Western society of complying with gender norms regarding the division of child care and paid work. We assert that conformity to such gender norms is counterproductive for individuals who experience critical events later in life. The following sections first summarize some results about deviance and conformity to norms in life-course research. Then, the article proposes an alternative by defining the concept of misleading norms from a life-course perspective that stresses the importance of changing life circumstances for understanding the impact of normative conformity. Third, based on empirical illustrations, the paper summarizes studies that are drawn from the Swiss National Centre of Competence in Research LIVES with regard to the question of how some gender norms increase vulnerability at three different stages of the life course—the transition to parenthood, divorce and family recomposition, and family interactions of people who are elderly. This article also presents some multilevel influences that account for the reproduction of misleading norms, notably personal networks and normative climates. The article concludes by stressing that the concept of misleading norms contributes to a better understanding of vulnerability across the life course beyond gender issues by sensitizing scholars and stakeholders to the negative effects for individuals of normative conformity priorly in the life course in several circumstances.

Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch), Past research on gender role attitudes has often focused on individual- rather than country-level explanations. Drawing on European Social Survey data from 21 countries, we examine the effect of societal normative climates (i.e., shared perceptions of others’ attitudes) on personal attitudes towards two non-traditional gender roles: Voluntary childlessness and working full-time while children are young. To detect potential gender differences, we analyse disapproval of men and women separately. Findings reveal that there are strong differences in normative climates across countries, and that people generally perceive more disapproval of women than of men for both behaviours. Most importantly, in countries where a higher share of respondents perceives disapproval of these behaviours, respondents themselves disapprove more strongly – even if they do not believe that others disapprove, and even after controlling for other relevant individual- and country-level characteristics. What is more, the independent effect of normative climate explains most of the differences between countries. This robust finding demonstrates the power of country-level normative climates in explaining individuals’ attitudes and between-country differences in attitudes toward gender roles.

This study investigated the direction of effects of temporal and downward social comparisons on self-rated health in very old age. Conversely, self-rated health can either reinforce or hinder comparison processes. In the framework of the Swiss Interdisciplinary Longitudinal Study on the Oldest Old, individuals aged 80 to 84 at baseline were interviewed and followed longitudinally for 5 years. Multilevel analyses were used to test the relative importance of temporal and social comparisons on self-rated health evaluations synchronically and diachronically (with a time lag of 12 to 18 months) as well as the direction of these relative influences. Results indicate that (a) at the synchronic level, continuity temporal comparisons have more impact than downward social comparisons on self-rated health; (b) both types of comparison had an independent and positive effect on self-rated health at the diachronic level; (c) self-rated health has an independent synchronic effect on both types of comparison and an independent diachronic effect in temporal comparison.

This paper assesses the impact of disturbing life events over five years on the wellbeing of 340 people aged 80–84 years at baseline, by analysing data from a longitudinal survey in Switzerland. The guiding proposition was that the negative effect of life events is moderated by the event domain, i.e. health, deaths and changes in family setting and relationships, and by cognitive adaptation to one's own health state (adopting a more or less optimistic view). Multi-level regression that controlled for the effect of socio-demographic and health factors was used. Corroborating the first hypothesis, a model that differentiated the event categories, instead of their additive inclusion, gave the best fit. In support of the second hypothesis, it was shown that the positive impact of self-rated health reduced the negative effect of life events on wellbeing for survivors, but not for those who died within five years. This suggests that the former made more optimistic appraisals of their mental and physical health, while the latter adjusted their subjective health rating to their functional abilities. Survivors had better psychological resources for coping with disturbing life events, while the deceased lacked these resources, which buffered the impact of negative events. The psychological meaning of stressful events at the end of life is discussed. By encouraging optimistic self-evaluations of health, and raising awareness of the range of normal functioning of older people, health- and social-care practitioners can promote the maintenance of meaningful lives in old age.

