Disparities in Coronavirus Disease 2019 Mortality by Country of Birth in Stockholm, Sweden: A Total-Population-Based Cohort Study.

Preliminary evidence points to higher morbidity and mortality from coronavirus disease 2019 (COVID-19) in certain racial and ethnic groups, but population-based studies using microlevel data are lacking so far. We used register-based cohort data including all adults living in Stockholm, Sweden, between January 31, 2020 (the date of the first confirmed case of COVID-19) and May 4, 2020 (n = 1,778,670) to conduct Poisson regression analyses with region/country of birth as the exposure and underlying cause of COVID-19 death as the outcome, estimating relative risks and 95% confidence intervals. Migrants from Middle Eastern countries (relative risk (RR) = 3.2, 95% confidence interval (CI): 2.6, 3.8), Africa (RR = 3.0, 95% CI: 2.2, 4.3), and non-Sweden Nordic countries (RR = 1.5, 95% CI: 1.2, 1.8) had higher mortality from COVID-19 than persons born in Sweden. Especially high mortality risks from COVID-19 were found among persons born in Somalia, Lebanon, Syria, Turkey, Iran, and Iraq. Socioeconomic status, number of working-age household members, and neighborhood population density attenuated up to half of the increased COVID-19 mortality risks among the foreign-born. Disadvantaged socioeconomic and living conditions may increase infection rates in migrants and contribute to their higher risk of COVID-19 mortality.

A population-based cohort study of socio-demographic risk factors for COVID-19 deaths in Sweden.

As global deaths from COVID-19 continue to rise, the world's governments, institutions, and agencies are still working toward an understanding of who is most at risk of death. In this study, data on all recorded COVID-19 deaths in Sweden up to May 7, 2020 are linked to high-quality and accurate individual-level background data from administrative registers of the total population. By means of individual-level survival analysis we demonstrate that being male, having less individual income, lower education, not being married all independently predict a higher risk of death from COVID-19 and from all other causes of death. Being an immigrant from a low- or middle-income country predicts higher risk of death from COVID-19 but not for all other causes of death. The main message of this work is that the interaction of the virus causing COVID-19 and its social environment exerts an unequal burden on the most disadvantaged members of society.

Neighbourhood Concentration and Representation of Non-European Migrants: New Results from Norway.

In a previous study, Andersson et al. (A comparative study of segregation patterns in Belgium, Denmark, the Netherlands and Sweden: neighbourhood concentration and representation of non-European migrants. Eur J Popul 34:1-25, 2018) compared the patterns of residential segregation between non-European immigrants and the rest of the population in four European countries, using the k-nearest neighbours approach to compute comparable measures of segregation. This approach relies on detailed geo-coded data and can be used to assess segregation levels at different neighbourhood scales. This paper updates these findings with results from Norway. Using similar data and methods, we document both similarities and striking differences between the segregation patterns in Norway and Belgium, Denmark, the Netherlands and Sweden. While the segregation patterns in Norway at larger scales are roughly comparable to those found in Denmark, but with higher concentrations of non-European immigrants in the most immigrant-dense large-scale neighbourhoods, the micro-level segregation is much lower in Norway than in the other countries. While an important finding by Andersson et al. (2018) was that segregation levels at the micro-scale of 200 nearest neighbours fell within a narrow band, with a dissimilarity index between 0.475 and 0.512 in the four countries under study, segregation levels at this scale are clearly lower in Norway, with a dissimilarity index of 0.429. We discuss possible explanations for these patterns.

Residential context and COVID-19 mortality among adults aged 70 years and older in Stockholm: a population-based, observational study using individual-level data.

