Differences in out-of-pocket costs of healthcare in the last year of life of older people in 13 European countries.

BACKGROUND: Research on the costs of healthcare provision has so far focused on insurer costs rather than out-of-pocket costs. Out-of-pocket costs may be important to patients making medical decisions. AIM: To investigate the self-reported out-of-pocket costs associated with healthcare in the last year of life of older adults in Europe. DESIGN: A post-death survey, part of the Survey of Health, Ageing, and Retirement in Europe, completed by proxy respondents in four waves from 2005 to 2012. SETTING/PARTICIPANTS: Proxy respondents for 2501 deceased adults of 55 years or over. Data from 13 European countries and four waves from 2005 to 2012 were used. RESULTS: The proportion of people with out-of-pocket costs ranged from 21% to 96% in different European Union countries. Out-of-pocket costs ranged from 2% to 25% of median household income. Secondary and institutional care was most often the largest contributor to out-of-pocket costs, with care received in a care home being the most expensive type of care in 11 of 13 countries. Multilevel analyses showed that limitations in more than two activities of daily living (coefficient = 6.47, 95% confidence interval = 1.81-11.14) and a total hospitalization time of 3-6 months (coefficient = 14.66; 95% confidence interval = 0.97-28.35) or more than 6 months (coefficient = 31.01; 95% confidence interval = 11.98-50.15) were associated with higher out-of-pocket costs. In total, 24% of the variance on a country level remained unexplained. CONCLUSION: Variation in out-of-pocket costs for healthcare in the last year of life between European countries indicates that countries face different challenges in making healthcare in the last year of life affordable for all.

Self-perceived health in older Europeans: Does the choice of survey matter?

BACKGROUND: Cross-national comparisons of health in European countries provide crucial information to monitor health and disease within and between countries and to inform policy and research priorities. However, variations in estimates might occur when information from cross-national European surveys with different characteristics are used. We compared the prevalence of very good or good self-perceived health across 10 European countries according to three European surveys and investigated which survey characteristics contributed to differences in prevalence estimates. METHODS: We used aggregate data from 2004 to 2005 of respondents aged 55-64 years from the European Union Statistics on Income and Living Conditions (EU-SILC), the Survey of Health, Ageing and Retirement in Europe (SHARE) and the European Social Survey (ESS). Across the surveys, self-perceived health was assessed by the same question with response options ranging from very good to very bad. RESULTS: Despite a good correlation between the surveys (intraclass correlation coefficient: 0.77), significant differences were found in prevalence estimates of very good or good self-perceived health. The survey response, sample size and survey mode contributed statistically significantly to the differences between the surveys. Multilevel linear regression analyses, adjusted for survey characteristics, showed a higher prevalence for SHARE (+6.96, 95% CIs: 3.14 to 10.8) and a lower prevalence (-3.12; 95% CIs: -7.11 to 0.86) for ESS, with EU-SILC as the reference survey. CONCLUSION: Three important health surveys in Europe showed substantial differences for presence of very good or good self-perceived health. These differences limit the usefulness for direct comparisons across studies in health policies for Europe.

Social participation and depression in old age: a fixed-effects analysis in 10 European countries.

We examined whether changes in different forms of social participation were associated with changes in depressive symptoms in older Europeans. We used lagged individual fixed-effects models based on data from 9,068 persons aged ≥50 years in wave 1 (2004/2005), wave 2 (2006/2007), and wave 4 (2010/2011) of the Survey of Health, Ageing and Retirement in Europe (SHARE). After we controlled for a wide set of confounders, increased participation in religious organizations predicted a decline in depressive symptoms (EURO-D Scale; possible range, 0-12) 4 years later (ß = -0.190 units, 95% confidence interval: -0.365, -0.016), while participation in political/community organizations was associated with an increase in depressive symptoms (ß = 0.222 units, 95% confidence interval: 0.018, 0.428). There were no significant differences between European regions in these associations. Our findings suggest that social participation is associated with depressive symptoms, but the direction and strength of the association depend on the type of social activity. Participation in religious organizations may offer mental health benefits beyond those offered by other forms of social participation.

Providing personal informal care to older European adults: should we care about the caregivers' health?

OBJECTIVE: In Europe, the demand for informal care is high and will increase because of the ageing population. Although caregiving is intended to contribute to the care recipient's health, its effects on the health of older European caregivers are not yet clear. This study explores the association between providing informal personal care and the caregivers' health. METHOD: Data were used from the longitudinal cohort (2004/2005-2010/2011) of the Survey of Health, Ageing and Retirement in Europe (SHARE) (n=7858). Generalized estimating equations were used to explore the longitudinal association of informal care and the caregiver's health using poor self-rated health (less than good), poor mental health (EURO-D score for depression ≥4), and poor physical health (≥2 health complaints). RESULTS: Providing informal personal care was significantly associated with poor mental health (OR=1.23, 95% CI=1.04-1.47) and poor physical health (OR=1.18, 95% CI=1.01-1.38), after adjusting for various socio-demographic and health-related factors. No statistical significant association was found for self-rated health in the adjusted models. CONCLUSION: Providing informal personal care may negatively influence the caregiver's mental and physical health. More awareness of the beneficial and detrimental effects of caregiving among policy makers is needed to make well-informed decisions concerning the growth of care demands in the ageing population.

