Mental health and self-rated health of older carers during the COVID-19 pandemic: evidence from England.

OBJECTIVES: Older carers play a vital role supporting population health and protecting health and social care systems, yet there has been little research on understanding the effect of the pandemic on this group. In this paper, we investigate caring as a factor contributing to mental and self-rated health. METHODS: We investigate cross-sectional and longitudinal associations between provision of family care and mental health and wellbeing using longitudinal data from 5,149 members of the English Longitudinal Study of Ageing who responded to Wave 9 (2018/2019) and two COVID-19 sub-studies (June/July 2020; November/December 2020). We use logistic or linear regression models depending on outcome measures, controlling for pre-pandemic socioeconomic, demographic, and health-related variables. RESULTS: Before the pandemic, 21% of respondents cared for family or friends. Older people caring for someone inside the household mostly continued to provide care during the pandemic, with more than a quarter reporting an increase in the amount of care provided. Co-resident carers were disproportionately female, older, in the lowest wealth quintile, and more likely to report disability and chronic conditions. Both cross-sectional and longitudinal analyses suggest that, compared to those caring for people living outside the household, co-resident carers were significantly more likely to report poorer mental health and self-rated health. CONCLUSION: The health of older carers worsened disproportionately in the first year of the pandemic, a period also characterised by disruptions to support and closure of respite services. Support for carers' mental and physical health requires greater policy attention, especially in pandemic conditions.

The impact of shielding during the COVID-19 pandemic on mental health: evidence from the English Longitudinal Study of Ageing.

BACKGROUND: During the COVID-19 pandemic, older and clinically vulnerable people were instructed to shield or stay at home. Policies restricting social contact and human interaction pose a risk to mental health, but we know very little about the impact of shielding and stay-at-home orders on the mental health of older people. AIMS: To understand the extent to which shielding contributes to poorer mental health. METHOD: We used longitudinal data from wave 9 (2018/2019) and two COVID-19 sub-studies (June/July 2020; November/December 2020) of the English Longitudinal Study of Ageing, and constructed logistic and linear regression models to investigate associations between patterns of shielding during the pandemic and mental health, controlling for sociodemographic characteristics, pre-pandemic physical and mental health, and social isolation measures. RESULTS: By December 2020, 70% of older people were still shielding or staying at home, with 5% shielding throughout the first 9 months of the pandemic. Respondents who shielded experienced worse mental health. Although prior characteristics and lack of social interactions explain some of this association, even controlling for all covariates, those shielding throughout had higher odds of reporting elevated depressive symptoms (odds ratio 1.87, 95% CI 1.22-2.87) and lower quality of life (ß = -1.28, 95% CI -2.04 to -0.52) than those who neither shielded nor stayed at home. Shielding was also associated with increased anxiety. CONCLUSIONS: Shielding seems associated with worse mental health among older people, highlighting the need for policy makers to address the mental health needs of those who shielded, both in the current pandemic and for the future.

Changes in health and social well-being in the COVID-19 clinically vulnerable older English population during the pandemic.

BACKGROUND: People with specific health profiles and diseases (such as diabetes, lung and heart conditions) have been classified as 'clinically vulnerable' (CV) to COVID-19, that is, at higher risk of severe illness and mortality from COVID-19, and were targeted for shielding. However, there is as yet little evidence on how the pandemic and shielding impacted the health and social well-being of CV older people. METHODS: We used data from wave 9 (2018/2019) and the first COVID-19 substudy (June/July 2020) of the English Longitudinal Study of Ageing. Using logistic and linear regression models, we investigated associations between being CV and health and social well-being during the pandemic, while controlling for prepandemic levels of the outcome variables. We also explored the interactions between CV and age group (50s, 60s, 70s, 80+), and between CV and shielding. RESULTS: CV people were more likely to report worse health and social well-being outcomes during the pandemic, even taking into account prepandemic differences. However, changes in health were not uniform across different age groups, and CV respondents were generally at greater risks of deterioration in health and social well-being compared with those not CV in the same age group. CV respondents who were shielding reported worse outcomes compared with those not CV and not shielding. CONCLUSIONS: While policies focusing on shielding CV older people reduce rates of hospitalisation and death from COVID-19, policymakers should also pay attention to understanding and addressing the wider needs of this group if their long-term health and social well-being are not to be compromised.

