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Ensuring distributive fairness in the long-term care sector is vitally important in the context of global population ageing and rising care needs. This study, part of the DETERMIND (DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers) programme, investigates socioeconomic inequality and inequity in the utilisation of long-term care for older people with and without dementia in England. The data come from three waves of the English Longitudinal Study of Ageing (ELSA, Waves 6–8, N = 16,458). We find that older people with dementia have higher levels of care needs and a lower socioeconomic status than those without dementia. The distribution of formal and informal care is strongly pro-poor. When care needs are controlled for, there is no significant inequality of formal or informal care among people with dementia, nor of informal care among people without dementia, but there is a significant pro-rich distribution of formal care among people without dementia. Unmet care needs are significantly concentrated among poorer people, both with and without dementia. We argue that the long-term care system in England plays a constructive role in promoting socioeconomic equality of long-term care for people with dementia, but support for older people with lower financial means and substantial care needs remains insufficient. Increased government support for older people is needed to break the circle between care inequality and health inequality.

Purpose To identify the changes of school burnout for Finnish adolescents in lower (grades 8–9) and upper secondary schools (grades 10–11) during years 2006–2019; and to examine the associations of personal—(gender, family socioeconomic, and immigrant status) and school-related (school level, urban–rural area) sociodemographic demands and resources in school burnout. Methods We used nationally representative data on 949,347 students in secondary school in Finland between 2006 and 2019. Generalized Linear Models were used to assess the effects of year, gender, school level, parental education, unemployment, immigrant status, and urban–rural area and the interactions of year, gender, and school level with each of the remaining sociodemographic variables on school burnout. Results School burnout increased among girls and slightly declined among boys. The increase intensified in girls and the decline in boys stagnated after 2011. The educational level of the parents had a constant protective impact over time, the gradient for boys slightly larger compared to girls. Urban areas contributed to the trend of increasing school burnout among girls but not among boys. Parental unemployment and immigration background were associated with the increasing trend of school burnout over time, although somewhat mitigated by parental education. Conclusion The results showed the trends in school burnout are often gendered and appeared to worsen aligned with the school budget cuts after 2011. In addition to considering school burnout related to lower parental education and urbanization, it is important to support those students in families experiencing unemployment and/or immigration, especially when concurring with lower parental education.

Objectives: We investigated whether people with dementia or low memory/orientation reported more help misaligned with needs–more unmet need and/or more unrequired help–than other people with similar levels of functional limitation, and examined associations with quality of life. Methods: From pooled English Longitudinal Study of Ageing data from waves 6, 7, and 8, we identified community-dwelling people aged 50+ with: dementia (n= 405); low memory/orientation but no dementia (n= 4520); and intact memory/orientation (n= 10,264). Unmet need (not receiving help for the functional limitation) and unrequired help (receipt of help without the respective functional limitation) were used as outcomes in two-part regressions. Quality of life (CASP-19) was used as a continuous outcome in a linear regression. Functional limitation and its interaction with cognitive status and socio-demographic factors were included in the models. Results: Those with dementia or low memory/orientation but few functional limitations reported more unmet needs and unrequired help than their counterparts with intact memory/orientation. At high levels of limitations, the needs of those with dementia or lower memory/orientation were met more often and the receipt of unrequired help was similar compared to those with intact memory/orientation. Unmet need and unrequired help were associated with poorer quality of life. Conclusions: Unmet need and unrequired help were particular challenges for those with poorer cognition and potentially at early stages of dementia; they were associated with lower quality of life. Our results highlight the importance of good-quality timely diagnosis, identification of needs, and person-centred assessment to help improve quality of life.

Background: Understanding the changes of unmet need in dementia may enable effective targeting of help and allow people to stay in their homes longer. Objective: We investigated changes in unmet need and functioning over a 4-year period and the role of socio-demographic factors in these changes among people with dementia. Methods: 234 community-dwelling people with dementia at baseline were studied in three consecutive waves (four years) of the English Longitudinal Study of Ageing (ELSA). Unmet needs (self/informant-reported limitations for which no help was received) and functional limitations (self/informant-reported difficulties in activities/instrumental activities of daily living and mobility) were modelled with latent growth curves. Sex, age, partnership, and socioeconomic status at baseline were used as predictors. Admission to a care home was an additional outcome. Results: Unmet needs increased over time, especially among those who initially had more functional limitations. Unmet needs contributed to faster decline in functional capability, except among those with many limitations initially. The major driver of increased unmet needs was not having a partner (direct effect). Age, sex, and wealth contributed indirectly via the initial level of functional limitations and/or unmet need. Those with several functional limitations but few unmet needs were most likely to move to a care home. Conclusion: Unmet need increases over time in those with dementia with mitigating effects of having a partner and initial levels of functioning. Meeting needs at early stages of dementia, especially for those living alone and when functional limitations are low may help slow functional decline.

While debate on how best to pay for social care in England continues, information about public attitudes on this issue is limited. We asked representative samples of the public whether care costs for older people should be met by the state, met by the service user or shared between state and user. We used an online survey of people aged 18–75 (n = 3,000) and interview survey of people aged 65 and over (n = 466). Respondents were given four vignettes (two home care, two residential care) and asked who should pay at different levels of user resources; and how much users should contribute when costs were shared. Fewer than one-fifth of the online sample and one-quarter of the interview sample considered that the state should meet the full costs whatever users’ resources; considerably lower proportions believed that users should meet the full costs in all cases. Two-thirds of the online sample and half the interview sample thought costs should be shared. The proportion of costs that users should contribute was relatively low (20–50 per cent, varying by user resources). The study illustrates that public views elicited through vignettes can provide evidence to inform policy on social care funding.