Survival in old age has been shown to be positively related to religiousness, and in particular to church attendance. This research provides new confirmation of this relationship under the Swiss Interdisciplinary Longitudinal Study in the Oldest Old ({N} = 340 at baseline), a study following subjects aged 80 to 84 at baseline since 1994. Results of logistic regression analyses indicate that participation in church services or a composite measure of religiousness comprising participation in services and the frequency of prayer is positively related to survival in a time interval of 12 to 18 months, controlling for other possible explanatory factors such as functional helath or depressive symptoms. To our knowledge, this is the first time that this effect has been demonstrated in a population of old old subjects and in a Latin country of Europe where the number of Catholic subjects is high. Religiosität und besonders religiöse Aktivitäten wie beispielsweise Gottesdienstbesuche scheinen bisherigen Forschungsergebnissen zufolge in positiver Beziehung zur Langlebigkeit und Überlebenswahrscheinlichkeit im hohen Alter zu stehen. Neuere Befunde zur Relation zwischen Religiosität und Mortalität stammen aus der Schweizer Interdisziplinären Längsschnittsstudie zum hohen Alter ({N} = 340 zum ersten Messzeitpunkt), in der 80- bis 84jährige seit 1994 regelmäßig befragt wurden. In den Analyzen wurden drei Maße der Religiosität verwendet: die Häufigkeit zu beten, die Häufigkeit der Gottesdienstbesuche sowie ein Religiositätindikator, der diese beiden Maße zusammenfasste. Die Ergebnisse logistischer Regressionen weisen darauf hin, daß die Teilnahme an Gottesdiensten sowie der Religiositätsindikator in positivem Zusammenhang zur Überlebenswahrscheinlichkeit 12 bis 18 Monate später stehen. Diese Befunde blieben auch nach Kontrolle anderer möglicher Einflussfaktoren wie funktionaler Gesundheit und depressiven Symptomen stabil. Unseren Wissens nach konnte die Beziehung zwischen Religiosität und Überlebenswahrscheinlichkeit damit zum ersten Mal (1.) für die Population der alten Alten und (2.) für ein europäisches Land mit einem bedeutenden Anteil an katholischer Bevölkerung nachwiesen werden.

Two questionnaire studies were conducted ({N} = 80 and {N} = 175) ti examine the structure and the social anchoring of the organizing principles of personal and governmental involvement concerning human rights. The results indicated that these organizing principles had, as hypothesized one abstract and one applied dimension. The second study evaluated the correlations between these dimensions and values. Results were consistent with Schwartz's (1992) model predicting both the internal structure of values and their relations with other variables. Amongst other results, self-transcendence values were positively correlated with the abstract involvements and the applied personal involvement, and negatively with the applied governmental involvement. The results concerning the links between different levels of social anchorings, particularly between the value types and variables such as religious affiliation and practice political preferences, and social and political activism were also presented and discussed.

This chapter which is based on a ten-year longitudinal study conducted with two cohorts of octogenarians, examines downward social comparison as an adjustment mechanism and its impact on well-being during the frailty process. The cognitive and affective dimensions of well-being are both taken into consideration. Our population of analysis was made up of self-respondents, aged between 80 and 84 at baseline. Descriptive analyses and multilevel models were used to examine the links between well-being, downward social comparison and the frailty process. A paradoxically slow decline in well-being was first observed over the ten years notwithstanding the general decline in health. Further analysis showed that the decline in well-being with encroaching frailty was less marked in the case of those who applied downward social comparison than those who did not. These results demonstrate that downward social comparison is an effective adjustment mechanism even in a population which, because of its advanced age, is more and more afflicted by frailty.

