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Active and healthy ageing in Europe: significance of social relationships
Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.ORCID iD: 0000-0003-2665-1736
2022 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Aktivt och hälsosamt åldrande i Europa : betydelsen av sociala relationer (Swedish)
Abstract [en]

Background: Social relationships have important roles in achieving active and healthy ageing. Social relationships are dynamic across the life course. A myriad of contextual and individual (e.g., sociodemographic and health-related) factors shape the levels of social relationship constructs (e.g., social contact, participation, and support) and how they change over time. This thesis aims to contribute to a better understanding of social relationships among the older European population, the impact of health on social relationships, the influence of social relationships on quality of life, and the impact of the COVID-19 pandemic on the levels of social relationships.

Methods: The study subjects were community-dwelling Europeans aged 50 and over who participated in the Survey of Health, Ageing and Retirement in Europe (SHARE) between 2004 and 2020. In Sub-study 1, multilevel growth modelling was used to analyse the trajectories of seven social relationship constructs, i.e., provision and receipt of instrumental support, social contact, and participation in volunteer work, sport/social club, educational activity, and political/community organisation. Sub-study 2 used latent class analysis (LCA) to identify social relationship typologies based on the seven social relationship constructs and perceived emotional support. Next, the associations between frailty and social relationship typologies were analysed using LCA-with-covariates. Sub-study 3 evaluated the possible causal effect of social support provision, support receipt, and participation on quality of life using doubly robust estimation and sensitivity analysis for unobserved confounding. Sub-study 4 used multilevel logistic regression analysis to determine whether individuals’ exposure to COVID-19 and the country’s COVID-19 policies stringency index (S-Index) were associated with the initiation of provision and receipt of instrumental support and volunteering during the first phase of the COVID-19 pandemic. 

Results: In contrast to instrumental support receipt, the probability of instrumental support provision, social contact, and participation declined slightly over time (Sub-study 1). Four social relationship types were identified: 1) poor, 2) frequent and emotionally close, 3) frequent, emotionally close, and supportive, and 4) frequent, emotionally close, and active (Sub-study 2). Poor self-rated health limited instrumental support provision and increased instrumental support receipt from outside the household (Sub-study 1). Being pre-frail or frail was associated with less active social relationship types, i.e., Types 1, 2, and 3 (Sub-study 2). Social participation and instrumental support provision for people outside the household were correlated with a higher quality of life while receiving instrumental support was associated with a lower quality of life. None of these associations could be considered causal (Sub-study 3). During the COVID-19 pandemic, the level of volunteering and instrumental support provision was lower, but the level of instrumental support receipt was higher than before the pandemic. Being exposed to COVID-19 was positively associated with support receipt initiation. The close ones’ exposure to COVID-19 was positively associated with volunteering, support provision, and support receipt. S-Index was positively associated with instrumental support provision initiation but negatively associated with support receipt initiation (Sub-study 4).

Conclusions: A significant share of older Europeans was socially active. Their engagement in social contact, support, and participation changed over time. The four social relationship types revealed the importance of having frequent contact in initiating instrumental support exchange and social participation. Health is a vital determinant of older adults’ social relationships. On the other hand, observed associations indicate that social relationships may influence older adults’ quality of life. The pandemic might lower social support provision and volunteering and increase support receipt levels in the population. However, the pandemic might also encourage older adults to provide help, likely to people within their neighbourhood. Overall, maintaining close social ties, especially with family and close friends, is important to stimulate active engagement in social support exchange and participation, which promotes healthy ageing.

Abstract [sv]

Bakgrund: Sociala relationer har stor betydelse för ett hälsosamt och aktivt åldrande, vilket också kan återspegla en hög livskvalitet bland äldre människor. Sociala relationer förändras över hela livet, och en rad olika kontextuella och individuella (d.v.s. sociodemografiska och hälsorelaterade) faktorer påverkar nivån och karaktären av våra sociala relationer (sociala kontakter, socialt deltagande och stöd) över tid. Syftet med denna avhandling är att bidra till en ökad förståelse av sociala relationer bland den åldrande befolkningen i Europa; hur hälsan inverkar på sociala relationer; hur sociala relationer inverkar på livskvalitet; samt hur COVID-19-pandemin inverkat på sociala relationer. 

