The link between vision impairment and depressive symptomatology in late life: does having a partner matter?

Visual impairment contributes to poor mental health among older adults by restricting everyday functioning and participation. This study examined whether the negative link between vision impairment and depressive symptomatology was less severe among partnered than among single older adults. We merged data from a survey among people with vision impairment with a reference population from the most recent wave of the Danish Longitudinal Study of Ageing (DLSA) (N = 5831 M age = 74.37, range: 65-97 years, 53.1% female), investigating whether paths from poor vision via three mediators-functional limitations, emotional support and participation in social activities-to depressive symptomatology differ by partnership status. Structural equation modeling suggested that the direct path from vision impairment to depressive symptomatology is more than twice as strong for single than for partnered older adults. Thus being partnered reduces the negative link from vision impairment to depressive symptomatology. However, the path from vision impairment to emotional support is significantly stronger among single than among partnered individuals. Thus negative spillover effects from the visual impairment on the non-impaired partner's mental health may compromise that partner's ability to provide emotional support. Taking into account both partnership status and the mental health of both partners may help professionals more precisely target interventions aimed at reducing the risk of depression in visually impaired older adults.

Trust in the publicly financed care system and willingness to pay for long-term care: A discrete choice experiment in Denmark.

Aging populations put pressure on the provision and financing of long-term care (LTC) services in many countries. The projected increase in LTC expenditures may in particular constitute a threat to the future sustainability of public budgets in welfare states, where LTC is financed through taxes. To accommodate the increasing number of 80+ year-olds in society, policy-makers and service administrators need a better understanding of care preferences among future older adults: What types of services do older citizens prefer most, and which factors shape their LTC preferences? A discrete choice experiment (DCE) was administered to a representative sample of the Danish population aged 54-64 from May to July 2019 (n = 1154), investigating which factors shape individuals' preferences and willingness-to-pay (WTP) for their future LTC. Our results reveal that respondents are willing to make additional out-of-pocket payments to supplement the care provided for free by the municipality. The WTP was highest for services such as receiving help from a regular care team ($129 per month) and an extra shower a week ($116 per month). Moreover, we find heterogeneous care preferences, with three user characteristics associated with higher WTP for services: higher education, high wealth, and a low trust in the publicly financed care system. Our results raise concerns that inequalities between relatively more- and less-resourceful older adults may increase in Scandinavian-type welfare states in the future. Such increasing inequality in service provision may undermine citizens' trust in and support of the publicly financed care system.

Negotiations of vulnerability in aging with vision impairment.

Longevity entails a higher prevalence of chronic impairments that often come with aging, such as age-related vision loss (ARLV). Dependence and increasing vulnerabilities contrast sharply with contemporary reductionist models of positive aging, and gradually worsening eyesight exposes older adults with ARLV to situations where idealized models of late life do not fit them. In analyzing semi-structured interviews conducted in Denmark with 40 older adults, aged 55-70 years, with vision loss, this study examines how people in late midlife and early late life negotiate their vulnerability, dependence, and need for help across different contexts. The findings illustrate how these lived experiences situate people with ARVL outside the idealized late life and how they negotiate their need for help in both their work life and private life. The findings also show how people with age-related vision loss perform a balancing act between the lived vulnerability and the prescribed role of vulnerability arising from social discourses. Some contexts allow people with ARVL to negotiate and re-negotiate their vulnerability, while others, such as work-life contexts, often offer less room for negotiating vulnerability and need for help. The study makes it clear that, given the cultural emphasis on extended work lives, the ways in which work cultures can adapt to age diversity and age-related disabilities must receive more attention.

The promise of assistive technology in institutionalized old age care: economic efficiency, improved working conditions, and better quality of care?

PURPOSE: Assistive technologies in care work are expected to alleviate the challenges related to population aging, namely the pressure on public budgets and a shortage of care professionals. This study examines how various stakeholders view the potentials of assistive technology in an institutionalized care setting in Denmark. METHOD: Using ethnographic field observations, interviews, and document analysis, we explore the residents', the staff's, and the municipality's perspectives on the technologies and analyze whether they live up to the stated expectations. RESULTS: We identify three parallel narratives representing each of the stakeholder's perspectives. The municipality's triple-win narrative emphasizes expected gains in terms of efficiency, improved working conditions, and better quality of care. The staff's ambiguity narrative contains both negative views regarding the motive for using technologies to save resources and positive accounts of how technologies have reduced work-related pain. The residents' limited agency narrative reflects an internalization of the staff's perspectives. CONCLUSIONS: We conclude that, despite both the staff and the municipality highlighting the residents' well-being and comfort as important outcomes of assistive technologies, the residents' wishes have limited influence on whether and, if so, how assistive technologies are used.IMPLICATIONS FOR REHABILITATIONDifferent stakeholders' views on assistive technology vary and are closely connected to their respective institutional interests and roles. These perspectives are important for a successful implementation of assistive technologies.Understanding the positions of staff and older care recipients, and differentiating between their respective perspectives can help both scholars and product developers understand the potentials and risks of AT in a more nuanced way.