BACKGROUND: Housing characteristics and neighbourhood context are considered risk factors for COVID-19 mortality among older adults. The aim of this study was to investigate how individual-level housing and neighbourhood characteristics are associated with COVID-19 mortality in older adults. METHODS: For this population-based, observational study, we used data from the cause-of-death register held by the Swedish National Board of Health and Welfare to identify recorded COVID-19 mortality and mortality from other causes among individuals (aged ≥70 years) in Stockholm county, Sweden, between March 12 and May 8, 2020. This information was linked to population-register data from December, 2019, including socioeconomic, demographic, and residential characteristics. We ran Cox proportional hazards regressions for the risk of dying from COVID-19 and from all other causes. The independent variables were area (m2) per individual in the household, the age structure of the household, type of housing, confirmed cases of COVID-19 in the borough, and neighbourhood population density. All models were adjusted for individual age, sex, country of birth, income, and education. FINDINGS: Of 279 961 individuals identified to be aged 70 years or older on March 12, 2020, and residing in Stockholm in December, 2019, 274 712 met the eligibility criteria and were included in the study population. Between March 12 and May 8, 2020, 3386 deaths occurred, of which 1301 were reported as COVID-19 deaths. In fully adjusted models, household and neighbourhood characteristics were independently associated with COVID-19 mortality among older adults. Compared with living in a household with individuals aged 66 years or older, living with someone of working age (<66 years) was associated with increased COVID-19 mortality (hazard ratio 1·6; 95% CI 1·3-2·0). Living in a care home was associated with an increased risk of COVID-19 mortality (4·1; 3·5-4·9) compared with living in independent housing. Living in neighbourhoods with the highest population density (≥5000 individuals per km2) was associated with higher COVID-19 mortality (1·7; 1·1-2·4) compared with living in the least densely populated neighbourhoods (0 to <150 individuals per km2). INTERPRETATION: Close exposure to working-age household members and neighbours is associated with increased COVID-19 mortality among older adults. Similarly, living in a care home is associated with increased mortality, potentially through exposure to visitors and care workers, but also due to poor underlying health among care-home residents. These factors should be considered when developing strategies to protect this group. FUNDING: Swedish Research Council for Health, Working Life and Welfare (FORTE), Swedish Foundation for Humanities and Social Sciences.

Residential Segregation of European and Non-European Migrants in Sweden: 1990-2012.

In this paper, we analyse how a migrant population that is both expanding and changing in composition has affected the composition of Swedish neighbourhoods at different scales. The analysis is based on Swedish geocoded individual-level register data for the years 1990, 1997, 2005, and 2012. This allows us to compute and analyse the demographic composition of neighbourhoods that range in size from encompassing the nearest 100 individuals to the nearest 409,600 individuals. First, the results confirm earlier findings that migrants, especially those from non-European countries, face high levels of segregation in Sweden. Second, large increases in the non-European populations in combination with high levels of segregation have increased the proportion of non-European migrants living in neighbourhoods that already have high proportions of non-European migrants. Third, in contrast to what has been the established image of segregation trends in Sweden, and in an apparent contrast to the finding that non-European migrants increasingly live in migrant-dense neighbourhoods, our results show that segregation, when defined as an uneven distribution of different populations across residential contexts, is not increasing. On the contrary, for both European migrants from 1990 and non-European migrants from 1997, there is a downward trend in unevenness as measured by the dissimilarity index at all scale levels. However, if segregation is measured as differences in the neighbourhood concentration of migrants, segregation has increased.

A Comparative Study of Segregation Patterns in Belgium, Denmark, the Netherlands and Sweden: Neighbourhood Concentration and Representation of Non-European Migrants.