Metod: Avhandlingen baseras på data från män och kvinnor, 50 år och äldre, som deltagit i undersökningen om ”hälsa, åldrande och pensionering i Europa” (SHARE) mellan åren 2004 och 2020. I delstudie 1 användes flernivåmodeller för att analysera trajektorier av sju typer av sociala relationer; tillhandahållande och mottagande av instrumentellt stöd, sociala kontakter, samt socialt deltagande i volontärarbete, -sport/social klubb, - utbildningsverksamhet och -politisk/samhällsorganisation. I delstudie 2 användes latent klassanalys (LCA) för att identifiera sociala relationstypologier baserat på de sju sociala relationerna och upplevt emotionellt stöd. Därefter analyserades sambanden mellan sociala relationstypologier och åldersskörhet. I delstudie 3 undersöktes ett möjligt orsakssamband mellan sociala relationer (tillhandahållande av socialt stöd, mottagande av socialt stöd, och socialt deltagande) och livskvalitet bland äldre, med hjälp av robust skattning och känslighetsanalys för icke-observerade faktorer. I delstudie 4 användes logistisk regression med flernivåanalys för att analysera om individers exponering för covid-19 och landets covid-19 policy, mätt som stringensindex (S-index,) var associerat med initieringen av tillhandahållande och mottagande av instrumentellt stöd och volontärarbete under den första fasen av covid-19-pandemin. 

Resultat: Till skillnad från mottagande av instrumentellt stöd minskade sannolikheten för tillhandahållande av instrumentellt stöd, sociala kontakter och socialt deltagande något över tiden (delstudie 1). Fyra sociala relationstypologier identifierades: 1) Svag, 2) Frekvent och känslomässigt nära, 3) Frekvent, känslomässigt nära och stödjande och 4) Frekvent, känslomässigt nära och aktiv (delstudie 2). Dålig självskattad hälsa minskade sannolikheten för tillhandahållande av instrumentellt stöd men ökade sannolikheten för mottagandet av instrumentellt stöd ixfrån någon utanför hushållet (Delstudie 1). Att vara pre-åldersskör eller åldersskör var associerat med de mindre aktiva typerna av sociala relationer, det vill säga typ 1, 2 och 3 (delstudie 2). Socialt deltagande och tillhandahållande av instrumentellt stöd till personer utanför hushållet var korrelerat med högre livskvalitet, medan mottagande av instrumentellt stöd var associerat med lägre livskvalitet. Inget av dessa samband kunde dock anses vara orsakssamband (delstudie 3). Under covid-19-pandemin var nivån på volontärarbete och tillhandahållande av instrumentellt stöd lägre, men nivån av mottagande av instrumentellt stöd högre än före pandemin. Att exponeras för covid-19 var positivt förknippat med initiering av mottagande av stöd. Närståendes exponering för covid-19 var positivt förknippad med volontärarbete, samt tillhandahållande och mottagande av instrumentellt stöd. S-Index var positivt associerat med initiering av tillhandahållande av instrumentellt stöd men negativt associerat med initiering av mottagande av instrumentellt stöd (delstudie 4).

Slutsatser: En betydande andel av äldre européer var socialt aktiva. Deras engagemang i sociala kontakter, tillhandahållande och mottagande av instrumentellt stöd och sociala deltagande förändrades över tid. De fyra sociala relationstypologierna visar på betydelsen av att ha täta sociala kontakter för att initiera tillhandahållande och mottagande av instrumentellt stöd, såväl som socialt deltagande. Hälsan är en avgörande bestämningsfaktor för äldres sociala relationer. Å andra sidan indikerar avhandlingsresultaten också att sociala relationer kan påverka livskvalitet. Pandemin kan ha begränsat tillhandahållandet av stöd och volontärarbete man stimulerat mottagande av instrumentellt stöd. Betydelsen av sociala band mellan människor för att initiera utbyte av socialt stöd blev mer påtaglig under pandemin. Sammantaget visar avhandlingen att det är viktigt att upprätthålla nära sociala band, särskilt med familj och vänner, för att uppmuntra aktivt engagemang i socialt stödutbyte och socialt deltagande, vilket främjar ett hälsosamt åldrande.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2022. , p. 125
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2206
Keywords [en]
older population, ageing, social relationships, social support, social participation, social contact, quality of life, frailty, panel data, latent class analysis, growth model, multilevel logistic regression, pandemic, Europe, SHARE
Keywords [sv]
äldre befolkning, åldrande, sociala relationer, socialt stöd, socialt deltagande, sociala kontakter, livskvalitet, åldersskörhet, paneldata, latent klassanalys, tillväxtmodell, flernivålogistisk regression, pandemi, Europa, SHARE
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology; Public health
Identifiers
URN: urn:nbn:se:umu:diva-200969ISBN: 978-91-7855-919-0 (electronic)ISBN: 978-91-7855-918-3 (print)OAI: oai:DiVA.org:umu-200969DiVA, id: diva2:1710547
Public defence
2022-12-09, Sal Q0, Bergasalen, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2022-11-18 Created: 2022-11-14 Last updated: 2022-11-17Bibliographically approved
List of papers
1. Changes in the provision of instrumental support by older adults in nine European countries during 2004-2015: a panel data analysis
Open this publication in new window or tab >>Changes in the provision of instrumental support by older adults in nine European countries during 2004-2015: a panel data analysis
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2020 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 20, no 1, article id 436Article in journal (Refereed) Published
Abstract [en]

