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Rationale: There is an urgent need to better understand how to maintain cognitive functioning at older ages with lifestyle interventions, given that there is currently no medical cure available to prevent, halt or reverse the progression of cognitive decline and dementia. However, in current models, it is still not well established which social and behavioral modifiable factors (e.g. education, BMI, physical activity, sleep, depression) matter most at which ages, and which behavioral profiles are most protective against cognitive decline. In the last years, advances in the fields of causal inference have equipped epidemiology and social sciences with methods and models to approach causal questions in observational studies. Method: The presentation will give an overview of the causal inference framework to investigate the value of behavior changes in cognitive aging. Motivated by conflicting recent publications if physical activity should or should not be recommended to reduce individual risk of cognitive decline, we emulate a target trial where sedentary people are followed over the course of the Survey of Health, Ageing and Retirement in Europe (SHARE) and compare their cognitive development depending on initiating or not physical activity at a later measurement. Extended inclusion/exclusion criteria, and concepts of incident versus prevalent users and multiple eligibility are introduced. Discussion: The causal inference framework applied to observational studies is able to guide study design to reconcile conflicting evidence from intervention and observational studies. Investigations under the new framework have fewer ethical considerations compared to intervention research and, considering the need to follow up individuals over several decades, are considerably more cost-effective. Limitations are discussed.

Researchers and entrepreneurs present technological innovations in dementia diagnosis and care, particularly through the use of wearables, apps, and novel data analysis techniques. These innovations address complex challenges of differential dementia diagnosis and ensuring high-quality and safe home and formal care.

The Data Management Plan is a compulsory deliverable of H2020 projects. It will be regularly updated over the course of the project.

Health is determined by socio-economic position not only of the individual, but also by that of their parents. The intergenerational transmission of health via parental socioeconomic status is suggested to vary according to contextual factors such as income inequality. Earlier studies with a comparative perspective had a limited number of countries available. This study uses 20 countries at up to five waves from the European Social Survey (2008-2016) and SWIID in order to examine the extent to which income inequality is related to the origins-health gradient. The higher the income inequality of a given country and year, the stronger the origins-health gradient. Contrary to earlier findings, this association can be fully explained by intergenerational transmission of status, i.e. education. Implications of this finding are that health is largely determined by educational attainment and associated health behaviors, giving societal context a less prominent role than earlier studies suggested.

This chapter reviews recent projections related to the aging of populations, developments in health expectancy and disability, and associated trends in need for and provision of long-term care, focusing on the developments in Europe but mentioning worldwide trends where possible. First, I present demographic trends in changing age structure of populations, expected costs of those changes, and discuss how innovative measures such as the ‘real elderly dependency ratio’ could offer a more balanced view on those trends. Second, projections of healthy life expectancy and time spent with morbidity and disability are presented. Then possible limitations of those projections are discussed, especially regarding recent evidence on changing incidence of dementia, and the possible further reductions in incidence if unfavorable lifestyle and health behaviours were reduced. After that, I will delineate demographic trends in need for assistance with care, and their implications for both formal and informal long-term care provision and costs. Specifically, a ‘care gap’ both in the provision of formal and informal care has been foreseen for several countries. Lastly, I discuss some trends and phenomena in long-term care provision which may influence the trends in long-term care needs and provision. In particular, estimated care gaps could become less threatening if the trend of migration of trained and untrained caregivers to provide live-in and institutional care in understaffed countries will continue, and if technological innovations will reduce care needs by enabling persons with disabilities to carry out activities of daily living autonomously.

Maintaining cognitive function is a prerequisite of living independently, which is a highly valued component in older individuals’ wellbeing. In this paper we assess the role of early-life and later-life nutritional status, education and literacy on the cognitive functioning of older adults living in poverty in Peru. We exploit the baseline sample of the Peruvian non-contributory pension program Pension 65 and find that current nutritional status and literacy are strongly associated with cognitive functioning for poor older adults. In a context of rising popularity of non-contributory pension programs around the world, our study intends to contribute to the discussion of designing accompanying measures to the pension transfer, such as adult literacy programs and monitoring of adequate nutrition of older adults.

Although cohort and country differences in average cognitive levels are well established, identifying the degree and determinants of inequalities in old age cognitive functioning could guide public health and policymaking efforts. We use all publicly available and representative old age surveys with comparable information to assess inequalities of cognitive functioning in six distinctive age groups of 29 countries. We document that cognitive inequalities in old age are largely determined by earlier educational inequalities as well as gender differential survival rates. For example, a one percentage point increase in the Gini index of past education is associated with an increase of 0.45 percentage points in the Gini index of delayed recall and 0.23 percentage points in the Gini of immediate recall. Results are robust to a variety of alternative explanations and persist even after controlling for gender-related biases in survival rates. Furthermore, we find evidence that unequal opportunities for education -captured by differences in parental background and gender- also have significant effects on inequality of old age cognition.

