Fleur Thomese

Socio-economic status by rapid appraisal is highly correlated with mortality risks in rural Africa.

Socio-economic status is an important determinant of health and survival in rural Africa and necessitates a practical and valid instrument to implement in health studies. Our objective was to investigate the validity of the rapid appraisal method to assess socio-economic status and its ability to identify individuals at risk. Among 1573 households in rural northern Ghana, we calculated the Demographic Health Survey (DHS) wealth index and conducted two rapid appraisal methods: self-reported wealth and interviewer-reported wealth. In addition we followed the 25,184 participants from these households for survival with a mean follow-up of 3.9 years, during which 885 participants died. The DHS wealth index was moderately correlated to self-reported wealth (Spearmans rho 0.59, P<0.001) and interviewer-reported wealth (Spearmans rho 0.75, P<0.001). Mortality risks were significantly higher for people with lower than average self-reported wealth [hazard ratio (HR) 1.30 (95% CI 1.11-1.51)] and lower interviewer-reported wealth [HR 1.40 (95% CI 1.21-1.62)]. Mortality risks were lower for people with higher self-reported wealth [HR 0.81 (95% CI 0.32-2.03)] and higher interviewer-reported wealth [HR 0.84 (95% CI 0.58-1.21)]. Similar discriminative mortality risks were assessed when using tertiles of the DHS wealth index (Ptrend<0.001).

When Grandmothers Matter

In a recent issue of this journal, Herndon [1] discussed the grandmother hypothesis and its implications for studies on cognitive ageing. According to this hypothesis, the long post-reproductive life span in human females is an adaptive mechanism that evolved to maximize female fitness by investing resources in the care of their grandchildren rather than by continuing to reproduce themselves. From this, Herndon deduces that special cognitive robustness to be maintained until after the age of menopause must have co-evolved because grandmothers can only exert the beneficial effect if their cognitive abilities remain intact. He therefore pleas to compare cognitive ageing in humans with other primates, especially chimpanzees, because they lack a long post-reproductive life span and would therefore not have evolved this cognitive robustness. Here, we question the important role of grandmothers in our evolutionary past, first because of the different family structures during this time and second because of the low number of females that actually lived to experience a post-reproductive lifespan. We also show that in a population that reflects our evolutionary past, grandmothers do not have an important role for child survival. Finally, we react on the implications for the study of cognitive ageing as put forward by Herndon.

Communes of elderly people: Between independence and colonization

Abstract While it is generally assumed that elderly people want to live alone, at least as long as they are physically able, this is not always the case. Not only has the rapid growth of communes of elderly people in the Netherlands attracted international attention, it has also become a social policy issue. The government and institutional care providers tend to see them as informal homes for the aged, whereas the elderly who are involved in this see the communes as positive alternatives to traditional ideas on aging. In a theoretical interpretation it is shown that both the communes and the different reactions to them represent in a nutshell important developments concerning aging and the position of the aged in Western society, as well as major trends in the modernization process.

Homeownership and Long-Term Care

We investigate the relationship between homeownership and institutionalization using longitudinal data from a Dutch community sample (N = 2372) collected between 1992 and 2005, and find a negative effect of housing tenure on the probability of moving to a nursing home between two subsequent waves. Our discrete time duration model is able to deal with time-varying covariates like health and is flexible with respect to time effects. We have detailed information about health status, presence of a partner and children, neighborhood, and housing. The effect of tenure remains significant after controlling for their impact. A variety of additional potential explanations related to housing wealth and the price of long-term care are found to lack explanatory power. We therefore interpret our findings as the result of a strong desire among the homeowners to stay where they are—in their own property—and the better possibilities that they have—as owners—to realize this desire.

Socioeconomic status determines sex-dependent survival of human offspring

In a polygynous African society, rich men have much more life time offspring than women through the marriage of multiple wives. In line with evolutionary predictions, we found that in rich households more newborn sons were registered, sons had lower mortality and higher body weight. Conscious or unconscious, this maximizes reproductive output.

The Trade-Off between Female Fertility and Longevity during the Epidemiological Transition in the Netherlands.