Background: Providing support to others has been shown to be beneficial to older adults. As people age, their health and social relationships change. These changes may also relate to changes in social support provision. We examined the trajectory of instrumental support provision by older people in three European regions throughout 11 years of follow-up. We then examined the extent to which age at baseline, sex, and region (representing welfare state regime) influenced the variations in the trajectory.

Methods: Data collected from 8354 respondents who had completed at least waves 1 and 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE) was analysed. Instrumental support provision was determined from asking a single question regarding whether the respondent provided help personally for people outside their household. Region, sex, and age at baseline were the main predictors tested. We used growth modelling to address the aims of this study.

Results: The northern European region (Sweden and Denmark) had the highest odds ratio of instrumental support provision. The likelihood of being involved in providing instrumental support decreased by 8% annually (OR: 0.916, 95%CI: 0.893,0.940) over the 11 years of follow-up. Older respondents were less likely to provide instrumental support and their trajectories declined faster than those of the younger respondents. Sex difference in instrumental support provision was more apparent among younger-older people in the southern European region.

Conclusions: Older European adults are an important source of instrumental support, especially for their families. The probability of instrumental support provision by European older adults declines over time. Age, sex, and welfare state regime predict this trajectory.

Place, publisher, year, edition, pages
BioMed Central, 2020
Keywords
Social support, Ageing, Europe, Panel data analysis, Growth model
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-177153 (URN)10.1186/s12877-020-01785-4 (DOI)000587996900002 ()33129257 (PubMedID)2-s2.0-85094636211 (Scopus ID)
Available from: 2020-12-08 Created: 2020-12-08 Last updated: 2023-03-24Bibliographically approved
2. Frailty and types of social relationships among older adults in 17 European countries: A latent class analysis
Open this publication in new window or tab >>Frailty and types of social relationships among older adults in 17 European countries: A latent class analysis
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2022 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 101, article id 104705Article in journal (Refereed) Published
Abstract [en]

Background: Frailty is a syndrome commonly associated with old age. Social relationships are an essential determinant of frailty progression, and frailty can negatively affect social relationships.

Objectives: To identify social relationship types among older adults in Europe; to evaluate whether social relationship types differ across European regions; and to assess the association between frailty status and social relationship type.

Methods: We used data from 56,226 individuals from 17 European countries who participated in Wave 6 of the Survey of Health, Ageing and Retirement in Europe. We constructed social relationship types from social relationship variables (contacts frequency, perceived emotional support, participation in social activities, providing and receiving instrumental support) using latent class analysis (LCA). Associations between social relationship types and frailty were examined using multinomial regression analyses integrated with LCA.

Results: We identified four social relationship types: ‘poor’; ‘frequent and emotionally close’; ‘frequent, emotionally close, and supportive’; and ‘frequent, emotionally close, and active’. Type 3 is also characterised by participation in sport/social clubs (in the northern region) or receiving support (in the eastern region). Participation in volunteering/charity activities (in the central and northern regions) and instrumental support provision (in the northern region) are Type 4′s characteristics as well. In all regions, being frail was associated with less active social relationships (Types 1, 2, and 3) relative to the more ‘active’ type (Type 4).

Conclusion: Frailty status was associated with social relationship types. The identified types may help tailor intervention programmes for older adults to prevent worsening frailty.

Keywords
Frailty, Latent class analysis, Older age, SHARE, Social participation, Social support
National Category
Other Social Sciences not elsewhere specified Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-194900 (URN)10.1016/j.archger.2022.104705 (DOI)000793742700007 ()35461166 (PubMedID)2-s2.0-85129513398 (Scopus ID)
Funder
Swedish Research Council, 2020-0254Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-05196
Available from: 2022-06-01 Created: 2022-06-01 Last updated: 2023-03-24Bibliographically approved
3. A longitudinal study on social support, social participation, and older Europeans' quality of life
Open this publication in new window or tab >>A longitudinal study on social support, social participation, and older Europeans' quality of life
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2021 (English)In: SSM - Population Health, ISSN 2352-8273, Vol. 13, article id 100747Article in journal (Refereed) Published
Abstract [en]