How do people think about later life when making workplace pension saving decisions?

While behavioural economists posit that 'present bias' influences adults' propensity to save, we know very little about the cultural frameworks and internalised rationalities that people apply in real life contexts when making pension choices. This paper investigates how people anticipate the future when they make decisions about workplace pensions, considering whether they think about later life at all; if so, how they conceptualise it; and how these views shape their saving behaviour. These are important questions in the UK where private pension saving is essential to provide for old age, yet an estimated 12 million people do not invest enough for income adequacy in later life. We investigate this issue through in-depth interviews with 42 full time employees aged between 20 and 50 years, working for three large employers - a privileged group facing relatively few structural barriers to saving. Later life was considered to be a distinct and uncertain phase in the long-term future, and thinking about it was uncomfortable. Most participants were unable to imagine what retirement might be like for them. People's thoughts about the future were disconnected from their pension saving decisions, even for those who were saving at higher levels. Instead people focussed on what they can afford in the present, prioritising stability and current standard of life over long-term saving; even the people who save do so because they feel they can afford to without jeopardising their standard of living. We expect that if those in our sample with their relative advantages did not connect their present pension actions to their long term futures, this disconnect may be amplified in less privileged and more precarious groups, who have many more demands on their immediate income and far more uncertain futures. We argue that what has previously been identified as an unconscious 'present bias' is instead a conscious and culturally constructed mechanism that embeds everyday structural privileges into long-term savings.

Lifetime employment histories and their relationship with 10-year health trajectories in later life: evidence from England.

BACKGROUND: Employment histories influence health. However, most studies have so far investigated cross-sectional associations between employment histories and health, failing to recognize health as a dynamic process in later life. METHODS: We use Waves 3-8 of the English Longitudinal Study of Ageing, including retrospective information on respondents' employment activities. We used dynamic hamming distances to summarize lifetime employment histories up to state pension age (64 for men and 59 for women). Multilevel growth curve models were then used to estimate the influence of lifetime employment histories on later life health trajectories over a 10-year period using quality of life (QoL), somatic health, and depression. RESULTS: Net of selection effect and a host of contemporaneous material and social resources, men who exited early started off with poorer health than those with continuous attachment to the labour market but had a very similar health profile by the end of the 10-year period considered. Among women, better somatic health and higher QoL were observed among those who had employment breaks for family care, and this health advantage was maintained over time. Lifetime employment histories are not related to depression for either men or women. CONCLUSION: Overall, differences in health by employment histories level off only among men who left earlier and those continuously employed. Flexible arrangements for men in poor health who benefit from leaving the labour market early and supporting women who wish to take breaks for family care may help reduce health inequalities in later life.

Trends in the prevalence of grandparents living with grandchild(ren) in selected European countries and the United States.

Research from the United States has shown significant increases in the prevalence of three-generation households and in households consisting solely of grandparents and grandchildren. Such shifts in household composition, which are associated with socio-economic disadvantage, may reflect the activation of grandparents as a latent network of support in response to social and demographic changes such as rising partnership disruption. However, to date, little is known in Europe about trends in grandparent households or whether these households are also likely to be disadvantaged. Moreover, we know little about how the familistic and defamilised policy environments in Europe may affect the activation of such latent kin networks. Employing the Integrated Public Use Microdata Series-International and the Office for National Statistics' Longitudinal Study for England and Wales, we used multivariate techniques to investigate changes in prevalence over time in co-residence with a grandchild across Austria, England and Wales, France, Greece, Portugal, Romania, and the United States. We expected increases in grandparent households in Portugal and Greece, familistic societies with few public alternatives to family support. However, only Romania (like the US) showed an increase in the percentage of people aged 40 and over co-residing with their grandchildren in three-generation households between the late 1970s and 2002. Given rises in poverty and limited support for low-income families in Romania, rises in grandparent coresidence may reflect a coping strategy among poorer families to increasing financial hardship. Regardless of the trends, grandparent households in all the countries studied remained associated with socio-economic disadvantage.