In this paper, we use geo-coded, individual-level register data on four European countries to compute comparative measures of segregation that are independent of existing geographical sub-divisions. The focus is on non-European migrants, for whom aggregates of egocentric neighbourhoods (with different population counts) are used to assess small-scale, medium-scale, and large-scale segregation patterns. At the smallest scale level, corresponding to neighbourhoods with 200 persons, patterns of over- and under-representation are strikingly similar. At larger-scale levels, Belgium stands out as having relatively strong over- and under-representation. More than 55% of the Belgian population lives in large-scale neighbourhoods with moderate under- or over-representation of non-European migrants. In the other countries, the corresponding figures are between 30 and 40%. Possible explanations for the variation across countries are differences in housing policies and refugee placement policies. Sweden has the largest and Denmark the smallest non-European migrant population, in relative terms. Thus, in both migrant-dense and native-born-dense areas, Swedish neighbourhoods have a higher concentration and Denmark a lower concentration of non-European migrants than the other countries. For large-scale, migrant-dense neighbourhoods, however, levels of concentration are similar in Belgium, the Netherlands, and Sweden. Thus, to the extent that such concentrations contribute to spatial inequalities, these countries are facing similar policy challenges.

Multi-scalar residential context and recovery from illness: An analysis using Swedish register data.

The aim of this paper is to analyse if recovery from ill-health is influenced by geographical context using a multi-scalar approach to context measurement and Swedish longitudinal register-based data on sickness benefit recipiency as an indicator of onset of and recovery from illness. Our sample consists of individuals that have stayed healthy and in work for a three-year period (2000-2002) and then falls ill during the fourth year (2003), some of who recover to good health in the fifth year (2004). The results show that in areas with above-average percentages of people receiving sickness-benefit there is a reduced probability of recovery. In contrast, high levels of employment in the neighbourhood and in the local area have a positive effect on the chances of recovery. These contextual effects are statistically significant but relatively weak in comparison to the influence of individual level factors such as age, sex, marital status, and income. Our conclusion is that individualised scalable neighbourhoods constitute a potentially valuable addition to the toolbox used in neighbourhood effect studies.

Comparing changes in late-life depressive symptoms across aging, disablement, and mortality processes.

Developmental processes are inherently time-related, with various time metrics and transition points being used to proxy how change is organized with respect to the theoretically underlying mechanisms. Using data from 4 Swedish studies of individuals aged 70-100+ (N = 453) who were measured every 2 years for up to 5 waves, we tested whether depressive symptoms (according to the Center for Epidemiologic Studies Depression Scale; Radloff, 1977) are primarily driven by aging-, disablement-, or mortality-related processes, as operationally defined by time-from-birth, time-to/from-disability-onset (1st reported impairment in Personal Activities of Daily Living; Katz, Ford, Moskowitz, Jackson, & Jaffe, 1963), and time-to-death metrics. Using an approach based on Akaike weights, we tested whether developmental trajectories (for each time metric) of depressive symptoms in late life are more efficiently described as a single continuous process or as a 2-phase process. Comparing fits of linear and multiphase growth models, we found that 2-phase models demonstrated better fit than did single-phase models across all time metrics. Time-to-death and time-to/from-disability-onset models provided more efficient descriptions of changes in depressive symptoms than did time-from-birth models, with time-to-death models representing the best overall fit. Our findings support prior research that late-life changes in depressive symptoms are driven by disablement and, particularly, mortality processes, rather than advancing chronological age. From a practical standpoint, time-to/from-disability-onset and, particularly, time-to-death metrics may provide better "base" models from which to examine changes in late-life depressive symptoms and determine modifiable risk and protective factors. Developmental researchers across content areas can compare age with other relevant time metrics to determine if chronological age or other processes drive the underlying developmental change in their construct of interest.

Aging in Sweden: local variation, local control.

Aging in Sweden has been uniquely shaped by its history-most notably the long tradition of locally controlled services for older adults. We considered how local variations and local control shape the experience of aging in Sweden and organized the paper into 3 sections. First, we examine aging in Sweden along demography, economy, and housing. Next, we trace the origins and development of the Swedish welfare state to consider formal supports (service provision) and informal supports (caregiving and receipt of care). Finally, we direct researchers to additional data resources for understanding aging in Sweden in greater depth. Sweden was one of the first countries to experience rapid population aging. Quality of life for a majority of older Swedes is high. Local control permits a flexible and adaptive set of services and programs, where emphasis is placed on improving the quality and targeting of services that have already reached a plateau as a function of population and expenditures.

