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Background: Although older adults are more vulnerable to the COVID-19 virus, a significant proportion of them do not follow recommended guidelines concerning preventive actions during the ongoing pandemic. This paper analyses the role of biased health beliefs for adaptive health behaviour such as reduced mobility, protection in public spaces, and hygiene measures, for the population aged 50 and older in 13 European countries. Methods: Health perception is measured based on the difference between self-reported health and physical performance tests for over 24,000 individuals included in the most recent Survey of Health, Ageing and Retirement in Europe. Logistic regressions are employed to explore how over- and underestimating health are related to preventive behaviours. Results: Results suggest that older adults who underestimate their health are more likely to show adaptive behaviour related to mobility reductions. In particular, they are more likely to stay at home, shop less, and go for walks less often. By contrast, overestimating health is not significantly associated with reduced mobility. Protective behaviour in public spaces and adopting hygiene measures do not vary systematically between health perception groups. Conclusion: As health beliefs appear relevant for the adoption of preventive health behaviours related to mobility, they have serious consequences for the health and well-being of older Europeans. While adaptive behaviour helps to contain the virus, exaggerated mobility reduction in those who underestimate their health might be contributing to the already high social isolation and loneliness of older adults during the ongoing pandemic.

Objective Muscle strength is a powerful predictor of mortality that can quickly and inexpensively be assessed by measuring handgrip strength (HGS). What is missing for clinical practice, however, are empirically meaningful cut-off points that apply to the general population and that consider the correlation of HGS with gender and body height as well as the decline in HGS during processes of normal ageing. This study provides standardised thresholds that directly link HGS to remaining life expectancy (RLE), thus enabling practitioners to detect patients with an increased mortality risk early on. Design Relying on representative observational data from the Health and Retirement Study, the HGS of survey participants was z-standardised by gender, age and body height. We defined six HGS groups based on cut-off points in SD; we use these as predictors in survival analyses with a 9-year follow-up and provide RLE by gender based on a Gompertz model for each HGS group. Participants 8156 US American women and men aged 50–80 years. Main outcome measures Z-standardised HGS and all-cause mortality. Results Even slight negative deviations in HGS from the reference group with [0.0 SD, 0.5 SD) have substantial effects on survival. RLE among individuals aged 60 years with standardised HGS of [−0.5 SD, 0.0 SD) is 3.0/1.4 years lower for men/women than for the reference group, increasing to a difference of 4.1/2.6 years in the group with HGS of [−1.0 SD, −0.5 SD). By contrast, we find no benefit of strong HGS related to survival. Conclusions HGS varies substantially with gender, age and body height. This confirms the importance of considering these heterogeneities when defining reference groups and risk thresholds. Moreover, survival appears to decrease at much higher levels of muscle strength than is assumed in previous literature, suggesting that medical practitioners should start to become concerned when HGS is slightly below that of the reference group.

Objectives: This study investigates the relationship between socioeconomic environment (SEE) and survival after ST-segment elevation myocardial infarction (STEMI) separately for women and men in the City of Vienna, Austria. Design: Hospital-based observational data of STEMI patients are linked with district-level information on SEE and the mortality register, enabling survival analyses with a 19-year follow-up (2000-2018). Setting: The analysis is set at the main tertiary care hospital of the City of Vienna. On weekends, it is the only hospital in charge of treating STEMIs and thus provides representative data for the Viennese population. Participants: The study comprises a total of 1481 patients with STEMI, including women and men aged 24-94 years. Primary and secondary outcome measures: Primary outcome measures are age at STEMI and age at death. We further distinguish between deaths from coronary artery disease (CAD), deaths from acute coronary syndrome (ACS), and other causes of death. SEE is proxied via mean individual gross income from employment in each municipal district. Results: Results are based on Kaplan-Meier survival probability estimates, Cox proportional hazard regressions and competing risk models, always using age as the time scale. Descriptive findings suggest a socioeconomic gradient in the age at death after STEMI. This finding is, however, not supported by the regression results. Female patients with STEMI have better survival outcomes, but only for deaths related to CAD (HR: 0.668, 95% CIs 0.452 to 0.985) and other causes of deaths (HR: 0.627, 95% CIs 0.444 to 0.884), and not for deaths from the more acute ACS. Conclusions: Additional research is necessary to further disentangle the interaction between SEE and age at STEMI, as our findings suggest that individuals from poorer districts have STEMI at younger ages, which indicates vulnerability in regard to health conditions in these neighbourhoods.

Health misperception can have serious consequences on health. Despite their relevance, the role of such biases in determining healthcare utilisation is severely underexplored. Here we study the relationship between health perception and doctor visits for the population 50+ in Europe. We conceptualise health misperception as arising from either overconfidence or underconfidence, where overconfidence is measured as overestimation of health and underconfidence is measured as underestimation of health. Comparing objective performance measures and their self-reported equivalents from the Survey of Health, Ageing and Retirement in Europe, we find that individuals who overestimate their health visit the doctor 17.0% less often than individuals who correctly assess their health, which is crucial for preventive care such as screenings. In contrast, individuals who underestimate their health visit the doctor more often (21.4% more). Effects are similar for dentist visits, but we find no effects on hospital stays. The results are robust to several sensitivity tests and, more important, to various conceptualisations of the health perception measure.