The decision to work after state pension age and how it affects quality of life: evidence from a 6-year English panel study.

Background: despite an increasing proportion of older people working beyond State Pension Age (SPA), little is known about neither the motivations for this decision nor whether, and to what extent, working beyond SPA affects quality of life (QoL). Methods: QoL was measured using the CASP-19 scale. Respondents in paid work beyond SPA were distinguished based on whether they reported financial constraints as the main reason for continuing in work. Linear regression models were used to assess the associations between paid work beyond SPA and CASP-19 scores among men aged 65-74 and women aged 60-69 (n = 2,502) cross-sectionally and over time using Wave 4 and Wave 7 of the English Longitudinal Study of Ageing. Results: approximately, one in five respondents were in paid work beyond SPA, one-third of whom reported financial issues as the main reason. These individuals reported significantly lower CASP-19 scores (ß = -1.21) compared with those who retired at the expected/usual age. Respondents who declared being in paid work beyond SPA because they enjoyed their work or wanted to remain active, reported significantly higher QoL (ß = 1.62). Longitudinal analyses suggest that those who were working post-SPA by choice, but who had stopped working at follow-up, also reported marginally (P < 0.10) higher CASP-19 scores. Conclusions: potential QoL benefits of working beyond SPA need to be considered in light of individual motivations for extending working life. Given the trend towards working longer and the abolishment of mandatory retirement ages, it is important that older people maintain control over their decision to work in later life.

Do work and family care histories predict health in older women?

Background: Social and policy changes in the last several decades have increased women's options for combining paid work with family care. We explored whether specific combinations of work and family care over the lifecourse are associated with variations in women's later life health. Methods: We used sequence analysis to group women in the English Longitudinal Study of Ageing according to their work histories and fertility. Using logistic regression, we tested for group differences in later life disability, depressive symptomology and mortality, while controlling for childhood health and socioeconomic position and a range of adult socio-economic circumstances and health behaviours. Results: Women who transitioned from family care to either part-time work after a short break from the labour force, or to full-time work, reported lower odds of having a disability compared with the reference group of women with children who were mostly employed full-time throughout. Women who shifted from family care to part-time work after a long career break had lower odds of mortality than the reference group. Depressive symptoms were not associated with women's work and family care histories. Conclusion: Women's work histories are predictive of their later life disability and mortality. This relationship may be useful in targeting interventions aimed at improving later life health. Further research is necessary to explore the mechanisms linking certain work histories to poorer later life health and to design interventions for those affected.

Is being in paid work beyond state pension age beneficial for health? Evidence from England using a life-course approach.

BACKGROUND: Given the current policy emphasis in many Western societies on extending working lives, we investigated the health effects of being in paid work beyond state pension age (SPA). Until now, work has largely focused on the health of those who exit the labour force early. METHODS: Our data come from waves 2-4 of the English Longitudinal Study of Ageing, including the life history interview at wave 3. Using logistic and linear regression models, we assessed the longitudinal associations between being in paid work beyond SPA and 3 measures of health (depression, a latent measure of somatic health and sleep disturbance) among men aged 65-74 and women aged 60-69. Our analyses controlled for baseline health and socioeconomic characteristics, as well as for work histories and health in adulthood and childhood. RESULTS: Approximately a quarter of women and 15% of men were in paid work beyond SPA. Descriptive bivariate analyses suggested that men and women in paid work were more likely to report better health at follow-up. However, once baseline socioeconomic characteristics as well as adulthood and baseline health and labour market histories were accounted for, the health benefits of working beyond SPA were no longer significant. CONCLUSIONS: Potential health benefits of working beyond SPA need to be considered in the light of the fact that those who report good health and are more socioeconomically advantaged are more likely to be working beyond SPA to begin with.