Behavioral correlates of depressive symptoms in older unlike-sex twin pairs.

BACKGROUND AND AIMS: This study examines gender-specific behavioral correlates of depressive symptoms using a secondary data analysis of a cross-sectional, population-based sample of older unlike-sex twins. METHODS: Unlike-sex twins aged 69-88 were identified through a national Swedish registry and sent a survey about health, including depressive symptoms (CES-D) and the frequency of engaging in physical, social and mental activities. A total of 605 complete twin pairs responded. RESULTS: Depressive symptom scores were associated with frequency of engagement in physical and mental activities, but only in men. No statistically significant associations with depressive symptom scores for any of the three types of activities were found in women. CONCLUSIONS: The results suggest that engaging in physical and mental activities may protect older men from developing depressive symptoms, but longitudinal data are needed to offer more conclusive findings on the role that physical, mental, and social activities play in the maintenance of psychological health in older men and women.

Sortilin receptor 1 predicts longitudinal cognitive change.

The gene encoding sortilin receptor 1 (SORL1) has been associated with Alzheimer's disease risk. We examined 15 SORL1 variants and single nucleotide polymorphism (SNP) set risk scores in relation to longitudinal verbal, spatial, memory, and perceptual speed performance, testing for age trends and sex-specific effects. Altogether, 1609 individuals from 3 population-based Swedish twin studies were assessed up to 5 times across 16 years. Controlling for apolipoprotein E genotype (APOE), multiple simple and sex-moderated associations were observed for spatial, episodic memory, and verbal trajectories (p = 1.25E-03 to p = 4.83E-02). Five variants (rs11600875, rs753780, rs7105365, rs11820794, rs2070045) were associated across domains. Notably, in those homozygous for the rs2070045 risk allele, men demonstrated initially favorable performance but accelerating declines, and women showed overall lower performance. SNP set risk scores predicted spatial (Card Rotations, p = 5.92E-03) and episodic memory trajectories (Thurstone Picture Memory, p = 3.34E-02), where higher risk scores benefited men's versus women's performance up to age 75 but with accelerating declines. SORL1 is associated with cognitive aging, and might contribute differentially to change in men and women.

IGEMS: the consortium on Interplay of Genes and Environment across Multiple Studies.

The Interplay of Genes and Environment across Multiple Studies (IGEMS) group is a consortium of eight longitudinal twin studies established to explore the nature of social context effects and gene-environment interplay in late-life functioning. The resulting analysis of the combined data from over 17,500 participants aged 25-102 at baseline (including nearly 2,600 monogygotic and 4,300 dizygotic twin pairs and over 1,700 family members) aims to understand why early life adversity, and social factors such as isolation and loneliness, are associated with diverse outcomes including mortality, physical functioning (health, functional ability), and psychological functioning (well-being, cognition), particularly in later life.

Needs and care of older people living at home in Iceland.

BACKGROUND: The Icelandic old-age care system is universal and the official goal is to support older people live independently for as long as possible. The aim of this study is to analyse living conditions and use of formal and informal care of older people in Iceland. METHODS: The results are based on the new study ICEOLD, a telephone survey which included questions on social network, health, activities of daily living, and received support from the community and/or from relatives, neighbours, and friends. RESULTS: Almost half of the sample (47%) receives some kind of care, with 27% of them receiving only informal care, which is understood to mean that informal care is of great importance and families are the main providers of help. For hypothetical future long-term care, older people wish to be cared for in their homes, but those already in need of assistance prefer to be cared for in institutions. DISCUSSION: Caring relatives are the main providers of support to older people in their homes and it is important to provide them with suitable formal support when the care responsibility increases. CONCLUSIONS: As the care system in Iceland is now under reconstruction, the important contribution of informal carers must be recognised and taken into account when planning the care of older people.

Changes in depressive symptoms in the context of disablement processes: role of demographic characteristics, cognitive function, health, and social support.