The Swiss Interdisciplinary Longitudinal Study on the Oldest Old (Swilsoo) was designed to investigate life and health trajectories during advanced opld age and their repercussions on elders' daily life. This chapter, divided in two sections, first introduces the reader to Swilsoo's design, samples and fieldwork. Two cohorts were assessed on an approximately yearly basis, the first for nine waves of interviews from 1994 to 2004, with 340 participants initially, and the second for five waves from 1999 to 2004, with 377 participants initially. The starting sample of each cohort was stratified by gender, age and geographical area (urban versus semi-rural) and was composed of community-dwelling participants aged between 80 and 84 years; those who moved later to a nursing home remained in the study. Several aspects were assessed during the interviews (health, bereavement, social relationships and activities, well-being, cognitive ability, etc.). This chapter describes more specifically five main features of Swilsoo: 1) its 10-year longitudinal design; 2) its focus on the very old; 3) its dual focus on two birth cohorts; 4) the stratified and random selection of its participants; 5) its multidisciplinary and standardized closed-end questionnaire. A total of 2,890 questionnaires were gathered during the 10 years of the field work. The second section of the chapter gives an overview of the elders' life course through two world wars, the Great Depression, and later the Golden Decades (1946-1975); it then describes the survey population in terms of socioeconomic and cultural resources, family network and health, highlighting the main gender, geographical area and cohort differences.

Les auteurs présentent un survol de la recherche pluridisciplinaire sur la grande vieillesse, avec ses tâtonnements, ses élaborations théoriques et ses principaux acquis. Ce domaine de recherche s'est constitué très récemment, dans la seconde moitié des années 1980, avec la prise de conscience de certaines implications de la longévité croissante, en particulier de la forte poussée démographique de la population très âgée. L'«agenda» initial de la recherche focalisait essentiellement les pathologies du grand âge et leurs implications en termes de politique de la vieillesse et de coûts de la santé. Au fil des années, la perspective s'est élargie et enrichie, l'intérêt se tournant également vers le vieillard «robuste», l'interrogation portant sur les différentes formes et trajectoires de vieillissement. Après à peine un quart de siècle, la «géographie» de la grande vieillesse comme l'étude de l'organisation de son déroulement sont assez bien balisés; la description est solide, mais l'explication demeure balbutiante. Une piste d'avenir pourrait résider dans un examen des trajectoires de vie des vieillards basé sur l'analyse combinée de données génétiques et d'informations biographiques. The authors give an overview of multidisciplinary research on advanced old age, its first hesitant steps, its forays into theory and its main achievements. This is a very young field of research, dating back only to the latter half of the 1980s, when when some of the implications of lengthening life expectancy, particularly the surge in the very old population, became evident. The initial agenda of this research focused essentially on the pathologies of very old age and their repercussions on old-age policy and the costsof health care. As time went by, the scope was broadened and enriched, with attention turning also to the healthy elderly and the various forms and trajectories of ageing. After barely a quarter of a century, both the "geography" of very old age and the way its progression is organised have become fairly clear; the description is well established but the explanation is still in its infancy. One promising avenue for further research could be to examine the life trajectories of the elderly by means of a combined analysis of genetic and biographical data.

Background and aims: Data from the literature reveal the contrasting influences of family members and friends on the survival of old adults. On one hand, numerous studies have reported a positive association between social relationships and survival. On the other, ties with children may be associated with an increased risk of disability, whereas ties with friends or other relatives tend to improve survival. A five-year prospective, population-based study of 295 Swiss octogenarians tested the hypothesis that having a spouse, siblings or close friends, and regular contacts with relatives or friends are associated with longer survival, even at a very old age. Methods: Data were collected through individual interviews, and a Cox regression model was applied to assess the effects of kinship and friendship networks on survival, after adjusting for socio-demographic and health-related variables. Results: Our analyses indicate that the presence of a spouse in the household is not significantly related to survival, whereas the presence of siblings at baseline improves the oldest old’s chances of surviving five years later. Moreover, the existence of close friends is a central component in the patterns of social relationships of oldest adults, and one which is significantly associated with survival. Overall, the protective effect of social relationships on survival is more related to the quality of those relationships (close friends) than to the frequency of relationships (regular contacts). Conclusions: We hypothesize that the existence of siblings or close friends may beneficially affect survival, due to the potential influence on the attitudes of octogenarians regarding health practices and adaptive strategies.