Objectives: DETERMIND (DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers) is designed to address fundamental, and, as yet unanswered, questions about inequalities, outcomes and costs following diagnosis with dementia. These answers are needed to improve the quality of care and equity of access to care, and therefore the quality of life, of people with dementia and their carers.\ud \ud Method: DETERMIND is a programme of research consisting of seven complementary workstreams (WS) exploring various components that may result in unequal dementia care:\ud WS1: Recruitment and follow-up of the DETERMIND cohort - 900 people with dementia and their carers from three geographically and socially diverse sites within six months following diagnosis, and follow them up for three years.\ud WS2: Investigation of the extent of inequalities in access to dementia care\ud WS3: Relationship between use and costs of services and outcomes \ud WS4: Experiences of self-funders of care \ud WS5: Decision-making processes for people with dementia and carers\ud WS6: Effect of diagnostic stage and services on outcomes \ud WS7: Theory of Change informed strategy and actions for applying the research findings\ud \ud Outcomes: During the life of the programme, analysing baseline results and then follow-up of the DETERMIND cohort over 3 years, we will establish evidence on current services and practice. DETERMIND will deliver novel, detailed data on inequalities in dementia care and what drives positive and negative outcomes and costs for people with dementia and carers, and identify factors that help or hinder living well with dementia.

Objectives To investigate associations between level and changes in social isolation and in memory in older men and women. Methods The sample included 6,123 women and 5,110 men aged 50+ from the English Longitudinal Study of Aging (ELSA). Extended latent change score models from six measurement occasions every 2 years from 2002 were used to investigate associations between social isolation and memory. Models were adjusted for age, socioeconomic position, and health. Results Social isolation increased and memory decreased over time. Among men an initially high level of social isolation was associated with a somewhat greater decrease in memory. Among women a greater increase in social isolation predicted a greater decrease in memory and a larger change in social isolation was associated with further larger changes in isolation, although when social isolation reached a higher level it subsequently decreased. Conclusions Results suggest that the association between social isolation and memory decline arises because social isolation is associated with increased memory decline rather than poor memory leading to increases in social isolation. Men with high levels of social isolation and women with accumulated social isolation over time are especially affected as these patterns of isolation were associated with more profound memory decline.

The aim of this longitudinal study among 9223 students from grade 7 and grade 9 (age 13–14 and 15–16) was to assess whether immigrant status and gender are associated with the level and change (slope) in school burnout among lower secondary school students in the Helsinki metropolitan area. Ninety-seven percent of the variation in school burnout was attributable to individual factors. Both the intercept (2.3, p < 0.001) and slope (0.5, p < 0.001) of school burnout were statistically significant. The slope showed increasing school burnout from grades 7–9. School burnout increased more in girls than in boys. Initially apparent higher school burnout among students who had immigrated to Finland within the last five years compared to Finnish native students was largely accounted for by sociodemographic and school-related factors. However, there was a persistent gender by immigrant status difference in the fully adjusted model: recently (< 5 years ago) immigrated boys experienced a larger increase in school burnout, especially due to increased cynicism, than recently immigrated girls.

A person-oriented approach was applied to identify profiles of study engagement and burnout (i.e., exhaustion, cynicism, inadequacy) in higher education in a large and representative sample of 12,394 higher education students at different phases of their studies in universities and polytechnics in Finland. Four profiles were identified: Engaged (44%), engaged-exhausted (30%) inefficacious (19%) and burned-out (7%). The engaged students had the most positive engagement accompanied with the least burnout symptoms compared to other groups. The engaged-exhausted students experienced emotional exhaustion simultaneously with academic engagement. The inefficacious group had heightened experience of inadequacy as a student. The burned-out students showed very high cynicism and inadequacy and very low academic engagement compared to the other groups. Of these groups, the engaged students tended to be in the earlier stages in their studies, whereas the burned-out and inefficacious students had been studying the longest. The pattern suggests that students starting out with high engagement and that burnout becomes more common later in the academic career. Supporting demands-resources model, the covariates reflecting the demands were higher and those reflecting resources were lower among the burned-out and inefficacious students compared to the engaged students.

We examine pathways between indicators of fertility tempo/quantum and depressive symptoms among parents aged 55+ with at least two children, using three waves of the English Longitudinal Study of Ageing. Using standard regression approaches and path analysis within the structural equation framework, we also investigate whether fertility trajectories mediated the association between childhood disadvantage and later-life depression. Results provide limited support for direct influences of fertility trajectories on depression, but indicate indirect linkages for both women and men. Associations are mediated by partnership history, social support, wealth, later-life smoking, and functional limitation. Associations between childhood disadvantage and later-life depression are partially mediated by fertility stressors. Results confirm the influence of life course experiences on depression at older ages and demonstrate the interlinked role of family and other life course pathways on later-life well-being.

Large family size and early parenthood have been associated with adverse health outcomes in old age whereas there is increasing evidence of the beneficial effects of physical activity. We examined the extent to which physical activity might mediate and/or moderate later life health disadvantages related to a high number of children and early parenthood. We used data from five waves of the English Longitudinal Study of Ageing collected in 2002–2010 (n = 11,233 in wave 1). Latent change score modelling was used to assess the direction of the association between physical activity and functioning. An interaction term of physical activity and fertility history was added in latent growth curves for functional limitation. The models were adjusted for age, gender, smoking, educational attainment, occupational status and wealth in wave 1, with whether married and depressive symptoms included as time-varying covariates. The models suggested that physical activity serves as a mediator in the association between fertility history and the level of later life functioning. However, there was no effect of fertility history on changes in physical activity or functional limitation. Among those who were physically active, functional limitations remained at a considerably lower level and high number of children and early parenthood were not associated with poorer levels of health. Physical activity thus moderates the level of health disadvantages related to high number of children and parenthood.