OBJECTIVES: Gerontological research suggests that depressive symptoms show antecedent and consequent relations with late-life disability. Less is known, however, about how depressive symptoms change with the progression of disability-related processes and what factors moderate such changes. METHODS: We applied multiphase growth models to longitudinal data pooled across 4 Swedish studies of very old age (N = 779, M age = 86 years at disability onset, 64% women) to describe change in depressive symptoms prior to disability onset, at or around disability onset (the measurement wave at which assistance in personal activities of daily living was first recorded), and postdisability onset. RESULTS: Results indicate that, on average, depressive symptoms slightly increase with approaching disability, increase at onset, and decline in the postdisability phase. Age, study membership, being a woman, and multimorbidity were related to depressive symptoms, but social support emerged as the most powerful predictor of level and change in depressive symptoms. DISCUSSION: Our findings are consistent with conceptual notions implicating disability-related factors as key contributors to late-life change and suggest that contextual and psychosocial factors play a pivotal role for how well people adapt to late-life challenges.

La diversificación y consolidación de los servicios sociales para las personas mayores en España y Suecia / Diversification and strengthening of services for older people in Spain and Sweden

La información sobre los servicios públicos para las personas mayores a menudo se limita a la atención residencial y a la ayuda a domicilio. Sin embargo, estos servicios básicos son en muchos países complementados o sustituidos por otros servicios de menor envergadura, como el transporte, comidas a domicilio, teleasistencia y centros de día. Esta diversificación partió de un racionamiento de los servicios para lograr una asignación más racional de los recursos y, si se podía, un menor gasto. En este trabajo se utilizan diversos datos sobre estos servicios en España y Suecia. Cuando se consideran todos los cuidados, la cobertura de atención es mucho mayor que si sólo se contemplan los servicios básicos. Esto indica una mayor consolidación de los mismos. Los datos sugieren mayor focalización en Suecia, y prestaciones fragmentadas en España, donde parece que los usuarios alcanzan lo disponible, con poca diferenciación entre sus necesidades. Cuando las tasas de cobertura son superiores, como en Suecia, hay mayor solapamiento entre el cuidado familiar y los servicios públicos. Con tasas más bajas, como en España, los cuidados familiares y los servicios públicos son sustitutos unos de otros. Se sugiere que una mayor diversidad de servicios, básicos y secundarios, puede adaptarse mejor y de manera más eficiente a las diversas necesidades de las personas mayores que la elección entre ningún servicio, ayuda domiciliaria o atención residencial. Aunque estos servicios secundarios también puedan ser utilizados como un sustituto de bajo coste, e inferior calidad, en la atención(AU)

Information on public services for older people is often limited to institutional care and Home Help/Home Care, be it for individuals in surveys, statistics for a specific country or for international comparisons. Yet, these two major services are in many countries supplemented – or substituted – by other, minor services. The latter include services such as transportation services, meals-on-wheels, alarm systems and day care. This diversification is the outcome of a rationing of services to achieve a more rational allocation of resources and attempts to keep down costs. In this presentation we use various data sources to provide information on all these types of support for Spain and Sweden. When all of them are considered, service coverage is much higher than by basic services alone, indicating further consolidation of services. Data suggests a high targeting in Sweden, but fragmented delivery in Spain, where – we suspect - users get what is available, with little differentiation between needs. With higher service rates, as in Sweden, there is greater overlap between family care and public services; with lower coverage rates, as in Spain, family care and public services are more often substituted for each other. It is suggested that a range of services, major and minor, may suit the varying needs of older people better – and more efficiently - than the choice between nothing, Home Help or institutional care, but that minor services may also be used as an inexpensive – and sometimes inferior - substitute for full support(AU)

KUD--a scale for clinical evaluation of moderate-to-severe dementia.