Understanding child-related costs is crucial given their impact on fertility and labour supply decisions. We explore the subjective cost of young children in Europe by analysing the effect of child births on parents’ self-reported ability to make ends meet, and link it to changes in objective economic well-being such as income, benefits, and employment. The study is based on EU-SILC longitudinal data for 30 European countries from 2004 to 2019, enabling comparisons between country groups of different welfare regimes. Results show that newborns decrease subjective economic well-being in all regions, yet with economies of scale for the number of children. Mediation analyses reveal that the substantial labour income losses of mothers (indirect costs) explain only a small part of subjective child costs. In the first year after birth, these losses are mostly compensated for via public transfers or increased labour income of fathers, except in regions where women take extensive parental leave. This suggests that the initial drop in subjective economic well-being after childbirth is caused by increased expenses due to the birth of a child (direct costs) and other drivers such as stress that are reflected in the self-reported indicator.

Sustainable development (SD) as popularized by the Brundtland Commission and politically enshrined in the Sustainable Development Goals has been the explicit focus of sustainability science. While there is broad agreement that the trend of human well-being (W) over time should serve as a sustainability criterion, the literature so far has mostly addressed this in terms of its determinants rather than focusing on W itself. There is broad agreement that an indicator for W should have multiple constituents, clearly going beyond gross domestic product. Here, we propose a tailor-made indicator to serve precisely this purpose following a set of specified desiderata, including its applicability to flexibly defined subnational populations by gender, place of residence, ethnicity, and other relevant characteristics. The indicator, years of good life (YoGL), reflects the evident fact that in order to be able to enjoy any quality of life, one has to be alive and thus is primarily based on life expectancy. However, since mere survival is not considered good enough, life years are counted conditional on meeting minimum standards in two dimensions: the objective dimension of capable longevity (consisting of being out of absolute poverty and enjoying minimal levels of physical and cognitive health) and the subjective dimension of overall life satisfaction. We illustrate the calculation of this indicator for countries and subpopulations at different stages of development and with different degrees of data availability.

This introduction to the 2021 special issue of the Vienna Yearbook of PopulationResearch explores demographic perspectives on human wellbeing across time andspace. While the idea of relating demographic parameters to wellbeing has beenaround for a while, a more concrete research agenda on this topic has only recentlygained momentum. Reviewing the research presented in this volume, we show howexisting theoretical concepts and methodological tools in demography can be usedto make substantial advances in the study of wellbeing. We also touch upon themany challenges researchers face in defining and measuring wellbeing, with themost important debate being about whether the focus should be on objective orsubjective measures. The studies discussed here define wellbeing as health andmortality; as income, education or other resources; as happiness or life satisfaction;or as a combination thereof. They cover wellbeing in historical and contemporarypopulations in high- and low-income countries, and also point out important barriersto research on wellbeing, including the lack of good quality data in many regions.Finally, we highlight the value of considering population heterogeneities when studying wellbeing in order to identify population subgroups who are likely to fallbehind, which can have important policy implications.

This study analyses age-specific differences in income trends in nine European countries. Based on data from National Accounts and the European Union Statistics on Income and Living Conditions, we quantify age-specific changes in income between 2008 and 2017 and decompose these changes into employment, wages, and public transfer components. Results show that income of the younger age groups stagnated or declined in most countries since 2008, while income of the older population increased. The decomposition analysis indicates that the main drivers of the diverging trends are higher employment among the older population and a strong increase in public pensions, especially for women.

The Years of Good Life (YoGL) indicator reflects the evident fact that in order to be able to enjoy any quality of life, one has to be alive and thus is primarily based on life expectancy. But since mere survival is not considered as good enough, life years are counted conditional on meeting minimum standards in two dimensions: the objective dimension of capable longevity (consisting of being out of absolute poverty and enjoying minimal levels of physical and cognitive health) and the subjective dimension of overall life satisfaction. Here we provide aggregate level datasets with shares of people who are out-of-poverty, free from cognitive limitations, free from physical limitations and have positive life satisfaction; and life tables from United Nations World Populations Prospects and Eurostat which were used to calculate YoGL. The aggregate level data were derived from several surveys: SHARE, WVS, the Study of Global Ageing and Adult Health (SAGE) and the Multi-Country Survey Study on Health and Responsiveness (MCSS). The details of combining several data sources to calculate YoGL are provided in the supplementary material.

The well-being of older Europeans is of increasing importance given the substantialageing of the population. This paper comprehensively analyses well-being forthe population aged 50+ in 26 European countries, using the newly proposedindicator “Years of Good Life” (YoGL), which measures the remaining yearsof life that an individual can expect to live in a “good” state. The indicatorenables the decomposition of well-being into various dimensions, thereby revealingimportant heterogeneities between regions and genders. Results show that numbersof YoGL at age 50 vary considerably between European countries. They are highestin Northern and Western European countries and lowest in Central and EasternEuropean countries, where many “good” years are lost due to low life satisfaction.Interestingly, the high life expectancy levels in Southern Europe do not translate intohigher numbers of YoGL, mainly due to the low levels of physical and cognitivehealth in this region. While women and men can expect to have similar numbersof YoGL, women are likely to spend a smaller proportion of their longer remaininglifetime in a good state. These results demonstrate the importance of using wellbeingindicators that consider population heterogeneity when measuring humanwell-being, especially for older populations.