The impact of social relationships on the maintenance of independence over periods of 12–18 months in a group of 306 octogenarians is assessed in this study. The study is based on the results of the Swilsoo (Swiss Interdisciplinary Longitudinal Study on the Oldest Old). Participants (80–84 years old at baseline) were interviewed five times between 1994 and 1999. Independence was defined as the capacity to perform without assistance eight activities of daily living. We distinguished in our analyses kinship and friendship networks and evaluated social relationships with the help of a series of variables serving as indicators of network composition and contact frequency. Logistic regression models were used to identify the shortterm effects of social relationships on independence, after controlling for sociodemographic and health-related variables; independence at a given wave of interviews was interpreted in the light of social factors measured at the previous wave. Our analyses indicate that the existence of a close friend has a significant impact on the maintenance of independence (OR=1.58, p

Correlated data are very common in the social sciences. Most common applications include longitudinal and hierarchically organized (or clustered) data. Generalized estimating equations (GEE) are a convenient and general approach to the analysis of several kinds of correlated data. The main advantage of GEE resides in the unbiased estimation of population-averaged regression coefficients despite possible misspecification of the correlation structure. This article aims to provide a concise, nonstatistical introduction to GEE. To illustrate the method, an analysis of selectivity effects in the Swiss Interdisciplinary Longitudinal Study on the Oldest Old is presented.

Sur la base d'un échantillon de 340 octogénaires suisses inclus dans l'étude longitudinale suisse des très âgés (SWILSO-O), cet article propose une définition opérationnelle de la fragilité utilisant cinq dimensions de la santé: la mobilité, les capacités sensorielles, l'énergie, la mémoire et les troubles physiques rapportés par les personnes âgées elles-mêmes. Nous postulons que la fragilité apparaît dès lors qu'il y a des problèmes ou des difficultés sur deux des cinq dimensions sus-mentionnées. En croisant l'indicateur de fragilité avec celui de dépendance fonctionnelle, 38% des enquêtés sont indépendants, 12% sont dépendants fonctionnels. Le suivi longitudinal sur cinq ans de la cohorte d'octogénaires démontre que l'indicateur de fragilité initialement proposé est cohérent avec la définition théorique de la fragilité: les personnes fragiles sont plus à risque de chutes, de maladies, d'incapacités fonctionnelles et de décès par rapport aux personnes indépendantes. Data are from 340 community-dwelling octogenarians participating in the Swiss Interdisciplinary Longitudinal Study on the Oldest-Old (SWILSO-O). We first operationalized the concept of frailty based on the presence of self reported deficiencies in two or more of the following domains: physical, mobility, energy, memory, and sensory. This gave rise to a distinction between frail and non-frail. We then combined the frailty indicator with the ADL. At study inception, 38% of the sample were independent, 50% were frail, and 12% were dependent. The «independent», «frail», and «dependent» groups differed qualitatively with respect to risks of adverse outcomes (falls, illnesses, and death).

Après 80 ans, les événements qui jalonnent la vie signifient la plupart du temps des pertes de quelque chose ou de quelqu'un. Sur la base de certains résultats obtenus dans le cadre de la recherche SWILSO-O, les auteurs résument quelques résultats concernant les effets à court et à moyen terme des événements sur le bien-être des aînés. Ils mettent l'accent sur les conséquences des événements sur le bien-être et l'identité psychosociale, ainsi que les processus qui permettent le cas échéant de réguler ces conséquences. In old old age, life events mos often are associated with losses. On the basis of SWILSO-O research, the authors resume some results concerning the short- and middle-term effects of life events on the oldest old's well-being. They underline the implications of life events on well-being and identity, as the processes used by the oldest old in order to regulate these consequences.