AIM: To develop a test of cognitive performance in persons with moderate-to-severe dementia. BACKGROUND: Various instruments are used to assess the course of dementia and to evaluate treatments in persons with dementia. Most neuropsychological assessments are inappropriate for measuring cognitive abilities in persons with severe dementia, because these persons perform at floor level in such measurements. DESIGN: A cross-sectional research design. METHODS: The test (Clinical Evaluation of Moderate-to-Severe Dementia; Swedish acronym: KUD) was developed from a pool of 25 test items with the final KUD consisting of 15 items. Reliability and validity were established using 220 subjects (with various dementia diagnoses) with scores of Mini-Mental State Examination between 0-20. Approximately two weeks after the first test, 116 of the original 220 subjects were retested. RESULTS: A factor analysis with the 15-item scale revealed an interaction factor comprising three items and a cognitive performance factor with 12 items. The internal consistence reliability was 0·93 for the KUD (Cronbach's alpha). Test-retest reliability was also high (0·92) and correlation between the KUD and the MMSE (≤20) was high (r=0·80). CONCLUSION: The KUD seems to be a valid, reliable performance-based assessment scale for measuring cognitive performance in persons with MMSE score below 12 or 15 points. RELEVANCE TO CLINICAL PRACTICE: It is of outmost interest that cognitive performance can be easily followed for persons with moderate-to-severe dementia in, for example, drug therapies and other therapies, but also in terms of treatment of and support to the person based on his or her abilities.

[Diversification and strengthening of services for older people in Spain and Sweden]. / La diversificación y consolidación de los servicios sociales para las personas mayores en España y Suecia.

Information on public services for older people is often limited to institutional care and Home Help/Home Care, be it for individuals in surveys, statistics for a specific country or for international comparisons. Yet, these two major services are in many countries supplemented - or substituted - by other, minor services. The latter include services such as transportation services, meals-on-wheels, alarm systems and day care. This diversification is the outcome of a rationing of services to achieve a more rational allocation of resources and attempts to keep down costs. In this presentation we use various data sources to provide information on all these types of support for Spain and Sweden. When all of them are considered, service coverage is much higher than by basic services alone, indicating further consolidation of services. Data suggests a high targeting in Sweden, but fragmented delivery in Spain, where - we suspect-users get what is available, with little differentiation between needs. With higher service rates, as in Sweden, there is greater overlap between family care and public services; with lower coverage rates, as in Spain, family care and public services are more often substituted for each other. It is suggested that a range of services, major and minor, may suit the varying needs of older people better - and more efficiently-than the choice between nothing, Home Help or institutional care, but that minor services may also be used as an inexpensive - and sometimes inferior-substitute for full support.

End-of-life care in the oldest old.

OBJECTIVE: The aim of this study was to describe the last year of life of a sample of the oldest old, focusing on care trajectories, health, social networks, and function in daily life activities. METHOD: Data originated from the NONA study, a longitudinal study of 193 individuals among the oldest old living in a Swedish municipality. During this longitudinal study, 109 participants died. Approximately one month after their death, a relative was asked to participate in a telephone interview concerning their relative's last year of life. One hundred two relatives agreed to participate. RESULTS: Most of the elderly in this sample of the oldest old (74.5%) died at an institution and the relatives were mostly satisfied with the end-of-life care. The oldest old relatives estimated that the health steadily declined during the last year of life, and that there was a decline in performing of daily life activities. They also estimated that those dying in institutions had fewer social contacts than those dying in a hospital or at home. SIGNIFICANCE OF RESULTS: Care at end of life for the oldest old is challenged by problems with progressive declines in ability to perform activities of daily living and health. The findings also highlight the need to support social networks at eldercare institutions.