Relationship between employment histories and frailty trajectories in later life: evidence from the English Longitudinal Study of Ageing.

BACKGROUND: Given the acceleration of population ageing and policy changes to extend working lives, evidence is needed on the ability of older adults to work for longer. To understand more about the health impacts of work, this study examined the relationship between employment histories before retirement and trajectories of frailty thereafter. METHODS: The sample comprised 2765 women and 1621 men from the English Longitudinal Study of Ageing. We used gendered typologies of life-time employment and a frailty index (FI). Multilevel growth curve models were used to predict frailty trajectories by employment histories. RESULTS: Women who had a short break for family care, then did part-time work till 59 years had a lower FI after 60 years than those who undertook full-time work until 59 years. Women who were largely family carers or non-employed throughout adulthood, had higher levels of frailty at 60 years but experienced a slower decline with age. Men who worked full-time but early exited at either 49 or 60 years had a higher FI at 65 years than those who worked full-time up to 65 years. Interaction between employment histories and age indicated that men in full-time work who experienced an early exit at 49 tended to report slower declines. CONCLUSIONS: For women, experiencing distinct periods throughout the lifecourse of either work or family care may be advantageous for lessening frailty risk in later life. For men, leaving paid employment before 65 years seems to be beneficial for decelerating increases in frailty thereafter. Continuous full-time work until retirement age conferred no long-term health benefits.

What Drives National Differences in Intensive Grandparental Childcare in Europe?

OBJECTIVES: Grandparents play an important role in looking after grandchildren, although intensive grandparental childcare varies considerably across Europe. Few studies have explicitly investigated the extent to which such cross-national variations are associated with national level differences in individual demographic and socio-economic distributions along with contextual-structural and cultural factors (e.g., variations in female labor force participation, childcare provision, and cultural attitudes). METHODS: We used multilevel models to examine associations between intensive grandparental childcare and contextual-structural and cultural factors, after controlling for grandparent, parent, and child characteristics using nationally representative data from the Survey of Health, Ageing and Retirement in Europe. RESULTS: Even controlling for cross-national differences in demographic and socio-economic distributions, contextual-structural factors play an important role in explaining grandparental childcare variations in Europe. In particular, higher levels of intensive grandparental childcare are found in countries with low labor force participation among younger and older women, and low formal childcare provision, where mothers in paid work largely rely on grandparental support on an almost daily basis. DISCUSSION: Encouraging older women to remain in paid work is likely to have an impact on grandchild care which in turn may affect mothers' employment, particularly in Southern European countries where there is little formal childcare.

Ethnicity as a determining factor for instrumental support in mid and later life in England and Wales.

OBJECTIVES: Minority ethnic groups are often assumed to exchange higher levels of informal support than the majority population, despite evidence that controlling for socioeconomic and health inequalities eliminates differences. Using a unique data set from England and Wales, we examined instrumental support across ethnic groups in mid and later life. METHOD: Employing data from the Home Office Citizenship Survey 2005 (N = 14,081), we investigated ethnic group differences in instrumental support among people aged 55 and older in England and Wales (n = 4,710). Multiple logistic regression was used to investigate the determinants of support given and received, guided by the Andersen-Newman behavioral model. RESULTS: Compared with the White British group, the Indian group reported significantly higher odds (odds ratio [OR] = 2.2, 95% confidence interval [CI] 1.0-4.7) of receiving instrumental support from household members but significantly lower odds of giving support to relatives outside the household (OR = 0.7, 95% CI 0.5-0.9). Three other ethnic groups (Pakistani and Bangladeshi, Mixed, Other) reported significantly lower odds in unadjusted findings, but when adjusted, ethnic group differences were no longer significant. DISCUSSION: Our analyses suggest few ethnic group differences in instrumental support once need and enabling factors were taken into account. Such findings are contrary to the belief that minority groups exchange more informal support and therefore have less need for formal services. The Andersen-Newman model is useful for guiding the analysis of support both given and received.