Old, Sick and Alone ? Living arrangements, health and well-being among older people

1. Old, Sick and Alone ? Living arrangements, health and well-being among older people RGS-IBG Annual International Conference London, 2006 Harriet Young and Emily Grundy London School of Hygiene and Tropical Medicine

2. Background • Demographic changes over the last century have led to older age structures throughout Europe. • Declines in the proportions of older people living with children and increases in proportions living alone.

3. Background What are the implications for health and well-being ? Research to date: • Those living with spouse are the most healthy • Contradictory evidence for those not living with spouse: more healthy living with other relatives or living alone ? • Mor et al (1989), Grundy (2001) • Selection effects • Effects vary according to cultural and socio-economic context

4. Research Objectives • Describe the magnitude of differences in living arrangements of those aged 60+ between regions of Europe • Analyse associations between living arrangements, health and happiness among older people • For all countries together • Examine variations between regions

5. Dataset: European Social Survey (ESS) • Two cross-sectional rounds of data – 2002 and 2004 • Using data from 18 countries – • Excluded 5 countries with response rates below 50% (Italy, France, Czech, Lux, Switz) • 3 additional countries (Ireland, Iceland, Israel) • Sample size 17,208 people aged 60+

6. Country groupings Total population size=17,208

7. Health and well-being: Self-rated health Happiness scale (0-10) Satisfaction with life (0-10) Living arrangements: MARRIED: spouse only, spouse and other, NOT MARRIED: Children or others only, Alone Other variables Age Gender Region Marital status Socio-economic status Social contacts Variables

8. Analysis • Carry out all analyses separately by gender • Descriptive analyses • Logistic regression with binary outcome (1st objective): • Married: living with spouse and others versus spouse only; • Non-married: living with non-spouse others versus living alone • Logistic regression with ordinal outcome (2nd objective) • poor, fair, good health • happiness scale

9. Results: Objective 1

10. Table 1: Adjusted odds ratios from logistic regression of region on living arrangements for women, ESS * * Model also controls for age, income, feelings about income, educational qualifications, health, and whether currently widowed for the non-married. ** p<0.01 *** p<0.001

11. Results: Objective 2

13. Table 2: Adjusted odds ratios from ordinal logistic regression of living arrangements on health and happiness for women, ESS* * Model also controls for age, region, indicators of socio-economic status, indicators of social contacts, and whether currently widowed ** p<0.01 *** p<0.001

14. Table 3: Odds ratios from ordinal logistic regression of living arrangements & other factors on health and happiness for non-married women, ESS* * Model also controls for age, region, income, education, feelings about income, indicators of social contacts, whether currently widowed, & region for Europe-wide model ** p<0.01 *** p<0.001

15. Table 3: Odds ratios from ordinal logistic regression of living arrangements & other factors on health and happiness for non-married women, ESS* * Model also controls for age, region, income, education, feelings about income, indicators of social contacts, whether currently widowed, & region for Europe-wide model ** p<0.01 *** p<0.001

16. Limitations • Varying response rates for different countries may introduce bias. • Exclusion of institutional population. • In the ESS there are no objective health measures. Only self-rated measures. • Cross-sectional analysis so unable to control for selection effects. • Small samples sizes in some analyses.

17. Conclusions • Region strongly associated with living arrangements after control for other factors. • Regional gradient for self-rated health & happiness: (worst) East–South–West–Nordic (best) • HEALTH: No significant associations between living arrangements and health, except in Nordic region: living alone less healthy. • HAPPINESS: Women least likely to be happy living alone, significantly so for South and West.

18. Acknowledgements • This research is funded by the ‘Understanding Population Trends and Processes’ (UPTAP) programme of the ESRC. • If you would like more information, do get in touch: Harriet.young@lshtm.ac.uk THANK YOU