SWILSO-O est une étude longitudinale sur le grand âge (80 ans et plus). Menée dans deux régions suisses depuis 1994, elle s'intéresse à l'autonomie et à l'environnement socioculturel des personnes âgées, avec pour thèmes principaux les aspects sociologiques, médicaux, psychologiques et la consommation de soins. Après avoir décrit brièvement les principales caractéristiques de l'étude, cet article se penche sur l'évolution de l'échantillon au cours des cinq premières vagues d'interrogation (1994-1999). La particularité de la population enquêtée (grand âge) explique les changements dans la composition de l'échantillon qui s'opèrent au fil des ans en ce qui concerne le genre, la résidence ou encore les sorties (décès). SWILSO-O is a longitudinal study on oldest-old individuals. Conducted in two different regions of Switzerland since 1994, SWILSO-O gives an emphasis on the autonomy and the socio-cultural environment of older persons, and particularly on sociological, medical, and psychological aspects, as well as health care consumption. After describing the main issues of the study, this paper focuses on the evolution of the sample during the first five waves (1994-1999). The distinctive features of the surveyed population (old and very old age) explain the changing composition of the sample across time in terms of gender, residence, and deaths.

In this paper three ways of measuring and defining change in cross-sectional designs are presented. The first measure of change concerns structural stability: continuity in the organisation of a set of variables across time. The second is level stability: the comparison of means in different groups differing on age or socio-cultural dimensions. The third is based on the changing parameter model (Firebaugh, 1997). In this model, it is the interaction between ageing effects or socio-cultural factors (period and cohort effects) and another variable that is assessed. These three approaches of change are illustrated on the basis of beliefs about the self, life and society assessed in representative populations of elders in two regions of Switzerland (Geneva and Central Valais) in 1979 ({N} = 1608) and 1994 ({N} = 2101).

Cette étude examine, pour une population très âgée, l'action de la vie relationnelle sur le maintien de l'indépendance à 12 ou 18 mois, en différenciant réseau familial et réseau amical. Elle se fonde sur les cinq premières vagues d'entretiens (1994-1999) de SWILSO-O (Swiss Interdisciplinary Longitudinal Study on the Oldest-Old). 306 personnes, âgées de 80 à 84 ans au départ, ont été retenues pour les analyses. L'indépendance est définie comme la capacité à accomplir, sans aide, huit activités de la vie quotidienne. Pour la vie relationnelle, on dispose d'une série de variables sur la composition des réseaux, ainsi que sur la fréquence des contacts. Des modèles de régression logistique ont été effectués, où l'indépendance à une vague donnée est expliquée par les facteurs sociaux mesurés à la vague précédente, sous contrôle de variables sociodémographiques et de santé. La présence d'un ami intime est significativement associée au maintien de l'indépendance (OR = 1.58, p < 0.05), ce qui n'est pas le cas des autres variables concernant la composition des réseaux. On constate également une influence positive des contacts familiaux sur la santé fonctionnelle (OR = 1.09, p < 0.05).

The death of a significant other is seen as a major life disruption. What are the consequences when such a loss occurs during advanced old age? Based on observation of an octogenarian cohort over a period of five years (1994-1999), this study investigates the impact of losing a significant other (close relative or friend) on the health of elders and on their family and social life. The bereaved are compared with two control groups: one declaring no significant change in their life and the other reporting a loss unrelated to bereavement. Results show that the death of a significant other has no impact on the measures of functional and physical health, nor is it a factor of isolation. However, the loss of a close relative is associated with more depressive symptoms while that of a relative or friend is related to the survivor's feeling of loneliness.

Après 80 ans, la vie devient marquée par des événements qui signifient le plus souvent la perte de quelque chose ou de quelqu'un. Les psychologues FSP Alain Clémence et Dario Spini présentent les résultats d'une étude longitudinale qui explore comment de tels événements affectent le bien-être des personnes très âgées.

