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BACKGROUND: This paper describes the methodological considerations of developing an urban Health and Demographic Surveillance System (HDSS), in the Sleman District of Yogyakarta, Indonesia.

METHODS: 1) The Sleman District was selected because it is mostly an urban area. 2) The minimum sample size was calculated to measure infant mortality as the key variable and resulted in a sample of 4942 households. A two-stage cluster sampling procedure with probability proportionate to size was applied; first, 216 Censuses Blocks (CBs) were selected, and second, 25 households in each CB were selected. 3) A baseline survey was started in 2015, and collected data on demographic and economic characteristics and verbal autopsy (VA); the 2nd cycle collected updated demographic data, VA, type of morbidity (communicable and non-communicable diseases, disability and injury) and health access. 4) The data were collected at a home visit through a Computer-Assisted Personal Interview (CAPI) on a tablet device, and the data were transferred to the server through the Internet. 5) The quality control consisted of spot-checks of 5% of interviews to control for adherence to the protocol, re-checks to ensure the validity of the interview, and computer-based data cleaning. 6) A utilization system was designed for policy-makers (government) and researchers.

RESULTS: In total, 5147 households participated in the baseline assessment in 2015, and 4996 households participated in the second cycle in 2016 (97.0% response rate).

CONCLUSIONS: Development of an urban HDSS is possible and is beneficial in providing data complementary to the existing demographic and health information system at local, national and global levels.

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.

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.

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.

The low- and middle-income countries (LMICs) are experiencing rapid population ageing, yet knowledge about disability among older populations in these countries is scarce. This study aims to identify the prevalence and factors associated with disability among people aged 50 years and over in six LMICs. Cross-sectional data from the World Health Organization (WHO) Study on global AGEing and adult health Wave 1 (2007-2010) in China, Ghana, India, Mexico, the Russian Federation, and South Africa was used. Multivariable logistic regression analyses were undertaken to examine the association between sociodemographic factors, health behaviours, chronic conditions, and activities of daily living (ADL) disability. The prevalence of disability among older adults ranged from 16.2% in China to 55.7% in India. Older age, multimorbidity, and depression were the most common factors related to disability in all six countries. Gender was significant in China (OR = 1.14, 95% CI: 1.01-1.29), Ghana (OR = 1.22, 95% CI: 1.01-1.48) and India (OR = 1.65, 95% CI: 1.37-1.99). Having no access to social capital was significantly associated with ADL disability in China (OR = 2.57, 95% CI: 1.54-4.31) and South Africa (OR = 4.11, 95% CI: 1.79-9.43). Prevalence data is valuable in these six ageing countries, with important evidence on mitigating factors for each. Identifying determinants associated with ADL disability among older people in LMICs can inform how to best implement health prevention programmes considering different country-specific factors.

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.

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.