Former global inequality models lack realistic features of the population (age, gender, education, behavior). Worldsim develops a panel sample based simulation of the world population until 2050, relying on UN, Cepii, etc, big data aggregated forecasts, that we individually disaggregate. The simulation confirms the decline of the world's Gini index, but underlines several paradoxes in the socioecodemography of the world, with increasing gaps between resources and needs. Compared to more standard socioeconomic simulations of inequalities, we provide more substantial characterization of the population, and compared to other global simulations, we capture the dimensions of social divergences between social groups and geographic regions.

Background. Mortality-by-cause analyses as done in the Global Burden of Disease 2016 update are helpful to monitor progress of public health improvements within and across countries. However, separate analyses by cause and country miss larger patterns of public health crises that are restricted to certain cohorts and periods. Those public health crises may go unnoticed even if they affect several countries and thus come with some threat potential. We propose a new method to detect cohorts with increased mortality at certain ages and periods. Method. We develop an analytical and visualizing technique based on established Age-Period-Cohort-Detrended (APCD) methodology (Chauvel and Schröder 2014). After detecting all-cause mortality increases, plotting the resulting age-period coefficients and APCD residuals in equilateral Lexis diagrams, mortality patterns can be distinguished as age, period, or cohort trends and fluctuations. Age-period interactions are plotted as ‘big red spots’. We employ the new technique in data from the Human Mortality Database, spanning 25-60 years of age, calendar years 1975-2010, and 25 countries. Results. We detect age-period interactions of young-adult cohorts in the early 1990s in Spain, other southern European countries and the U.S. Additional analyses with WHO mortality data show that mortality increases are mostly due to increased HIV/AIDS mortality. Discussion. Country-specific explanations, such as political frustrations in Spain, have been proposed to explain the 1990s increases in HIV/AIDS mortality. However, the new technique suggests that increases in HIV/AIDS mortality were more likely to be due to specific behaviors of cohorts of certain ages in a certain period. We discuss limitations of the method, such as detecting social class mortality differences of affected cohorts. Altogether, the new technique offers intuitive and efficient handling of large amounts of age-country-year mortality information. The method can further be ap

In the sub-Saharan African countries, a large number of young adults enters the labour market each year. Scarcity of regular employment opportunities and the wish to become an entrepreneur lead many young people to start their own business. However, young people are often not able to become regular microloan customers due to both higher risks associated with young age and lack of experience with managing finances. If microfinance products should become accessible to young people, the loans need to be accompanied by non-financial services, i.e., financial advice and mentoring. In order to advance local economies and community health, we see two distinct problems around microfinance products for young adults. First, microfinance products combined with non-financial services are not sustainable, i.e. additional external funds are needed that render these microloan products unprofitable in the long run. Second, if improvements in community water, development, and health are envisaged, then new microfinance products need to be designed to serve the purpose of supporting the SDG goals of clean water and sanitation for all. We used an existing initiative of microfinance for young entrepreneurs and applied the social innovation lab methodology to gather experts in relevant fields. The SDG lab, co-sponsored by Future Earth and Appui au Développement Autonome Microfinance Luxembourg and hosted by the University of Luxembourg, first addressed the problem of sustainability of microfinance products for young entrepreneurs. Second, the SDG lab defined actors, processes, and goals to design microfinance products for young people to support the SDG goals of clean water and sanitation for all.

PurposeWe sought to examine how different activities performed during employment gaps are associated with later cognitive function and change.MethodsFive cognitive measures were used to indicate cognitive impairment of 18,259 respondents to the Survey of Health, Ageing, and Retirement in Europe (ages 50-73) in 2004/5 or 2006/7. Using complete employment histories, employment gaps of ≥6 months between ages 25 and 65 were identified.ResultsControlling for early life socioeconomic status, school performance, and education, higher risk of cognitive impairment was associated with employment gaps described as unemployment (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.04-1.35) and sickness (OR, 1.78; 95% CI, 1.52-2.09). In contrast, lower risk of cognitive impairment was associated with employment gaps described as training (OR, 0.73; 95% CI, 0.52-1.01) or maternity leave (OR, 0.65; 95% CI, 0.57-0.79). In longitudinal mixed effects models, training and maternity leave were associated with lower 2-year aging-related cognitive decline.DiscussionPeriods away from work described as unemployment or sickness are associated with lower cognitive function, whereas maternity and training leaves are associated with better late-life cognitive function. Both causation and selection mechanisms may explain these findings.

In times of wide availability of yearly mortality information of age and period groups all over the world, we lack in tools that detect and graph fine-grained deviations from mortality trends. We provide a new age-period-cohort based methodology, combining information from age-period (AP) and APC-Detrended (APCD) analyses to detect all-cause mortality increases. Plotting the resulting AP coefficients and APCD residuals in equilateral Lexis diagrams, mortality patterns can easily be distinguished as age, period, or cohort trends and fluctuations. Additionally, we detect abnormalities as interactions of age and period (‘big red spots’). We then investigate the ‘red spots’ of mortality of young-adult cohorts in the early 1990s in Spain, other southern European countries and the U.S. to delineate their simultaneously occurring public health crises. Additional analyses with WHO mortality data show that mortality increases are mostly due to increased HIV/AIDS mortality. We discuss possible applications of the new method.