Plusieurs recherches, avant tout américaines, indiquent un lien entre la pratique religieuse et la survie des personnes âgées. A ce jour, peu d'études ont vérifié cet effet dans un pays européen et tares sont celles qui portent sur des populations très âgées. Nous présentons ici des résultats issus de la recherche SWILSO-O (Swiss Interdisciplinary Longitudinal Study on the Oldest Old), qui suit, depuis 1994, 340 personnes âgées de 80 à 84 ans au départ. Des analyses de régression logistique confirment que la pratique religieuse est positivement liée à la survie mesurée 12 ou 18 mois plus tard, compte tenu de l'effet d'autres facteurs tels que la santé fonctionnelle ou les symptômes dépressifs. Les interprétations possibles de ce résultat sont discutées. A notre connaissance, il s'agit de la première recherche qui révèle cet effet dans une population du quatrième âge et composée d'une forte représentation de croyants catholiques. Different studies, particularly in the United States of America, have shown a positive relationship between religiousness and survival. Few studies conducted in Europe, or in a population of old old respondents, have verified it. This research provides new confirmation of this relationship under the Swiss Interdisciplinary Longitudinal Study on the Oldest Old (N = 340 at baseline), a study following subjects aged 80 to 84 at baseline since 1994. Results of logistic regression analyses indicate that religious practice is positively related to survival in a time interval of 12 to 18 months, controlling for other possible explanatory factors such as functional health or depressive symptoms. Different interpretations of this result are discussed here. To our knowledge, this is the first time that this effect has been demonstrated in a population of old old subjects composed of a large sample of Catholic believers.

Los autores presentan el desarrollo y algunos resultados de los cinco primeros años del SWILSO-O (Swiss Interdisciplinary Study on Old-Old). Este estudio se inició en 1994 con una cohorte de 340 individuos que vivían en dos regiones muy diferentes de Suiza (Ginebra y Valais central). La muestra, estratificada por sexos y regiones, estaba compuesta por personas que vivían en sus casas y tenían 80 a 84 años de edad al iniciar la investigación. La edad muy avanzada (o cuarta edad) se abordó desde una perspectiva del curso de la vida que permitió distinguir diferentes estadios en función del grado de dependencia de las personas ancianas; éstos se establecieron utilizando una lista de actividades de la vida diaria que permite definir tres estados de salud funcional (independientes, frágiles, dependientes). Superando los límites de un enfoque transversal, los autores analizaron la dinámica de la salud funcional durante este período de vida; la evolución de los estados funcionales durante los 5 años mostró la tendencia al declive de la autonomía en la edad muy avanzada, mientras que el análisis de las transiciones entre los diferentes estados de salud funcional moderó está visión y señaló la estabilidad de la salud funcional a corto y a largo plazo. Por último se examinaron los factores asociados a la dependencia para ilustrar las posibilidades de análisis ofrecidos por SWILSO-O.

Les auteurs présentent la démarche et quelques résultats des cinq premières années de SWILSO-O (Swiss Interdisciplinary Longitudinal Study on Oldest-Old). Cette étude longitudinale a débuté en 1994 avec une première cohorte de 340 individus habitant dans deux régions contrastées de Suisse (Genève et Valais central). L'échantillon, également stratifié par genre, se compose de personnes vivant à domicile et âgées de 80 à 84 ans au début de la recherche. La grande vieillesse (ou le quatrième âge) est abordée dans une perspective de parcours de vie, qui permet de distinguer différents stades en fonction du degré de dépendance des personnes âgées; ceux-ci sont établis au moyen d'une liste d'activités de la vie quotidienne qui sert à l'élaboration de trois statuts de santé fonctionnelle (indépendants, fragiles, dépendants). Dépassant les limites d'une approche transversale, les auteurs abordent alors la dynamique de la santé fonctionnelle dans cette période de vie: l'évolution des statuts fonctionnels sur les cinq années met en évidence la tendance au déclin de l'autonomie dans le grand âge, tandis qu'une analyse des transitions entre les différents états de santé fonctionnelle modère cette vision et souligne la stabilité de la santé fonctionnelle à court comme à long terme. Finalement, les facteurs associés à la dépendance sont examinés pour illustrer les possibilités d'analyse offertes.SWILSO-OThis paper gives an overview of the design, as well as some results, of the first five years of Swilso-o (Swiss Interdisciplinary Longitudinal Study on Oldest-Old). This longitudinal study was launched in 1994 with a first cohort of 340 subjects living in two specific regions (Geneva and Valais central). The sample (stratified by gender and region) is composed of subjects living at home and aged 80 to 84 at baseline. Old old age is defined in a life course perspective which distinguishes different steps in function of the degree of dependency of the persons. These steps are based on a list of activities of daily living which serves to define three statuses of functional health (independent, frail, dependent). Completing a cross-sectional approach, the authors illustrate the dynamics of functional health during this life period : the evolution of functional statuses during the five years shows a general tendency of decline from autonomy in old old age. An analysis of the transitions among the different states of functional health moderates this vision and underlines its stability at a short as well as a long term. Finally, some factors associated with a dependent status are examined in order to illustrate the possibilities of analysis offered by Swilso-o.