Voluntary work for the physical and mental health of older volunteers: A systematic review.

Background: The increasing imbalance between the number of older adults not working and the number of adults in the age range of labour force participation (age range 20-64) has long been a fundamental public policy challenge in the Organization for Economic Co-operation and Development member countries. At a societal level, this growing imbalance raises serious concerns about the viability and funding of social security, pensions and health programmes. At an individual level, the concern is probably more that of aging well with the prospect of many years in retirement. Some research suggests that retiring for some carries the risk of a fast decline in health. Volunteering can play a significant role in people's lives as they transition from work to retirement, as it offers a "structured" means of making a meaningful contribution in society once the opportunity to do so through work has been cut off. Some older people consider voluntary work as a way to replicate aspects of paid work lost upon retirement, such as organisational structure and time discipline. In many countries, volunteering of the older adults is increasing and programmes designed specifically for this subpopulation are emerging. Volunteering may contribute to both individuals aging well and society aging well, as volunteering by the older adults at the same time relieves the societal burden if it helps maintain health and functionality for those who volunteer. It thus remains to be established to what extent volunteering impacts on the physical and mental health of those who volunteer. Objectives: The main objective of this review is to answer the following research question: what are the effects of volunteering on the physical and mental health of people aged 65 years or older? Search Strategy: Relevant studies were identified through electronic searches of bibliographic databases, governmental and grey literature repositories, hand search in specific targeted journals, citation tracking, contact to international experts and internet search engines. The database searches were carried out to December 2018 and other resources were searched in September 2019 and October 2019. We searched to identify both published and unpublished literature. The searches were international in scope. Reference lists of included studies and relevant reviews were also searched. Selection Criteria: The intervention of interest was formal volunteering which can be described as voluntary, on-going, planned, helping behaviour that intend to increase the well-being of strangers, offers no monetary compensation and typically occurs within an organisational context. We included older people aged 65 or over who are engaged in formal voluntary work. The primary focus was on measures of physical and mental health. All study designs that used a well-defined control group were eligible for inclusion. Studies that utilised qualitative approaches were not included. Data Collection and Analysis: The total number of potential relevant studies constituted 17,046 hits. A total of 90 studies, met the inclusion criteria and were critically appraised by the review authors. The 90 studies analysed 47 different populations. Only 26 studies (analysing 19 different populations) could be used in the data synthesis. Forty-six studies could not be used in the data synthesis as they were judged to have too high risk of bias and, in accordance with the protocol, were excluded from the meta-analysis on the basis that they would be more likely to mislead than inform. Eighteen studies did not provide enough information enabling us to calculate an effects size and standard error or did not provide results in a form enabling us to use it in the data synthesis. Finally, of the 26 studies that could be used in the data synthesis, two pairs of studies used the same two data sets and reported on the same outcome(s), thus in addition two studies were not used in the data synthesis.Meta-analysis of both physical health outcomes and mental health outcomes were conducted on each metric separately. All analyses were inverse variance weighted using random effects statistical models that incorporate both the sampling variance and between study variance components into the study level weights. Random effects weighted mean effect sizes were calculated using 95% confidence intervals (CIs).Sensitivity analysis was carried out by restricting the meta-analysis to a subset of all studies included in the original meta-analysis and was used to evaluate whether the pooled effect sizes were robust across components of risk of bias. Results: The 24 studies (analysing 19 different populations), used for meta analysis were from Australia, Ireland, Israel, Japan, Korea and United States, three were a randomised controlled trial and 21 were NRS. The baseline time period (the year the voluntary work that was analysed was measured) spanned by the included studies is 30 years, from 1984 to 2014 and on average the baseline year was 2001. On average the number of follow up years was 5, although with great variation from 0 to 25 years. The average number of volunteers analysed (not reported in four studies) was 2,369, ranging from 15 to 27,131 and the average number of controls was 13,581, ranging from 13 to 217.297. In total the average number of participants analysed was 14,566, ranging from 28 to 244.428.Ten studies analysed the effect of voluntary work on mortality, however, eight studies reported a hazard ratio and two studies reported an odds ratio. We analysed these two types of effect sizes separately. A hazard ratio <1 indicates that the treated, the volunteers is favoured. That is, the conditional mortality rate is lower for volunteers. All reported results indicated an effect favouring the volunteers, primary study effect sizes lied in the range 0.67-0.91. The random effects weighted mean hazard ratio was 0.76 (95% CI, 0.72-0.80) and statistically significant. The two studies that reported odds ratios of mortality supported this result. There was no heterogeneity between the studies in either of the meta analyses.Three studies analysed the effect of voluntary work on incident functional disability, using a hazard ratio as effect measure. All reported results indicated an effect favouring the volunteers, primary study effect sizes lied in the range 0.70-0.99. The random effects weighted mean hazard ratio was 0.83 (95% CI, 0.72-0.97) and statistically significant. There was a small amount of heterogeneity between the studies.Two studies analysed the effect of voluntary work on decline in instrumental activities of daily living, using an odds ratio as effect measure. Both reported results indicated an effect favouring the volunteers (0.63 and 0.83). The random effects weighted mean odds ratio was 0.73 (95% CI, 0.53-1.01) and not statistically significant. There is no heterogeneity between the two studies.Three studies analysed the effect of voluntary work on maintenance of functional competence, using an odds ratio as effect measure. All reported results indicated an effect favouring the volunteers, primary study effect sizes lied in the range 0.67-0.83. The random effects weighted mean odds ratio was 0.81 (95% CI, 0.70-0.94) and statistically significant. There is no heterogeneity between the studies.In addition a number of other physical outcomes were reported in a single study only.Three studies analysed the effect of voluntary work on depression, and reported results that enabled the calculation of standardised mean difference (SMD) and variance. The effect sizes are measured such that a positive effect size favours the volunteers. All reported results indicated an effect favouring the volunteers, primary study effect sizes lied in the range 0.05-0.66. The random effects weighted SMD was 0.12 (95% CI, 0.00-0.23) and statistically significant. There is a very small amount of heterogeneity between the studies.In addition, a number of other mental health outcomes were reported in a single study only.We did not find any adverse effects.There were no appreciable changes in the results across components of risk of bias as indicated by the sensitivity analysis. Authors' Conclusions: The review aimed to examine effects on all types of physical and mental health outcomes. With the exception of mortality, there was insufficient evidence available. The available evidence, however, does suggest that there is an effect on the mortality of volunteers, although the effect is small. We found evidence that voluntary work reduces the mortality hazard of the volunteers aged 65 and above. The effect corresponds to a 43% chance of the volunteers dying first which should be compared to a fifty-fifty chance (50%) of dying first if the intervention had no effect. The evidence seems robust in the sense that we did not find any heterogeneity between the studies. As the intervention, unlike most other interventions in the social welfare area, is not costly, it could be prescribed to more older adults. In fact as the intervention in contrary to carrying a cost is a productive activity contributing directly to community well-being and has a positive effect on the volunteers it probably should be prescribed universally. However, due to the very nature of the intervention, it is voluntary and it cannot be prescribed. But more people could be encouraged to take up voluntary work if the opportunity was immediately available and visible.

