Cecilia Tomassini

Contacts between elderly parents and their children in four European countries: current patterns and future prospects

Frequency of contacts with the family is an indicator of the strength of intergenerational exchange and potential support for older people. Although the availability of children clearly represents a constraint on potential family support, the extent of interaction with and support received from children depends on factors other than demographic availability alone. This study examined the effects of socio-economic and demographic variables on weekly contacts with children in Great Britain, Italy, Finland and The Netherlands using representative survey data which included information on availability of children and extent of contact. Our results confirm the higher level of parent adult-child contact in Italy than in northern European countries, but levels of contact in all the countries considered were high. Multivariate analysis showed that in most countries characteristics such as divorce were associated with a reduced probability of contact between fathers and children; in Finland this also influenced contact between mothers and children. Analyses are also included of possible future scenarios of contact with children that combine the observed effects of the explanatory variables with hypothetical changes in population distribution.

Socio-economic status differences in older people's use of informal and formal help: a comparison of four European countries

This study investigates the variations by older peoples socio-economic status (SES) (i.e. educational level and social class) in the use of informal and formal help from outside the household in Great Britain, Italy, Belgium and The Netherlands. In all these countries, it was older people in low SES groups who mostly used such help. Multinomial logistic regression analyses showed that, in each country and for both types of help, there were SES gradients in the utilisation of both formal and informal care, and that differences in age, health and marital status largely accounted for the former but not the latter. Cross-national differences in the use of both informal and formal help remained when variations in sex, age, SES, health, marital status, home ownership and the use of privately-paid help were taken into account. Significant interaction effects were found, which indicated that older people in low SES groups in Great Britain and The Netherlands had higher odds of using informal help from outside the household than their counterparts in Italy, and similarly that those in The Netherlands were more likely to use formal help than their Italian peers. The results are discussed in relation to the cultural differences and variations in the availability of formal services among the countries.

Revisiting convergence and divergence: support for older people in Europe

Recent commentators have distinguished ‘weak’ from ‘strong’ family societies, arguing that older people in less family-oriented societies receive less support from family members than those in countries with strong family ties (e.g. Southern Europe). This study explored the north-south divide in various dimensions associated with support for older people among selected European countries participating in a European Scientific Foundation network, ‘Family Support for Older People: Determinants and Consequences’ (FAMSUP). Employing data from a wide variety of sources (e.g. nationally representative surveys, censuses, and official publications) we used principal components and cluster analysis to investigate patterns across countries in four dimensions designed to be indicative of the balance between family and formally provided resources for older people and the socio-economic, demographic and policy contexts in which these are provided. Rather than a clear-cut north-south division European countries reflect a more complex classification in terms of support for older individuals when a wide range of measures associated with different dimensions of support for older people are used. Future research requires comparable cross-national data on key indicators of family support.

Marital history, health and mortality among older men and women in England and Wales