La perte d'un être cher est considérée comme une perturbation majeure. Qu'en est-il quand cette perte affecte des vieillards? Sur la base du suivi sur cinq années (1994-1999) d'une cohorte d'octogénaires, on analyse l'impact du décès d'un parent proche et/ou d'un ami sur la santé et sur la vie relationnelle des vieillards. Les endeuillés sont comparés à deux groupes témoins (ne déclarent pas de changement important; déclarent une perte autre qu'un décès). On n'observe pas d'impact spécifique de la perte sur les échelles de santé fonctionnelle et troubles somatiques; de même, elle n'est pas un facteur d'isolement. Cependant, la disparition d'un parent est associée à une augmentation des symptômes dépressifs, celle d'un parent ou d'un ami aiguise le sentiment de solitude du survivant. The death of a significant other is seen as a major life disruption. What are the consequences when such a loss occurs during advanced old age? Based on a five-year follow-up of an octogenarian cohort, this study investigates the impacts from losing a significant other (close relative and/or friend) on the health of the elders and on their family and social life. The bereaved are compared with two control groups: those who declared no significant change in their life and those reporting a significant change, but not bereavement related. Results show that the death of a significant other has no impact on the measures of functional and physical health, nor is it a factor of isolation. However, the loss of a close relative increases the level of depressive symptoms and deepens the loneliness feeling among the survivors; with the death of a friend, only the latter applies.

Cet article, qui s'inscrit dans le cadre du programme de recherche Swilso-o (Swiss Interdisciplinary Study on Old-Old), porte sur la relation entre la vie sociale et affective d'un échantillon aléatoire d'octogénaires (n = 295) et leur trajectoire de décès ou de survie pendant cinq ans (1994-1999). L'intensité de leur vie familiale et relationnelle ainsi que l'existence d'un lien affectif fort sont établies sur la base des données de départ. Nous n'enregistrons aucune relation entre la fréquence des échanges familiaux et amicaux et la survie ou le décès à cinq ans. En revanche, une relation forte est établie entre l'existence d'un lien d'amitié et la trajectoire de survie. Cette association est indépendante de la santé fonctionnelle, de l'âge et du sexe. Ce résultat souligne les enjeux de la relations d'amitié et de sa qualité dans la vie au quatrième âge. This article, which was carried out within the framework of the research program Swilso-o (Swiss Interdisciplinary Longitudinal Study on Old-Old), studies the relation between the social and emotional life of a cohort of octogenarians (n = 295) and their trajectories of survival or decease during 5 years (1994-1999). The intensity of their family and relational life as well as the existence of a strong emotional tie is established on the basis of the data at baseline. On one hand, no association has been observed between the frequency of exchanges of the family and the friends and the survival or death at five years. On the other hand, a strong effect of having a close friend on survival has been found. This association is independent of functional health, gender and age and underlines the importance of friendship and its quality in old old age.