Older Adults and Emerging Digital Service Delivery: A Mixed Methods Study on Information and Communications Technology Use, Skills, and Attitudes.

Based on data from a survey (n = 3291) and 14 qualitative interviews among Danish older adults, this study investigated the use of, and attitudes toward, information communications technology (ICT) and the digital delivery of public services. While age, gender, and socioeconomic status were associated with use of ICT, these determinants lost their explanatory power when we controlled for attitudes and experiences. We identified three segments that differed in their use of ICT and attitudes toward digital service delivery. As nonuse of ICT often results from the lack of willingness to use it rather than from material or cognitive deficiencies, policy measures for bridging the digital divide should focus on skills and confidence rather than on access or ability.

Driving Cessation Anno 2010: Which Older Drivers Give Up Their License and Why? Evidence From Denmark.

This study focuses on the decision to either stop or continue driving among a cohort of Danish seniors whose driving licenses expire, for the first time, at the age of 70. Based on 1,537 standardized telephone interviews with licensed drivers, we compared persons who intended to renew or not to renew their licenses. The results partly recapture the findings of earlier studies. However, in contrast to former cohorts, a much higher percentage of older drivers intended to keep their licenses. The strongest factors predicting the intention to renew were active car use, feeling safe as a driver, and not having illnesses that impaired driving ability. Three of these factors were strongly correlated with gender, indicating that efforts to prevent premature driving cessation should especially focus on increasing women's confidence and experience in driving.