BackgroundHealth benefits of marriage have long been recognised and extensively studied but previous research has yielded inconsistent results for older people, particularly older women. At older ages accumulated benefits or disadvantages of past marital experience, as well as current marital status, may be relevant, but fewer studies have considered effects of marital history. Possible effects of parity, and the extent to which these may contribute to marital status differentials in health, have also been rarely considered.MethodsWe use data from the Office for National Statistics Longitudinal Study, a large record linkage study of 1% of the population of England & Wales, to analyse associations between marital history 1971-1991 and subsequent self-reported limiting long-term illness and mortality in a cohort of some 75,000 men and women aged 60-79 in 1991. We investigate whether prior marital status and time in current marital status influenced risks of mortality or long term illness using Poisson regression to analyse mortality differentials 1991-2001 and logistic regression to analyse differences in proportions reporting limiting long-term illness in 1991 and 2001. Co-variates included indicators of socio-economic status at two or three points of the adult life course and, for women, number of children borne (parity).ResultsRelative to men in long-term first marriages, never-married men, widowers with varying durations of widowerhood, men divorced for between 10 and twenty years, and men in long-term remarriages had raised mortality 1991-2001. Men in long-term remarriages and those divorced or widowed since 1971 had higher odds of long-term illness in 1991; in 2001 the long-term remarried were the only group with significantly raised odds of long-term illness. Among women, the long-term remarried also had higher odds of reporting long-term illness in 1991 and in 2001 and those remarried and previously divorced had raised odds of long-term illness and raised mortality 1991-2001; this latter effect was not significant in models including parity. All widows had raised mortality 1991-2001 but associations between widowhood of varying durations and long-term illness in 1991 or 2001 were not significant once socio-economic status was controlled. Some groups of divorced women had higher mortality risks 1991-2001 and raised odds of long-term illness in 1991. Results for never-married women showed a divergence between associations with mortality and with long-term illness. In models controlling for socio-economic status, mortality risk was raised but the association with 1991 long-term illness was not significant and in 2001 never-married women had lower odds of reporting long-term illness than women in long-term first marriages. Formally taking account of selective survival in the 20 years prior to entry to the study population had minor effects on results.ConclusionsResults were consistent with previous studies in showing that the relationship between marital experience and later life health and mortality is considerably modified by socio-economic factors, and additionally showed that taking womens parity into account further moderated associations. Considering marital history rather than simply current marital status provided some insights into differentials between, for example, remarried people according to prior marital status and time remarried, but these groups were relatively small and there were some disadvantages of the approach in terms of loss of statistical power. Consideration of past histories is likely to be more important for later born cohorts whose partnership experiences have been less stable and more heterogeneous.

The long-term consequences of partnership dissolution for support in later life in the United Kingdom

ABSTRACT There has long been an interest in the United Kingdom about whether and how changes in family life affect support for older people, but nevertheless the consequences of partnership dissolution for late-life support have been little researched. Using data from the British Household Panel Study (1991–2003), this study investigated the longitudinal association between partnership dissolution and two types of support for 1,966 people aged 70 or more years: (i) informal support from children in the form of contacts and help (e.g. household assistance including care), and (ii) formal support from community care services (i.e. health visitor or district nurse, home-help and meals-on-wheels). The paper also examines the level of reported support among: (i) all parents aged 70 or more years and (ii) 1,453 unpartnered parents in the same age group (i.e. those lacking the most important source of support in later life: a spouse). We found diversity in the experience of partnership dissolution in the past lives of people aged 70 or more years. Patterns of support varied by the respondents age, whether partnered, the timing and type of partnership dissolution, and by gender, having a daughter and health status. Overall, however, partnership dissolution did not show the expected detrimental relationship with later-life support. Health needs and increasing age were strongly associated with increases in contact and informal and formal help, regardless of family history.

Marital disruptions and loss of support in later life: a longitudinal study of the United Kingdom

Marital disruption (i.e. due to death, divorce or separation) at older ages is an important issue as it removes the usual primary source of help and support: a husband or wife. To date, few studies have investigated the support implications (both informal, here defined as perceived support and social embeddedness and formal, defined as use of domiciliary care services) of marital disruptions in later life. This issue needs addressing as widow(er)hood and divorce are increasingly occurring at older ages. Employing data from the longitudinal British Household Panel Survey (BHPS) (1991–2003) we investigated the association between marital disruption and first loss of (a) perceived support and (b) at least weekly contact with at least one non-relative friend, among those aged 50 and over. We also examined first use of domiciliary care services (i.e. health visitor or district nurse, home help or meals-on-wheels) among those aged 70 and over. Our findings show that marital separation increased the odds of losing perceived support whereas widow(er)hood showed no significant association among people aged 50 and over. Separation and widow(er)hood increased the odds of losing weekly contact with non-relative friends (although the odds were greater for separation) in this age group. Finally, widow(er)hood increased the odds of using domiciliary care services among respondents aged 70 and over.