There is ongoing debate about how the funding system for social care of older people in England should best be reformed. We investigated how public attitudes to individual and state responsibility for paying for social care in later life vary with demographic and socio-economic characteristics. Four vignettes of individuals in need of home care or residential care with varying levels of savings, income and housing wealth were presented to a sample of people aged 18–75 years (n = 3000) in December 2018. Respondents were asked if care costs should be paid by the user, the state or shared. They were also asked about the best way to pay for social care in old age. Latent class analysis was used to identify sub-groups with similar preferences for paying for care, and to explore their socio-demographic characteristics. We identified five classes. The majority (Class 1, 58%) preferred that the state and the user should share social care costs. Class 2 (18%) thought that the state should pay all costs regardless of users' savings, income or housing wealth. Class 3 (15%) preferred users to pay all costs at all levels of savings, income and housing wealth, with the exception of those unable to afford the costs. Classes 4 and 5 (5% each) were characterised by different patterns of ‘don't know’ answers. Socio-economic status was higher among those proposing higher user contributions (Class 3) and lower among those with several ‘don't’ know’ responses (Classes 4 and 5). Concerns about care costs in old age were high among those proposing that the state pays all costs (Class 2) and those preferring that users pay all costs (Class 3). This study shows that public views on social care funding vary with respondents' characteristics and that proposals to reform the system need to be carefully calibrated.

Objectives To investigate the association between fertility history and cognition in older men and women. Method We analyzed associations between number of children (parity) and timing of births with level and change in cognition among 11,233 men and women aged 50+ in England using latent growth curve models. Models were adjusted for age, socioeconomic position, health, depressive symptoms, control, social contacts, activities, and isolation. Results Low (0–1 child) and high parity (3+ children) compared to medium parity (2 children) were associated with poorer cognitive functioning, as was an early age at entry to parenthood (35) was associated with better cognitive function. Conclusion Associations between fertility history and cognition were to large extent accounted for socioeconomic position, partly because this influenced health and social engagement. Poorer cognition in childless people and better cognition among mothers experiencing child birth at higher ages suggest factors related to childbearing/rearing that are beneficial for later cognitive functioning, although further research into possible earlier selection factors is needed.

In social science, we typically work with measures that are laden with errors. Theories are generally couched in terms of constructs or phenomena that are unobserved or unobservable but nevertheless have empirical implications. It is these unobservable indicators that we actually analyze. Hence, an important preliminary task for an analyst is to specify the assumed relationship of observable indicators to the underlying phenomenon that is to be measured. Better still, one can test hypotheses about these relations. The focus of this volume is on cross-cultural methods; this brings with it further complexities for deriving adequate social measurement in that we cannot expect to necessarily see the same empirical patterns of observations across cultures (for instance, on a set of related questionnaire items measuring a single attitude) even where the underlying phenomenon is in fact the same. Absent some resolution of this problem, comparisons of the true differences in, say, attitudes or beliefs across cultures are problematic because of the conflation of such differences as may exist with differences in the ways in which the observable indictors “behave” across the very same cultural boundaries.

Background: Previous research shows associations between fertility histories and later life health. The childless, those with large families, and those with a young age at entry to parenthood generally have higher mortality and worse health than parents of two or three children. These associations are hypothesised to reflect a range of biosocial influences, but underlying mechanisms are poorly understood. Objective: To identify pathways from fertility histories to later life health by examining mediation through health-related behaviours, social support and strain, and wealth. Additionally to examine mediation through allostatic load - an indicator of multisystem physical dysregulation, hypothesised to be an outcome of chronic stress. Methods: Associations between fertility histories, mediators, and outcomes were analysed using path models. Data were drawn from the English Longitudinal Study of Ageing. Outcomes studied were a measure of allostatic load based on 9 biomarkers and self-reported long-term illness which limited activities. Results: Early parenthood (Conclusions: In England early parenthood and larger family size are associated with less wealth and poorer health behaviours and this accounts for much of the association with health. At least part of this operates through stress-related physiological dysfunction (allostatic load).

Background Little is known about the psychological status of partners of women with severe fear of childbirth (FOC). In this longitudinal study from Helsinki University Central Hospital, we investigated FOC, depression, and posttraumatic stress in the partners of women with severe FOC, and possible effects of group psychoeducation and mode of birth.Methods: During pregnancy, 250 partners of nulliparous women with severe FOC participated, 93 in the intervention group and 157 in the control group. At 3 months postpartum, 52 partners in the intervention group and 93 in the control group participated. Both the partners and the childbearing women filled in the Wijma Delivery Expectancy/Experience Questionnaire and the Edinburgh Postnatal Depression Scale mid‐pregnancy as well as 3 months postpartum, when they also filled in the Traumatic Event Scale. Results Partners of women with severe FOC reported less antenatal and postnatal FOC and fewer depressive symptoms than the childbearing women. No partner reached the threshold of severe FOC. No partner reported a possible posttraumatic stress disorder. Group psychoeducation with relaxation was not associated with better or worse psychological well‐being of the partners. An emergency cesarean delivery was associated with a more fearful delivery experience in the partners. Conclusion Partners of nulliparous women with severe FOC neither seem to suffer from severe FOC nor reported posttraumatic stress symptoms after childbirth. They reported better psychological well‐being than the mothers both during pregnancy and after delivery. An unexpected cesarean may be a negative experience even for partners of childbearing women. peerReviewed