Older drivers' reasons for reducing the overall amount of their driving and for avoiding selected driving situations.

Structured telephone interviews were conducted with 840 older drivers to explore their reasons for self-regulating their driving. The main reason for reduced driving was having fewer activities to drive to, and for avoidance of driving situations, reasons also included not liking or feeling insecure about driving in the situation. The lower-functioning participants, but still only a minority, were more likely to indicate decline in vision and reaction time as reasons for avoidance. Women were more likely to indicate lack of confidence as a reason for avoidance. The results suggest that the reduction in driving and avoidance of driving situations are separate types of self-regulatory behavior; that self-regulation of driving is an automatic process, in which older drivers are not aware that they are compensating for functional loss; and that it is important to acknowledge gender differences when designing interventions aimed at enhancing safe mobility.

Cognitive problems, self-rated changes in driving skills, driving-related discomfort and self-regulation of driving in old drivers.

Ageing in general is associated with functional decline that may have an adverse effect on driving. Nevertheless, older drivers have been found to show good judgement and to self-regulate their driving, which may enable them to continue driving safely despite functional decline. The process of the self-monitoring of driving ability and the awareness of functional decline, and its association with the self-regulation of driving is, however, not fully understood. The aim of the present study was to examine the perceived changes in driving skills, the discomfort experienced in driving, and the self-regulation of driving as measured by the avoidance of certain driving situations by older drivers with different levels of self-rated cognitive problems. Eight hundred and forty Danish drivers aged 75-95 completed a structured telephone interview. The results showed that the recognition of cognitive problems was associated with an experience of improvement in higher level driving skills but also of a decline in lower level driving skills. Moreover, cognitive problems recognised by drivers were associated with discomfort in, and avoidance of, driving situations. Finally, a linear relationship between discomfort in driving and avoidance was found and this tended to be stronger for drivers recognising cognitive problems. The results indicate that older drivers who recognise problems with cognitive functions display good self-assessment of changes in their driving skills. In addition, the results suggest that driving-related discomfort is an important factor affecting the self-regulation of driving. Finally, the findings indicate that driving-related discomfort functions as an indirect self-monitoring of driving ability and may contribute to the safe driving performance of Danish older drivers.

Cognitive screening of older drivers does not produce safety benefits.

Although screening policies for older drivers based on chronological age are widely used in many countries, previous research has shown that increasing age does not cause higher crash rates and that consequently, chronological age per se is at best only a weak predictor of safe driving performance. Previous research on age-based mandatory screening of older drivers has not been able to demonstrate any safety benefits from screening measures. The present study is a population-based evaluation of the safety effects that the introduction of the cognitive test as an age-based screening tool has had in Denmark. The primary data used came from the Danish road accident register. The present study compared the number of fatal accidents before and after the implementation of screening for cognitive impairment. There were two main findings. First, there was no statistically significant difference in the number of older drivers involved in fatal accidents before and after the implementation of the screening process, indicating that the screening had no effect on the safety of older drivers. Second, there was a significant increase in the number of unprotected older (but not younger) road users who were killed between the two periods of observation, suggesting that the screening process produced a modal shift among older persons from driving to unprotected, significantly less safe modes of transportation. As a consequence, the number of fatalities in this group increased. Older driver screening is an example of a political measure that intuitively makes sense, but fails to produce the desired benefits. On the contrary, on a system level, it decreases the overall safety and is connected to various direct and indirect costs.

Deconstructing a gender difference: driving cessation and personal driving history of older women.

PROBLEM: The purpose of this study is to understand the reasons behind older women's driving cessation by comparing the driving histories of Finnish women who either gave up or renewed their drivers license at the age of 70. METHOD: A mail survey was sent to all Finnish women born in 1927 who gave up their license in 1997 (N=1,476) and to a corresponding random sample of women who renewed their license (N=1,494). The total response rate was 42.1%. RESULTS: The length and level of activity of personal driving history were strongly associated with driving cessation and continuation. Ex-drivers tended to have an inactive driving career behind them, whereas drivers had a more active personal driving history. In addition, those women with an active, "male-like" driving history who had decided to stop driving gave reasons for driving cessation that were similar to what is known about older men's reasons to give up driving. The results suggest that the decision to stop driving is related to driving habits rather than gender.