The association between quality of life (QoL) and social relationships is well established. This paper further analyses whether and how participation in social activities as well as providing and receiving social support, independently, are associated with QoL among the older population in 16 European countries. QoL was measured using the CASP-12 scale. The baseline data came from Wave 6 and the outcome from Wave 7 of the Survey of Health, Ageing and Retirement in Europe (SHARE). The associations of interest were analysed using multivariable linear regression. The effect of possible non-ignorable dropout was tested. Then, doubly robust estimation and sensitivity analyses for unobserved confounding were performed to evaluate the possible causal interpretation of the associations found. Our findings show that participation in at least one of the socially productive activities was positively associated with QoL at two-year follow-up (Average Causal Effect, ACE: 0.474; 95%CI: 0.361, 0.587). The association was stronger among women, people aged 75+, and those in the Southern European region. Providing social support had a positive association with QoL, but only among people aged 75+ (ACE: 0.410; 95%CI: 0.031, 0.789). Conversely, receiving social support had a negative association (ACE: -0.321; 95%CI: -0.448, -0.195) with QoL, especially for men, people aged 75+, and those in Eastern European countries. Sensitivity analyses for unobserved confounders showed that the associations found cannot be attributed to causal effects.

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
Older population, Panel data, Quality of life, Social participation, Social support
National Category
Public Health, Global Health, Social Medicine and Epidemiology Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-180792 (URN)10.1016/j.ssmph.2021.100747 (DOI)000636560000012 ()2-s2.0-85100764155 (Scopus ID)
Available from: 2021-02-25 Created: 2021-02-25 Last updated: 2023-09-05Bibliographically approved
4. Volunteering and instrumental support during the first phase of the pandemic in Europe: the significance of COVID-19 exposure and stringent country’s COVID-19 policy
Open this publication in new window or tab >>Volunteering and instrumental support during the first phase of the pandemic in Europe: the significance of COVID-19 exposure and stringent country’s COVID-19 policy
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2024 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 24, no 1, article id 99Article in journal (Refereed) Published
Abstract [en]

Background: The COVID-19 control policies might negatively impact older adults’ participation in volunteer work, instrumental support provision, and the likelihood of receiving instrumental support. Studies that quantify changes in these activities and the related factors are limited. The current study aimed to examine the level of volunteering, instrumental support provision and receipt before and during the first phase of the COVID-19 pandemic in Europe and to determine whether older adults’ volunteering, instrumental support provision and receipt were associated with individual exposure to COVID-19 and the stringency of country’s COVID-19 control policy during the first phase of the COVID-19 pandemic.

Methods: A cross-sectional survey using data from the Survey of Health, Ageing and Retirement in Europe (SHARE) Corona Survey 1 was designed to focus on community-dwelling Europeans aged ≥50 years. History of participation in volunteering work and instrumental support provision or receipt was assessed from the previous SHARE Wave data. The country’s COVID-19 control policy stringency index (S-Index) was from the Oxford COVID-19 Government Response Tracker database. A total of 45,669 respondents from 26 European countries were included in the volunteering analysis. Seventeen European countries were included in the analyses of instrumental support provision (N = 36,518) and receipt (N = 36,526). The multilevel logistic regression model was fitted separately to analyse each activity.

Results: The level of volunteering and instrumental support provision was lower during the pandemic, but instrumental support receipt was higher. The country S-Index was positively associated with support provision (OR:1.13;95%CI:1.02–1.26) and negatively associated with support receipt (OR:0.69;95%CI:0.54–0.88). Exposure to COVID-19 was positively associated with support receipt (OR:1.64;95%CI:1.38–1.95). COVID-19 exposure on close ones positively associated with volunteering (OR:1.47;95%CI:1.32–1.65), support provision (OR:1.28;95%CI:1.19–1.39), and support receipt (OR:1.25;95%CI:1.15–1.35).

Conclusions: The COVID-19 pandemic impacted older Europeans’ volunteering, instrumental support provision, and instrumental support receipt from outside their household. When someone close to them was exposed to COVID-19, older Europeans were likely to receive instrumental support and to volunteer and provide instrumental support. A stricter country’s COVID-19 control policy might motivate older adults to provide instrumental support, but it prevents them from receiving instrumental support from outside their households. 

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
s COVID-19, Social support, Social participation, Volunteering, Older population, SHARE, Europe, Ageing population
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-200954 (URN)10.1186/s12889-023-17507-5 (DOI)2-s2.0-85181485748 (Scopus ID)
Funder
EU, Horizon 2020, 101015924
Note

Originally included in thesis in manuscript form.

Available from: 2022-11-11 Created: 2022-11-11 Last updated: 2024-01-24Bibliographically approved

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Lestari, Septi Kurnia

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