Christian Lalive d'Epinay

Dynamics of Frailty and ADL Dependence in a Five-Year Longitudinal Study of Octogenarians

Using a sample of octogenarians from the Swiss Interdisciplinary Longitudinal Study on the Oldest Old, the authors investigated the predictive validity of an expanded working definition of frailty based on deficiencies in mobility, memory, energy, and physical or sensory capacities and analyzed the resulting health transitions. The five domains were considered as predictors of the onset of dependence in activities of daily living (ADLs) and death using logistic multilevel and Cox survival regression models. Health transitions were studied with Markov chains. Deficiencies in memory, energy, and sensory capacities contributed to the prediction of the onset of ADL dependence and death in participants free of physical pains and mobility impairments. With two domains affected, frailty in very old persons indicated an increased risk of adverse outcomes. The study of transitions showed that ADL-independent frailty was a highly probable and relatively long transitional stage between robustness and ADL dependence.

Association between social relationships and survival of Swiss octogenarians. A five-year prospective, population-based study

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

Bereavement in Very Old Age: Impact on Health and Relationships of the Loss of a Spouse, a Child, a Sibling, or a Close Friend

This article deals with the following two questions: In very old age, which are the main sources of bereavement? And what are the consequences of such losses on health and on relationships? The findings are based on the complete set of data compiled in the course of the Swiss Interdisciplinary Longitudinal Study on the Oldest Old (SWILSOO), which provided a 10-year follow-up of a first cohort (1994–2004) and a 5-year follow-up of a second (1999–2004). The data revealed that, in very old age, the great majority of the dear ones who died were either siblings or close friends. Taken as a whole, the bereaved suffered a marked and lasting increase in depressive symptoms, together with a short-term deterioration in their functional status; those bereft of a spouse or a child saw their functional status worsen and exhibited enduring depressive symptoms but they also benefited from support in the form of increased interaction; those bereft of siblings only suffered from a mild, short-term deterioration in functional status; those who had lost a close friend suffered a very significant increase in depressive symptoms. In the medium term, most of these effects disappeared, lending weight to the claim that the survivors manage to cope with the misfortunes of life.

The Death of a Loved One: Impact on Health and Relationships in Very Old Age:

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

The Elderly and their Families, 1979-94: Changing Networks and Relationships

This article analyses the changes occurring in the structure of the family network of older people and their family interactions over a 15-year period. Data are from two Swiss cross-sectional surveys carried out on a random sample of people aged 65-94 years, in 1979 (N = 1519) and 1994 (N = 1447). Both were conducted in two specific regions, namely, the Alpine canton of Valais, steeped in a rural tradition, and the city-canton of Geneva. Our results show a widening of the family circle due to increased life expectancy and a sharp drop in the number of childless families in the urban region because of the baby boom; at the same time, family ties multiplied, contrary to the widely held view that family relationships are weakening. Furthermore, while in 1979 each region had its own specific family culture, an alignment of family structures and relationships in the two regions took place over the 15-year period. Finally, an analysis of the instrumental support relationships based on the 1994 survey reveals the strong involvement of the elderly in their families.

Beyond the Antinomy: Work Versus Leisure?

Abstract Starting from the period where, among the free market industrialized societies, the ethos of work was dominant and where work defined the identity of an individual, the author suggests a periodisation of the actual cultural mutation: 1930–1950: The limits of the duty of work. Changes among the social structure and the political field allowed the surge of a new concept of solidarity with people suffering unintentional unemployment. Legitimate “not-working” (but not leisure!) situations were defined and received social recognition. 1950–1975: Leisure time and the raise of the ethos of self fulfilment. The Golden Sixties leaded to a de-mythification of work which is now shown as mere “job” allowing the quest of happiness in the realm of leisure and private life. 1975-…: Beyond the alternative work/leisure: toward a new construction of identity. The world-wide restructuring of economy and its erratic reactions, new technologies and the tremendous strain of the labour market are signs of the end of th...