Objective: Workers approaching retirement may be particularly vulnerable to economic downturns. This study assesses whether exposure to economic downturns around retirement age leads to poorer cognitive function in later life. Method: Longitudinal data for 13,577 individuals in the Health and Retirement Study were linked to unemployment rates in state of residence. Random- and fixed-effect models were used to examine whether downturns at 55–64 years of age were associated with cognitive functioning levels and decline at ≥65 years, measured by the Wechsler Adult Intelligence Scale-Revised. Results: Longer exposure to downturns at 55–64 years of age was associated with lower levels of cognitive function at ≥65 years. Compared to individuals experiencing only up to 1 year in a downturn at 55–64 years of age, individuals experiencing two downturns at these ages had 0.09 point (95% Confidence Interval [CI, −0.17, −0.02]) lower cognitive functioning scores at ≥65 years (3 years: b = −0.17, 95%CI [−0.29, −0.06]; 4 years: b = −0.14, 95%CI [−0.25, −0.02]; ≥5 years: b = −0.22, 95%CI [−0.38, −0.06]). Downturns at 55–64 years of age were not associated with rates of cognitive decline. Discussion: Exposure to downturns around retirement is associated with a long-lasting decline in cognitive function in later life. Policies mitigating the impact of downturns on older workers may help to maintain cognitive function in later life.

This paper examines the extent to which well-being levels change in the transition to retirement depending on transitioning from being employed, unemployed, or economically inactive. Whereas transitioning from employment to unemployment has been found to cause a decrease of subjective well-being with more time spent in unemployment, it is not clear how transitioning from unemployment to retirement affects well-being levels. We use the Survey of Health, Ageing and Retirement in Europe to monitor life satisfaction of respondents who retire in between two waves. We portray well-being scores before and after retirement and then identify the change in life satisfaction during the retirement transition using a First Difference model. Results indicate that being unemployed before retirement is associated with an increase in life satisfaction, but presents mainly a catching-up effect compared to employed persons transitioning to retirement. Retirement from labour market inactivity does not lead to significant changes in well-being. Findings are robust to selection into unemployment and country differences. As well-being of unemployed persons recovers after transitioning to retirement, especially the currently unemployed population should be supported to prevent detrimental consequences of economically unfavourable conditions and lower well-being.

Social inequalities in dementia can be found in diagnosis, cure, care, and research. Less advantaged groups are women, persons with ethnic minority status, lower income, lower education, and living in more deprived or rural areas. These social inequalities suggest that funding of research and medical and care expenses related to dementia may not be equitably allocated to those in need, even in the most advanced countries. Experience from the field of heart disease gives an estimate on the timescale and efforts it takes to successfully address social inequalities related to gender. Strong concerted efforts will be needed to mitigate social inequalities in dementia.

We use CDC microdata on cause of death and CPS data on populations by age to create suicide rates for five-year age groups at five-year intervals, further cross-classified by race/ethnicity, education, and marital status. We examine the suicide history 1990-2010 of U.S. birth cohorts, net of age and cohort linear trends. These de-trended cohort deviations follow familiar patterns: most pronounced in the Baby Boom, least pronounced during the Baby Bust, they illustrate the so-called Easterlin effect. Suicide rates for women show similar patterns as suicide patterns for men. We show persistence of those effects net of micro factors (especially education and marriage) implicated in suicide behavior and correlated at the macro level with relative cohort size. Analysis of suicide patterns over time for high- and low-educated men and women shows that white men with low education face a sharp increase, significantly above the linear time trends, in suicide rates among cohorts born between 1955 and 1970. This bump is mostly unrelated to secular trends of increasing average educational attainment rates, at least if no interaction between age and cohort is involved in the explanation. No obvious pattern related to cohort size is found for African-American high- and low-educated men, which makes sense given the very different historical dynamics for this minority sub-population.

Birth cohort effects in suicide rates are well established, but to date there is no methodological approach or framework to test the temporal stability of these effects. We use the APC-Detrended (APCD) model to robustly estimate intensity of cohort effects identifying non-linear trends (or ‘detrended’ fluctuations) in suicide rates. The new APC-Hysteresis (APCH) model tests temporal stability of cohort effects. Analysing suicide rates in 25 WHO countries (periods 1970–74 to 2005–09; ages 20–24 to 70–79) with the APCD method, we find that country-specific birth cohort membership plays an important role in suicide rates. Among 25 countries, we detect 12 nations that show deep contrasts among cohort-specific suicide rates including Italy, Australia and the United States. The APCH method shows that cohort fluctuations are not stable across the life course but decline in Spain, France and Australia, whereas they remain stable in Italy, the United Kingdom and the Netherlands. We discuss the Spanish case with elevated suicide mortality of cohorts born 1965-1975 which declines with age, and the opposite case of the United States, where the identified cohort effects of those born around 1960 increase smoothly, but statistically significant across the life course.