Psychometric properties and confirmatory factor analysis of the CASP-19, a measure of quality of life in early old age: the HAPIEE study.

OBJECTIVES: The aim was to assess the reliability and validity of the quality of life (QoL) instrument CASP-19, and three shorter versions of CASP-12 in large population sample of older adults from the HAPIEE (Health, Alcohol, and Psychosocial factors In Eastern Europe) study. METHODS: From the Czech Republic, Russia, and Poland, 13,210 HAPIEE participants aged 50 or older completed the retirement questionnaire including CASP-19 at baseline. Three shorter 12-item versions were also derived from original 19-item instrument. Psychometric validation used confirmatory factor analysis, Cronbach's alpha, Pearson's correlation, and construct validity. RESULTS: The second-order four-factor model of CASP-19 did not provide a good fit to the data. Two-factor CASP-12v.3 including residual covariances for negative items to account for the method effect of negative items had the best fit to the data in all countries (CFI = 0.98, TLI = 0.97, RMSEA = 0.05, and WRMR = 1.65 in the Czech Republic; 0.96, 0.94, 0.07, and 2.70 in Poland; and 0.93, 0.90, 0.08, and 3.04 in Russia). Goodness-of-fit indices for the two-factor structure were substantially better than second-order models. CONCLUSIONS: This large population-based study is the first validation study of CASP scale in Central and Eastern Europe (CEE), which includes a general population sample in Russia, Poland, and the Czech Republic. The results of this study have demonstrated that the CASP-12v.3 is a valid and reliable tool for assessing QoL among adults aged 50 years or older. This version of CASP is recommended for use in future studies investigating QoL in the CEE populations.

Poor health, unhealthy behaviors, and unfavorable work characteristics influence pathways of exit from paid employment among older workers in Europe: a four year follow-up study.

OBJECTIVES: The aim of this study was to get insight into the role of poor health, unhealthy behaviors, and unfavorable work characteristics on exit from paid employment due to disability pension, unemployment, and early retirement among older workers. METHODS: Respondents of the longitudinal Survey of Health, Ageing, and Retirement in Europe (SHARE) in 11 European countries were selected when (i) aged between 50 years and the country-specific retirement age, (ii) in paid employment at baseline, and (iii) having information on employment status during the 4-year follow-up period (N=4923). Self-perceived health, health behaviors, and physical and psychosocial work characteristics were measured by interview at baseline. Employment status was derived from follow-up interviews after two and four years. Cox proportional hazards regression analyses were used to identify determinants of unemployment, disability pension, and early retirement. RESULTS: Poor health was a risk factor for disability pension [hazard ratio (HR) 3.90, 95% confidence interval (95% CI) 2.51-6.05], and a lack of physical activity was a risk factor for disability pension (HR 3.05, 95% CI 1.68-5.55) and unemployment (HR 1.84, 95% CI 1.13-3.01). A lack of job control was a risk factor for disability pension, unemployment, and early retirement (HR 1.30-1.77). CONCLUSIONS: Poor health, a lack of physical activity, and a lack of job control played a role in exit from paid employment, but their relative importance differed by pathway of labor force exit. Primary preventive interventions focusing on promoting physical activity as well as increasing job control may contribute to reducing premature exit from paid employment.

Do positive or negative experiences of social support relate to current and future health? Results from the Doetinchem Cohort Study.

BACKGROUND: Cross-sectional studies have reported associations between social support and health, but prospective evidence is less conclusive. This study aims to investigate the associations of positive and negative experiences of social support with current and future lifestyle factors, biological risk factors, self-perceived health and mental health over a 10-year period. METHODS: Data were from 4,724 Dutch men and women aged 26-65 years who participated in the second (1993-1997) and in the third (1998-2002) or fourth (2003-2007) study round of the Doetinchem Cohort Study. Social support was measured at round two using the Social Experiences Checklist. Health was assessed by several indicators such as smoking, alcohol consumption, physical activity, fruit and vegetable intake, overweight, hypertension, hypercholesterolemia, self-perceived health and mental health. Tertiles of positive and negative experiences of social support were analysed in association with repeated measurements of prevalence and incidence of several health indicators using generalised estimating equations (GEE). RESULTS: Positive and negative experiences of social support were associated with prevalence and incidence of poor mental health. For the lowest tertile of positive support, odds ratios were 2.74 (95% CI 2.32-3.23) for prevalent poor mental health and 1.86 (95% CI 1.39-2.49) for incident poor mental health. For the highest tertile of negatively experienced support, odds ratios for prevalent and incident poor mental health were 3.28 (95% CI 2.78-3.87) and 1.60 (95% CI 1.21-2.12), respectively. Low levels of positive experiences of social support were also associated with low current intake of fruits and vegetables, but not with future intake. Negative experiences of social support were additionally associated with current smoking, physical inactivity, overweight and poor self-perceived health. Furthermore, high levels of negative experiences of social support were associated with future excessive alcohol consumption (OR 1.42; 95% CI 1.10-1.84), physical inactivity (95% CI 1.28; 1.03-1.58) and poor self-perceived health (OR 1.36; 95% CI 1.01-1.82). CONCLUSIONS: This study showed that social support might have a beneficial effect on lifestyle and health, with negative experiences of social support affecting lifestyle and health differently from positive experiences of social support.