Objectives: Gerotranscendence has been defined as a developmental shift in meta-perspective from a materialistic and pragmatic view to a more cosmic and transcendent view. Although gerotranscendence has been argued to increase with age and life experiences, the results have been mixed and based on cross-sectional studies. We use a longitudinal setting to investigate the role of negative life events, age, and gender on change in one dimension of gerotranscendence, cosmic transcendence. Method: 1569 individuals (ages 58-89) answered a questionnaire on cosmic transcendence in two cycles of the Longitudinal Aging Study Amsterdam in 1995-1996 (time 1) and 1998-1999 (time 2). Controlling for education, marital status, religious affiliation, chronic diseases, functional limitations, depressive symptoms, and social support, change models based on structural equation modeling were fitted to the data to test whether negative life events, age, and gender were associated with change in cosmic transcendence. Results: A higher number of negative life events, especially negative life events other than deaths of others, were associated with increased cosmic transcendence, whereas experiencing no negative life events was associated with decreased cosmic transcendence. The level of cosmic dimension was higher at older than younger ages. Cosmic transcendence decreased over time among the older participants and women, whereas it increased among the younger participants and men. Conclusion: Experiencing negative life events has the potential to promote the development of cosmic transcendence, even when controlling for age and gender. In the absence of negative life events, however, cosmic transcendence was observed to decline with aging. © 2013 Taylor & Francis.

Social engagement has powerful effects on wellbeing, but variation in individual engagement throughout the lifecourse is wide. The trajectories may differ by gender and be affected by socio-economic status (SES). However, long-term development of social engagement is little studied and the effect of childhood SES on later-life social engagement remains obscure. We aimed to describe the social engagement development from childhood to middle age by gender and test the effect of childhood SES on middle age social engagement. Data (N=16,440, 51.3% male) are drawn from the on-going National Child Development Study, following British babies born in 1958. Social engagement was measured by social activities, voluntary work and social contacts, with follow-ups at age 11, 16, 23 and 50. SES was measured by father's occupational social class and tenure status. Structural equation modelling suggested inter-individual stability in social engagement, showing that development of social engagement started in childhood and increased social engagement in middle age through adolescence and early adulthood. Longitudinal effects were detected within and across the social engagement domains. Lower childhood SES was significantly related to a lower level of voluntary work and social activity in middle age, but to higher levels of social contacts. Although stability in social engagement is moderate over the lifecourse, variation within and across the different social engagement domains is shaped by differences in childhood SES.

Objectives. To investigate whether number of children and, among parents, having a daughter is associated with older people’s likelihood of at least weekly face-to-face social contact and later receipt of help if needed. Method. Multivariate analysis of data from Waves 1 and 2 of the English Longitudinal Study of Ageing (ELSA). Results. Older parents in England had higher chances of at least weekly face-to-face social contact than their childless counterparts but larger family size had only a slight additional effect. For parents, having at least one daughter was more important than number of children. Larger family size was positively associated with receipt of help from a child by parents with activities of daily living (ADL) or instrumental activities of daily living (IADL) limitations. Childless women were more likely than mothers to receive help from friends but even so had lower odds of receiving help from any informal source. Contact with a child in 2002 predicted receipt of help 2 years later. Discussion. These results show some advantages for older parents compared with childless individuals in terms of social contact and receipt of help and, among parents, an additional effect of having a daughter. Changes in family size distributions have implications for the support of older people and for planners of formal services. n the U.K., as in many other populations, there were a number of significant changes in the family-building patterns of cohorts born in the 20th century. These included a trend toward increased concentration on family sizes of two children and a decline in the proportions of women having larger families of four or more children. The proportions never having children showed a U-shaped trend, first falling and then rising, with women born in the mid-century including the lowest proportions remaining childless (Chamberlain & Smallwood, 2004; Murphy, Martikainen, & Pennec, 2006). Reductions in mortality also mean that the propor tions of children surviving to their parents’ later life have increased substantially, although now that survival to midlife is almost universal, the potential impact of future changes in mortality is much lower (Murphy & Grundy, 2003). Many previous studies of the implications of family size for the social support and well-being of older people have focused on comparisons between the childless and those with children. Past and possible future changes in family size distributions suggest that we also need to know about implications of changing numbers of children among those who are parents. Gender of children, particularly the availability of a daughter, is also potentially important and is associated with family size as the larger the family the greater the chance of having at least one daughter. In this article, we use data from the English Longitudinal Study of Ageing (ELSA) to analyze associations between number of living natural children, and in analyses of a subsample of parents, availability of a daughter, with two indicators of social support for older people, frequent face-toface contact and receipt of instrumental help, both of which may be regarded as indicators of intergenerational solidarity (Silverstein & Bengtson, 1997). We also investigate whether social contacts at one time point predict subsequent receipt of instrumental support as suggested in conceptual models, which view social contacts as an indicator of the social network from which social support, including instrumental help, may be drawn (Berkman, Glass, Brissette, & Seeman, 2000). A third important aim of the article is to investigate whether those with no or few children “compensate” through a greater propensity to meet and receive help from friends and relatives other than children.

Objective: To examine the effects of individual and group factors on the changes in child-rearing practices in a parenting program. Method: At risk and non at-risk parents ( N = 496), who varied by sociodemographic factors, participated in 94 groups that differed by size and composition. Latent growth curve modeling was used to examine the impact of individual and group variables on pre–post changes in inductive, coercive, and permissive-neglecting practices. Results: Inductive parenting increased and coercive and permissive-neglecting parenting decreased over the intervention and the proportion of change was influenced by family structure, parents' gender and group composition. Low-risk groups and mixed (at-risk and non at-risk) groups did better than medium/high-risk groups in changing inductive and coercive practices whereas all groups did well in changing permissive-neglecting practices. Conclusion: To test the effectiveness of a group-based intervention requires taking into account both individual and group sources of variation in the implementation process.