La soledad de las personas mayores en España y Suecia: contexto y cultura / Loneliness among the Elderly in Spain and Sweden: context and Culture

Introducción. Históricamente, las personas mayores españolas y de países del sur de Europa manifiestan índices de soledad percibida muy superiores a los de los países nórdicos. Estudios desde los años 70 hasta ahora confirman esta paradoja. Este estudio analiza la soledad como producto de expectativas culturales y contextuales comparando datos de España y Suecia. Material y método. Se revisarán todas las encuestas en España y Suecia sobre soledad de las personas mayores y en especial, la Encuesta de Condiciones de Vida de 2006 para España y la Encuesta Nacional de 2002–03 para Suecia. Resultados. En promedio, un 24% de los mayores en España y un 10% de los mayores en Suecia expresan soledad (encuestas 2006 y 2002–03, respectivamente). La estructura del hogar y la salud percibida son efectos determinantes de la soledad en ambos países, aunque los niveles difieren. Los mayores con buena salud que viven solos son 5 veces más propensos a sentirse solos en España (45%) que en Suecia (9%) y 2–3 veces más probable cuando viven solos y con mala salud (82–32%). Y para los mayores que conviven con su pareja sin otros y con buena salud es igual de infrecuente en España y en Suecia que experimenten soledad (4–5%) y si surge, parece que tiene que ver con el hecho de cuidar al compañero o con problemas en la relación. Conclusiones. Los resultados destacan los aspectos contextuales (la salud y la estructura del hogar) y las expectativas culturales para entender la soledad manifestada por los mayores(AU)

Objectives. Older people in Spain and other Southern European countries are reported to feel lonelier than the older people in the North of Europe. Data from the 1970s and onwards consistently show this. The present study explores feelings of loneliness as a product of both cultural and situational determining factors, by comparing survey data for Spain and Sweden. Material and method. Data derived from several national surveys of the older people in Spain and Sweden with questions about loneliness. For closer analysis we use the Spanish 2006 Encuesta de Condiciones de Vida (Living conditions Questionnaire), and the Swedish 2002–2003 Survey of Living Conditions. Results. On average, 24% of older people in Spain and 10% of elderly Swedish people expressed sentiments of loneliness in the surveys used here (2006 and 2002-03 respectively). Living arrangements and perceived health are related with factors of loneliness in both countries, although levels differ. For example, people in good health who live alone are five times more likely to feel lonely in Spain (45%) than in Sweden (9%) and two-three times more likely when living alone in poor health (82% and 32% respectively). People in good health who live with their spouse/partner only are equally unlikely in both Spain and Sweden to express loneliness (4–5%). It often seems — when it occurs — to be due to caring for a spouse/partner, or problems in the relationship. Conclusions. Results highlight the importance of contextual features — health and living arrangements — and cultural expectations in interpreting reported loneliness(AU)

[Loneliness among the elderly in Spain and Sweden: context and culture]. / La soledad de las personas mayores en España y Suecia: contexto y cultura.

OBJECTIVES: Older people in Spain and other Southern European countries are reported to feel lonelier than the older people in the North of Europe. Data from the 1970s and onwards consistently show this. The present study explores feelings of loneliness as a product of both cultural and situational determining factors, by comparing survey data for Spain and Sweden. MATERIAL AND METHOD: Data derived from several national surveys of the older people in Spain and Sweden with questions about loneliness. For closer analysis we use the Spanish 2006 Encuesta de Condiciones de Vida (Living conditions Questionnaire), and the Swedish 2002-2003 Survey of Living Conditions. RESULTS: On average, 24% of older people in Spain and 10% of elderly Swedish people expressed sentiments of loneliness in the surveys used here (2006 and 2002-03 respectively). Living arrangements and perceived health are related with factors of loneliness in both countries, although levels differ. For example, people in good health who live alone are five times more likely to feel lonely in Spain (45%) than in Sweden (9%) and two-three times more likely when living alone in poor health (82% and 32% respectively). People in good health who live with their spouse/partner only are equally unlikely in both Spain and Sweden to express loneliness (4-5%). It often seems--when it occurs--to be due to caring for a spouse/partner, or problems in the relationship. CONCLUSIONS: Results highlight the importance of contextual features--health and living arrangements--and cultural expectations in interpreting reported loneliness.