Several hypotheses have been put forward to explain the relationship between women’s fertility and their post-reproductive longevity. In this study, we focus on the disposable soma theory, which posits that a negative relationship between women’s fertility and longevity can be understood as an evolutionary trade-off between reproduction and survival. We examine the relationship between fertility and longevity during the epidemiological transition in the Netherlands. This period of rapid decline in mortality from infectious diseases offers a good opportunity to study the relationship between fertility and longevity, using registry data from 6,359 women born in The Netherlands between 1850 and 1910. We hypothesize that an initially negative relationship between women’s fertility and their longevity gradually turns less negative during the epidemiological transition, because of decreasing costs of higher parities. An initially inversed U-shaped association between fertility and longevity changes to zero during the epidemiological transition. This does suggest a diminishing environmental pressure on fertility. However, we find no evidence of an initial linear trade-off between fertility and post-reproductive survival.

Social inclusion in the neighbourhood and the professional role identity of group home staff members: views and experiences of staff regarding neighbourhood social inclusion of people with intellectual disabilities

ABSTRACT During the last decades, people with intellectual disabilities have moved to regular neighbourhoods and policies have incorporated goals related to social inclusion. However, people with intellectual disabilities are still experiencing social isolation. We investigated the role of group home staff members, on the assumption that neighbourhood social inclusion cannot be considered a standard element of their professional role identity. The aim of our study was to gain insight into the individual perceptions of staff and the institutional environment in relation to staff’s professional role identity in dealing with neighbourhood social inclusion. We conducted semi-structured group interviews with staff from nine group homes in three neighbourhoods in the Netherlands. Our analysis yielded five themes: 1) staff perceptions of residents’ neighbourhood contacts: positive and negative experiences; 2) staff perceptions of residents’ needs and capabilities; 3) staff perceptions of neighbours and neighbourhood; 4) staff perceived role in social inclusion in the neighbourhood; and 5) staff perceived role of service provider. Our study showed that individual perceptions of a professional role identity primarily focused on care tasks, and the (lack of) experienced support from service providers hinders staff in creating opportunities for social inclusion in the neighbourhood. To enhance social inclusion in the neighbourhood we recommend service providers invest in supporting staff in acquiring the necessary skills.

Fitness effects of grandparental investments in contemporary low-risk societies

Coall & Hertwig (C&H) suggest that, because grandparental investments do not impact on child mortality in low-risk societies, fitness effects are not plausible any more. We found that grandparental investments could very well alleviate contemporary constraints on fertility. Cultural factors may influence both the occurrence and impact of grandparental investments.

Homeownership and demand for long-term care

This discussion paper resulted in a publication in Housing Studies (2013). Volume 28, issue 5, pages 746-763. Elderly home-owners get institutionalized less often than renters do. We hypothesize that housing tenure itself explains this behavior. Using longitudinal data from a Dutch community sample (N= 2,372) collected between 1992 and 2005, we find a negative effect of housing tenure on the probability of moving to a nursing home between two subsequent waves. This effect remains significant after controlling for health, socio-economic status and the presence of a partner and or children. We could not reduce this finding to a variety of explanations directly related to housing tenure. There was no substantial effect of higher payments for long-term care for wealthy people before 1997. Neither did we find evidence that home owners have a strategic bequest motive, and use their house to attract informal care from their children. We do find that homeowners use informal care-at-home to postpone or avoid institutionalization. Homeowners do not appear to live in houses more suitable to the needs of old age than renters, they do not have better social networks from which they can recruit informal caregivers. However, they express a greater satisfaction with their housing situation than renters, even if their health deteriorates. We therefore interpret our findings as the result of a strong desire among homeowners to stay where they are -in their own property- and better possibilities they have -as owners- to realize this desire.

Living apart (or) together-neighbours’ views and experiences on their relationships with neighbours with and without intellectual disabilities

BACKGROUND Neighbours play an important role in the social inclusion of people with intellectual disabilities. Neighbouring in general might help understand the social interactions between neighbours with and without intellectual disabilities. Our study focuses on gaining insight into neighbouring patterns and how people with intellectual disabilities fit in them. METHOD 26 interviews were conducted with 29 neighbours of people with intellectual disabilities on their norms and behaviours towards neighbours with and without disabilities. RESULTS Four patterns were identified: feeling an outsider, fleeting contacts, individualized neighbourliness and sense of community. DISCUSSION Participants perceived neighbours with intellectual disabilities as different: they are difficult to approach and show inappropriate behaviour. The groups shared most general perceptions, but there were differences. The first two groups mostly had fleeting encounters, whereas the last groups seemed more open to communal activities and assisting neighbours. In enhancing social inclusion, staff should be aware of these neighbouring patterns.