To assess genetic and environmental contributions to personal goals, 1279 twins aged 20-26 filled in Personal Project Analysis and NEO-FFI inventories. Personal goals relating to education, the respondent's own family, friends, property, travel and self showed primarily genetic and unique environmental effects, whereas goals related to parents and relatives showed both shared and unique environmental effects. The variation in goals related to health, work, hobbies and life philosophy was attributable to non-shared environmental effects. Openness to experience and personal goals related to family, education and property shared a significant amount of genetic influence. The same was true for extraversion and self-related goals, and agreeableness and goals related to property.

Having self-focused goals is often a risk factor for a higher level of depressive symptoms. The present study investigated whether developmental task-related personal goals could moderate the association between self-focused goals and depressive symptoms in young adulthood. A total of 1,276 Finnish twins aged 21-26 filled out a questionnaire on personal goals. The General Behavior Inventory for depressive symptoms at age 17 and 21-26 was applied. Longitudinal path analyses were carried out. Among those who had a goal related to their own family or life philosophy, self-focused goals were not associated with depressive symptoms, whereas among those who did not express these goals there was a strong association between self-focused goals and higher level of depressive symptoms. Among those who had a goal related to education, the association between self-focused goals and depressive symptoms was weaker compared to those who did not express these goals. These results suggest that goals related to one's own family, life philosophy, and education have the potential to decrease the association between self-focused goals and depressive symptoms.

In this paper we examine associations between the fertility histories of older British women and men and their quality of life using data on a sample of 6,374 men and women born between 1923 and 1949 drawn from the British Household Panel Survey (BHPS). Quality of life in 2001 was measured using scores from the four subscales of the CASP-19 questionnaire: control, autonomy, pleasure and self-realisation. Fertility histories were derived using information on the births of children collected in all waves of the BHPS. The aspects of fertility history investigated were number of children born and parents' ages at birth of first and last child. Age, education, marital status, tenure status, smoking, co-residence with one or more children, perceived social support and health limitations were included as covariates. The results suggested that early entry to parenthood and to some extent high parity were related to poorer quality of life. These associations were mostly mediated by socio-economic, social support and health factors. Compared to women with two children, nulliparous women expressed a higher level of autonomy, and both nulliparous women and those with four or more children a higher level of self-realisation. Low parity was related to a lower level of pleasure, especially among men, but this relationship appeared weaker and among women was not significant when background factors were controlled.

As shared family context may be an important influence on mental health, and gender differences in mental health, in later life we investigated how gender, family-related variables and gender roles were associated with mental health in older married couples.Using data on a sample of 2,511 married couples born between 1923 and 1953 (drawn from the British Household Panel Survey) we analysed differences in the mental health of husbands and wives by fertility history, length of marriage, presence of co-resident children, reported social support, hours of household work, attitudes to gender roles and health of husband and wife. Mental health in 2001 was measured using the General Health Questionnaire (GHQ-12). Multilevel modelling was used to assess effects in husbands and wives and variations between husbands and wives.Results showed that although the mental health of married couples was correlated, wives had poorer mental health than their husbands. The gender difference was smaller in couples who lived with a child aged 16 or more (and had no younger co-resident children) and in couples in which both spouses had experienced early parenthood. The influence of individual and family characteristics on mental health also differed between husbands and wives. For husbands, early fatherhood and co-residence with a child or children aged 16 or more increased the odds of poor mental health. For wives, having had a child when aged 35 or more appeared protective while having traditional gender role attitudes increased the odds of poorer mental health.The role of family characteristics in the shared marital context has complex associations with mental health, some of which seem gender specific. Although wives express more mental distress, husbands in general show poorer mental health related to family characteristics.

Social, or ‘generalized’ trust is often characterised as the ‘attitudinal dimension’ of social capital. It has been posited as key to a host of normatively desirable outcomes at the societal and individual levels. Yet the origins of individual variation in trust remain something of a mystery and continue to be a source of dissensus amongst researchers across and within academic disciplines. In this paper we use data from two British birth cohort studies to test the hypothesis that a propensity to express generalized trust varies systematically as a function of individual intelligence. Intelligence, we argue, fosters greater trust in one's fellow citizens because more intelligent individuals are more accurate in their assessments of the trustworthiness of others. This means that, over the life-course, their trust is less often betrayed and they are able to accrue the benefits of norms of reciprocity. Our results show that standard measures of intelligence administered when cohort members were aged 10 and 11 can explain variability in expressed trust in early middle age, net of a broad range of theoretically related covariates.

A propensity to believe that fellow citizens will not act against our interests in social and economic transactions has been identified as key to the effective functioning of democratic polities. Yet the causes of this type of ‘generalized’ or ‘social’ trust are far from clear. To date, researchers within the social and political sciences have focused almost exclusively on social-developmental and political/institutional features of individuals and societies as the primary causal influences. In this paper we investigate the intriguing possibility that social trust might have a genetic, as well as an environmental basis. We use data collected from samples of monozygotic and dizygotic twins to estimate the additive genetic, shared environmental, and non-shared environmental components of trust. Our results show that the majority of the variance in a multi-item trust scale is accounted for by an additive genetic factor. On the other hand, the environmental influences experienced in common by sibling pairs have no discernable effect; the only environmental influences appear to be those that are unique to the individual. Our findings problematise the widely held view that the development of social trust occurs through a process of familial socialization at an early stage of the life course.