Fatherhood history and later life health and mortality in England and Wales: A record linkage study

Abstract Fatherhood is an important domain of the lives of most men but, in contrast to extensive research into associations between marriage and health, possible effects of paternity on later life health and mortality have attracted relatively little attention. Of those studies that have been undertaken, many relate to historical or less developed country populations with high levels of fertility and much less is known about associations in contemporary developed societies. In this paper we use data from a large nationally representative record linkage study of men in England and Wales to analyse associations between aspects of paternity history and subsequent mortality and health in a sample of 20,260 mature men in long‐term first marriages. At entry to the study in 1981 sample members had a mean age of 63 and a mean duration of marriage of 38 years. Mortality was observed for a twenty three year period (1981–2004) and indicators of health status measured ten (in 1991) and twenty years (in 2001) after entry into the analysis. Paternity characteristics investigated included number of children born and, among men who were fathers, early or late paternity; experience of a particularly short or long interval between marriage and first birth; and experience of one or more short intervals between births. Socio‐economic characteristics included in the analysis were based on measures relating to educational attainment, occupational social class and housing tenure, in the latter two cases observed at more than one point of time. Contrary to our hypotheses, results showed no later life disadvantages of childlessness in this sample of men who had experienced long term first marriages. However, aspects of paternity history were associated with later life health and mortality. Most notably men who had had a child before the age of 23 had higher mortality and higher odds of poor health in 1991 and 2001 than other fathers, while men who had a child at ages 40 or over had lower mortality and lower risks of long term illness in 1991. Men who had had four or more children also appeared to have worse later life health in some of the health indicators used in this study. Limitations of the data include absence of information on contacts with children or on health related behaviours hypothesised to be associated with fatherhood. Results nevertheless suggest long‐term consequences of particular paternity pathways.

The changing age structure of the UK population

This chapter explores changes in the age structure of the UK population over the last three decades. The ways in which the age profile of the population might change in the future are also discussed. Mid-year population estimates for 2004 are compared with those for selected years back to 1971, using changes in the median age and in the population age structure. Country patterns within the UK are examined, and this chapter includes a comparison with changes that have occurred in the age structure of Japan, where the population is ageing rapidly. As well as age distribution, this chapter analyses the changing distribution of the UK population by legal marital status.

Sex Differences in Medication and Primary Healthcare Use before and after Spousal Bereavement at Older Ages in Denmark: Nationwide Register Study of over 6000 Bereavements

Background. The study aimed to examine sex differences in healthcare use before and after widowhood to investigate whether reduced healthcare use among widowers compared with widows may partially explain excess mortality and more adverse health outcomes among men than women after spousal loss. Methods. All individuals alive and aged at least 60 years in 1996 and who became widowed in the period from 1996 to 2003 were selected from the 5% sample of the total Danish population and all Danish twins. The healthcare use was assessed as the average daily all-cause and major system-specific medication use and the average annual number of visits to general physicians (GPs). Results. The average daily use of all-cause and major system-specific medications, as well as the number of GP visits increased over the period from 1 year before and up to 5 years after a spouses death, but there were no sex-specific patterns in the trajectories of medication use and number of GP visits after conjugal loss. Conclusion. We found little support for the hypothesis that reduced healthcare use contributes to the explanation of more adverse health outcomes after conjugal loss in men compared with women in Denmark.

Twins and their health cost: consequences of multiple births on parental health and mortality in Denmark and England and Wales.

The rapid increase in twinning rates in developed countries has increased interest in the question as to whether twin mothers have higher mortality and more health problems than mothers of singletons. Here we use a national survey, the Office for National Statistics Longitudinal Study of England & Wales, and a linkage between the Danish Twin Registry and the Danish population register to examine mortality patterns after age 45 (50 for fathers) for twin parents and the whole population born from 1911 to 1950. For England and Wales, presence of limiting long-term illnesses and self-rated health status was also investigated. Overall similar health and mortality was found for twin parents and the whole population although both life table methods and survival analysis suggested a slight excess mortality among older cohorts of twin mothers in England and Wales.