The aim of the present study was to calculate the overall heritability of some routine biochemical analyses. Furthermore, as genetic and environmental influences might differ across various segments, genetic impact in the highest and lowest thirds of the distributions was estimated.Ninety-six monozygotic and 120 dizygotic same-sex twin pairs aged 82 and older were tested. Structural equation modelling was used to estimate the genetic and environmental influences on serum levels of albumin, calcium, total cholesterol, HDL-cholesterol, GGT, potassium, sodium, creatinine, urea, urate, cobalamin, folate, homocysteine, free thyroxine and thyroid stimulating hormone (TSH).Additive genetic influence of between 66% and 28% of the variance was accounted for all values except creatinine, for which the genetic influence was marginal. The highest influence was found for homocysteine, cobalamin, folate and HDL-cholesterol. Genetic influence for the tests was mainly in congruence with previous findings in younger samples. When limited to the highest and lowest thirds of distribution, there were substantial differences in the proportion of genetic influence for some tests.For the majority of biochemical tests, the magnitude of genetic influence is considerable. Heritability estimates, however, should be considered in a broad context, with age, gender, morbidity and medication taken into account. Notably, for many test values, the genetic impact may differ considerably between the highest and the lowest range of the distribution.

This study examined genetic and environmental influences on older women’s personal goals by using data from the Finnish Twin Study on Aging. The interview for the personal goals was completed by 67 monozygotic (MZ) pairs and 75 dizygotic (DZ) pairs. The tetrachoric correlations for personal goals related to health and functioning, close relationships, and independent living were higher in MZ than DZ twins, indicating possible genetic influence. The pattern of tetrachoric correlations for personal goals related to cultural activities, care of others, and physical exercise indicated environmental influence. For goals concerning health and functioning, independent living, and close relationships, additive genetic effect accounted for about half of the individual variation. The rest was the result of a unique environmental effect. Goals concerning physical exercise and care of others showed moderate common environmental effect, while the rest of the variance was the result of a unique environmental effect. Personal goals concerning cultural activities showed unique environmental effects only.

Background and aims: The primary aim of the present study was to examine whether there is an association between blood pressure and the risk of subsequent cognitive decline in the oldest old. Various factors associated with blood pressure and cognitive function were considered. Methods: The study comprised 599 individuals of a population-based sample, 199 men (mean age at baseline 82.8 years, range 80-95) and 400 women (mean age at baseline 83.3 years, range 80-100). Cognitive function was evaluated by the Mini Mental State Examination (MMSE). For a subgroup of 385 subjects (130 men, 255 women), data were available on blood pressure and MMSE at baseline and two follow-ups at two-year intervals. Baseline blood pressure was studied in one group with reduced cognition and in another group with intact cognition across the following four years. The association of systolic blood pressure (SBP) with the MMSE score through the follow-up period was analysed controlling for frailty (time to death), age, gender, apoprotein E, homocysteine, hypertension, congestive heart failure, and stroke. Results: A medical history of arterial hypertension was associated with lower MMSE scores and a higher prevalence of dementia and cognitive decline at baseline. However, intact cognition through the observation period was associated with higher baseline SBP. This relationship also remained when the frailty of aging subjects, indicated by remaining time to death, was taken into account. Conclusions: Lower SBP in the oldest old is associated with an increased risk of cognitive impairment even after adjustment for compromised vitality. In late life, the risk of cognitive decline needs to be considered in clinical practice.

Having self-focused goals is often a risk factor for a higher level of depressive symptoms. The present study investigated whether developmental task-related personal goals could moderate the association between self-focused goals and depressive symptoms in young adulthood. A total of 1,276 Finnish twins aged 21-26 filled out a questionnaire on personal goals. The General Behavior Inventory for depressive symptoms at age 17 and 21-26 was applied. Longitudinal path analyses were carried out. Among those who had a goal related to their own family or life philosophy, self-focused goals were not associated with depressive symptoms, whereas among those who did not express these goals there was a strong association between self-focused goals and higher level of depressive symptoms. Among those who had a goal related to education, the association between self-focused goals and depressive symptoms was weaker compared to those who did not express these goals. These results suggest that goals related to one's own family, life philosophy, and education have the potential to decrease the association between self-focused goals and depressive symptoms.

Objectives: Previous studies of older European populations have established that disability and morbidity vary with indicators of socio-economic position (SEP). We undertook a systematic narrative review of the literature to ascertain to what extent there is evidence of similar inequalities in the subjective health and well-being of older people in Europe. Method: Relevant original research articles were searched for using Medline, Global Health, Embase, Social Policy and Practice, Cinahl, Web of Science and International Bibliography of the Social Sciences (IBSS). We included studies of SEP and indicators of subjective health and well-being (self-rated health; life satisfaction; quality of life) conducted since 1991 using population-based samples of older people in Europe and published 1995–2013. Results: A total of 71 studies were identified. Poorer SEP was associated with poorer subjective health and well-being. Associations varied somewhat depending on the SEP measure and subjective health and well-being outcome used. Associations were weaker when social support and health-related behaviours were adjusted for suggesting that these factors mediate the relationship between SEP and subjective health and well-being. Associations tended to be weaker in the oldest age groups. The patterns of associations by gender were not consistent and tended to diminish after adjusting for indicators of health and life circumstances. Conclusion: The results of this systematic narrative review of the literature demonstrate the importance of social influences on later life subjective health and well-being and indicate areas which need further investigation, such as more studies from Eastern Europe, more longitudinal studies and more research on the role of mediating factors.

Stability and change in the mean levels and sources of variation in personality was examined. A sample of 149 monozygotic and 202 dizygotic twin pairs over 80 years were studied three times with a 2-year interval between measurement occasions. The Eysenck Personality Inventory to measure extraversion and neuroticism was used. Linear mixed models and Cholesky variance decomposition were carried out (age, gender and mortality controlled). High mean level stability was found in extraversion and neuroticism. Mortality was related to lower scores in extraversion and higher scores in neuroticism. In extraversion and neuroticism, genetic effects were moderate. Though no new genetic contributions emerged over time, significant new environmental effects were found over time. Controlling for mortality slightly increased genetic effect in extraversion.

We investigated sex differences in genetic and environmental effects on cognitive abilities among older adult twins. We drew participants from the Swedish Twin Registry; our sample included 647 twin pairs. Our cognitive measures included Synonyms, Block Design, Digit Span, Thurstone's Picture Memory, Symbol Digit, and general cognitive ability tests. Higher age was related to lower performance in all cognitive measures, except synonyms. For digit span forward, symbol digit, and general cognitive ability tasks, there was a Sex x Age interaction, with greater deficits in the performance of women compared with those of men at higher ages. We found no sex-specific genetic influences. In other words, the same genetic effects were operating for men and women. Furthermore, the magnitude of genetic effect was similar for men and women.

Abstract. The present study investigated the appropriateness of Antonovsky's model, in which generalized resistance resources (GRRs) facilitate an individual's sense of coherence (SOC); which in turn is assumed to sustain health. The proposed model was tested using a sample of 320 Finnish persons (132 of them were men and 188 women) aged 65-69 years. The GRRs investigated were family income, cognitive functioning, years of formal education, marital status, and physical exercise. Health was measured by means of a multidimensional indicator composed of physical, social and mental health. Structural Equation Modelling (SEM) within the framework of LISREL models were used to test the hypothesized model. The results showed that good cognitive functioning and physical activity in the whole sample, and marital status in men, were associated with a strong SOC, which in turn was positively related to physical, and especially, social and mental health.

Supplemental digital content is available in the text., Objective Allostatic load, a composite measure of accumulated physical wear and tear, has been proposed as an early sign of physiological dysregulation predictive of health problems, functional limitation, and disability. However, much previous research has been cross sectional and few studies consider repeated measures. We investigate the directionality of associations between allostatic load, self-rated health, and a measure of physical function (walking speed). Methods The sample included men and women 60 and older who participated in Wave 2 (2004) and Wave 4 (2008) of the English Longitudinal Study of Ageing (n = 6132 in Wave 2). Allostatic load was measured with nine biomarkers using a multisystem summary approach. Self-rated health was measured using a global 5 point summary indicator. Time to walk 8 ft was used as a measure of function. We fitted and tested autoregressive cross-lagged models between the allostatic load measure, self-rated health, and walking speed in Waves 2 and 4. Models were adjusted for age, sex, educational level, and smoking status at Wave 2 and for time-varying indicators of marital status, wealth, physical activity, and social support. Results Allostatic load predicted slower walking speed (standardized estimate = −0.08, 95% confidence interval [CI] = −0.10 to −0.05). Better self-rated health predicted faster walking speed (standardized estimate = 0.11, 95% CI = 0.08-0.13) as well as lower allostatic load (standardized estimate = −0.15, 95% CI = −0.22 to −0.09), whereas paths from allostatic load and walking speed to self-rated health were weaker (standardized estimates = −0.05 [95% CI = −0.07 to −0.02] and 0.06 [95% CI = 0.04–0.08]). Conclusions Allostatic load can be a useful risk indicator of subsequent poor health or function.

In order to further understand why depressive symptoms are associated with negative goal appraisals, the present study examined the genetic and environmental correlations and interactions between depressive symptoms and career-related goal appraisals. A total of 1,240 Finnish twins aged 21–26 years completed a questionnaire containing items on the appraisal of their career goals along five dimensions: importance, progress, effort, strain, and self-efficacy. In the same questionnaire, the 10-item General Behavior Inven- tory assessed depressive symptoms. Structural equation modeling was used to evaluate the genetic and environmental correlations and gene–environment interactions between the career-goal appraisals and depressive symptoms. Associations were identified, and were attributed to environmental factors. Of the career-related goal appraisals, the shared environmental component was of a higher magnitude for the dimension of strain among the depressed compared with non-depressed subjects. The results indicate that the interplay between depressive symptoms and negative career-related goal appraisals is significantly affected by environmental factors, and thus possibly susceptible to targeted interventions. peerReviewed

Objectives. Several theoretical viewpoints suggest that older adults need to modify their personal goals in the face of functional decline. The aim of this study was to investigate longitudinally the association of mobility limitation with changes in personal goals among older women. Method. Eight-year follow-up of 205 women aged 66–78 years at baseline. Results. Health-related goals were the most common at both measurements. Goals related to independent living almost doubled and goals related to exercise and to cultural activities substantially decreased during the follow-up. Higher age decreased the likelihood for engaging in new goals related to cultural activities and disengaging from goals related to independent living. Women who had developed mobility limitation during the follow-up were less likely to engage in new goals related to exercise and more likely to disengage from goals related to cultural activities and to health and functioning. Discussion. The results of this study support theories suggesting that age-related losses such as mobility limitation may result in older adults modifying or disengaging from personal goals. peerReviewed

Objectives To investigate the association between fertility history and cognition in older men and women. Method We analyzed associations between number of children (parity) and timing of births with level and change in cognition among 11,233 men and women aged 50+ in England using latent growth curve models. Models were adjusted for age, socioeconomic position, health, depressive symptoms, control, social contacts, activities, and isolation. Results Low (0–1 child) and high parity (3+ children) compared to medium parity (2 children) were associated with poorer cognitive functioning, as was an early age at entry to parenthood ( 35) was associated with better cognitive function. Conclusion Associations between fertility history and cognition were to large extent accounted for socioeconomic position, partly because this influenced health and social engagement. Poorer cognition in childless people and better cognition among mothers experiencing child birth at higher ages suggest factors related to childbearing/rearing that are beneficial for later cognitive functioning, although further research into possible earlier selection factors is needed.

This study investigated the associations of personal goals with exercise activity, as well as the relationships between exercise-related and other personal goals, among older women. Both cross-sectional and longitudinal designs were used with a sample of 308 women ages 66–79 at baseline. Women who reported exercise-related personal goals were 4 times as likely to report high exercise activity at baseline than those who did not report exercise-related goals. Longitudinal results were parallel. Goals related to cultural activities, as well as to busying oneself around the home, coincided with exercise-related goals, whereas goals related to own and other people’s health and independent living lowered the odds of having exercise-related goals. Helping older adults to set realistic exercise-related goals that are compatible with their other life goals may yield an increase in their exercise activity, but this should be evaluated in a controlled trial.

Our aim was to study the effects of sense of coherence (SOC) on training adherence and interindividual changes in muscle strength, mobility, and balance after resistance training in older people with hip fracture history. These are secondary analyses of a 12-week randomized controlled trial of progressive resistance training in 60- to 85-year-old community-dwelling people 0.5–7 years after hip fracture (n = 45; ISRCTN34271567). Pre- and posttrial assessments included SOC, knee extension strength, walking speed, timed up-and-go (TUG), and Berg Balance Scale (BBS). Group-by-SOC interaction effects (repeated-measures ANOVA) were statistically significant for TUG (p = .005) and BBS (p = .040), but not for knee extension strength or walking speed. Weaker SOC was associated with poorer training adherence (mixed model; p = .009). Thus, more complicated physical tasks did not improve in those with weaker SOC, independently of training adherence. Older people with weaker SOC may need additional psychosocial support in physical rehabilitation programs to optimize training response.

This RCT intervention among nulliparous pregnant women with an intense fear of childbirth sought to promote preparedness for childbirth and to enhance positive parenting. Pregnant women (n = 8,611) filled in a ‘fear of childbirth’ questionnaire. Nulliparous women with severe fear of childbirth (n = 355) were randomized into intervention (n = 131; 41 refused) and control (n = 224) groups. They rated themselves on a preparedness scale in middle and late pregnancy, and on a motherhood scale three months after childbirth. The intervention included six psycho-education group sessions during pregnancy and one after childbirth. This intervention increased the mothers’ preparedness for childbirth, which predicted an increase in positive motherhood.

We investigated associations between later-life health and fertility history for women and men, using the British Household Panel Survey. We modelled health and its rate of change jointly with sample retention over an 11-year period. For women, childlessness is associated with limitation of activity for health reasons and faster acquisition of the limitation. High parity (four or more children) is associated with poorer health for both women and men. For the parous, this association is also found when age at first birth is controlled. Early parenthood is associated with poorer health. For parents of two or more children, a birth interval of less than 18 months is associated with having a health limitation and an accelerated rate of acquiring it. We conclude that biosocial pathways link parenthood careers and the later-life health of both women and men, and that implications of closely spaced births for parents merit further attention.

We use a multi-level modelling approach to estimate the effect of ethnic diversity on measures of generalized and strategic trust using data from a new survey in Britain with a sample size approaching 25,000 individuals. In addition to the ethnic diversity of neighbourhoods, we incorporate a range of indicators of the socio-economic characteristics of individuals and the areas in which they live. Our results show no effect of ethnic diversity on generalized trust. There is a statistically significant association between diversity and a measure of strategic trust, but in substantive terms, the effect is trivial and dwarfed by the effects of economic deprivation and the social connectedness of individuals.

The authors of this chapter examine data from the European Social Survey (ESS) and, using structural equation modelling techniques, develop measures for three elements of social capital; social trust, institutional trust and civic association. The analysis explores how these three elements are related after controlling for a range of social and psychological factors, including age, gender, income and personality type. The relationship between social trust and institutional trust is found to be resistant to controlling for sociodemographic variables and to controlling for life satisfaction.

BackgroundPrior studies suggest that certain types of personality are at higher risk for developing depressive disorders. This study examined the relationship between old age depressive symptoms and two middle-age personality dimensions, neuroticism and extraversion.MethodThe present study is part of the Finnish Twin Study on Aging, where altogether 409 female twins who had completed the Eysenck Personality Inventory at the age of 38–51 years were studied for depressive symptoms 28 years later using Center for the Epidemiologic Studies Depression Scale. Logistic regression analysis suitable for dependent data and univariate and Cholesky models for decomposing the genetic and environmental factor were used.ResultsMiddle age extraversion protected from later depressive symptoms while neuroticism increased the risk. Twin modeling indicated that the association between neuroticism and depressive symptoms resulted from shared genetic risk factors common to both traits. However, a substantial proportion of the genetic vulnerability was specific to old age depressive symptoms and was not shared with neuroticism. Middle age extraversion had no genetic relationship with old age depressive symptoms.ConclusionsThe relationship between middle age neuroticism and old age depressive symptoms is strong but only partly the result of genetic factors that predispose to both neuroticism and depressive symptoms. Extraversion, by contrast, has no genetic relationship with depressive symptoms experienced in old age.