Findings

Research field:
Health and well-being

Review of Healthy Life Years indicators

The first deliverable for the Health and well-being research field is a review of the variety in levels of, and trends in, healthy life expectancy (PDF, 4.5MB) and important health indicators for older people in 27 EU countries at three ages, 50, 65 and 85 years, and for both men and women.

Determinants of social involvement in older people with poor health

The second deliverable explores determinants of social involvement in older people with poor health. To increase older people’s participation is an important goal of current policy, stressed for example by the 2012 European Year of Active Ageing (European Commission, 2012). Participation is a broad concept, encompassing both activities that have economic value (such as volunteering, labour market participation and caregiving) and activities that are more consumptive. Both types of activities may have a strong positive impact on older people’s health and well-being.

Older people in better health generally participate more than those in poorer health. Given the current trend of demographic ageing and thus an increasing prevalence of chronic diseases and multimorbidity (the co-existence of two or more chronic diseases), there is a need to develop strategies that promote the social participation of people with chronic diseases in particular. So far, little evidence exists on the specific determinants of participation in those with poor health.

The studies in this task address determinants of six different types of social participation:

  1. Volunteering

  2. Caregiving

  3. Labour market participation

  4. Participation in educational activities

  5. Participation in social and physical leisure activities

  6. Religious participation

The studies focus specifically on differences between groups with and without multimorbidity. Five of the studies use individual level data from SHARE (Survey of Health, Ageing and Retirement in Europe), and one is based on individual level data from EPOSA (European Project on Osteoarthritis).

Findings

Across types of participation, findings show considerable differences in the level of participation between those with and without multimorbidity, in favour of the group in better health. However, determinants of social participation appeared to be quite similar between those with and without multimorbidity. In both groups, and across the different types of participation, factors that were associated with a higher level of participation included a higher socioeconomic status, a larger social network, being active in other types of participation (but not labour market participation) and having better physical and psychological health.

If differences were observed between multimorbidity groups, this was often related to opportunity structures (for example indicated by income level, home ownership) being more important for the participation of those without multimorbidity, as compared to the older people with multimorbidity. At the same time, findings indicated that transportation possibility was more relevant for the level of leisure participation of those with multimorbidity.

Other findings were quite specific for the type of social participation. For example, being married in those with multimorbidity was associated with a higher level of caregiving, but with a lower level of volunteering activity. Also, mental health problems affected labour market participation to a greater extent in those with multimorbidity than in their healthy peers.

Overall, the reports show that health status does influence older people’s level of participation, but the level of health should only be a minor factor in designing intervention strategies. Each paper discusses the specific results in light of previous findings, and considers policy implications for increasing older people’s social participation.

Fostering social participation of older people with health limitations

The third finding focuses on the infrastructure for social participation of older people with health limitations on the meso‐level. The goal of this report was to provide information about the success factors, barriers and preconditions of current initiatives that foster social participation of older people with health limitations. Research was undertaken in four countries representing different European welfare regime types: the conservative (Austria), Former USSR (Estonia), the post‐communist (Poland) and social democratic (Netherlands).

The summary report is available in English (PDF, 293KB) and Dutch (PDF, 158KB).

National reports are available (in English) for each of the four research countries.

Policies that facilitate social involvement in older people with poor health

The fourth report provides information about macro-level policies that foster health and social involvement of people with health limitations, in selected countries, chosen to represent different welfare regimes in Europe: the conservative (Austria), the southern European (Italy), the post-communist (Poland) and the social democratic (Netherlands).

The summary report is available in English (PDF, 169KB) and Dutch (PDF, 96KB).

National reports are available (in English) for each of the four research countries.

A scenario analysis

The continued growth of the older population and relatively small improvements in health achieved so far form an important challenge for European countries. The European Union has formulated an increase of healthy life expectancy by two years as one of the Horizon 2020 goals. Given the increasing prevalence of multimorbidity, an important way to increase healthy life years is limiting the disabling effect of chronic diseases. This MOPACT study considers the promotion of social participation among older individuals with multimorbidity as one of the tools to do so.

The effect of increasing social participation on HLE (PDF, 2.8MB) study is the last task of this research field. The aim is to generate innovative scenarios that foster social engagement in older people with multimorbidity, and to assess the effects of these scenarios on healthy life expectancy for a selected number of countries. The idea is that improving social participation among individuals with multimorbidity will limit the prevalence of limitations among this group, and this will be reflected in the healthy life expectancy of the population as a whole.

The research question is: what increases in social participation can be achieved for older individuals with multimorbidity within the coming ten years, and how do these increases affect healthy life expectancy for the older population as a whole?

We developed a formal framework to perform scenario analyses of increases in social participation among older individuals with multimorbidity and the effect on healthy life expectancy. As ingredients we used estimates of the effect of different forms of social participation (volunteering, informal caregiving, labour participation, educational activities, leisure activities, religious activities) on disability based on the empirical literature and own estimates using SHARE data.

We found that generic policies to increase social participation of older individuals with multimorbidity are not a very effective way to improve healthy life expectancy. Increases in the social participation rate of older individuals with multimorbidity only have a very modest effect on healthy life expectancy.

Our main scenarios result in improvements of healthy life expectancy between 0 and 0.1 years. Even scenarios with very high increases in social participation rates and high estimates of the effects of social participation on disability, result in an improvement of healthy life expectancy of 0.2 to 0.4 years at best.

Given the ageing of the population, and the increasing prevalence of chronic diseases, focusing on social participation among older individuals with multimorbidity is of importance. However, its effect on average years spent without disability is limited. Given the size of the challenge, substantial increases in healthy life expectancy cannot be expected to come from a single intervention alone but will have to be the result of combined efforts on several fronts.

Published papers

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Sowa, A., Golinowska, S., Deeg, D. et al. (2016) ‘Predictors of religious participation of older Europeans in good and poor health’, European Journal of Ageing, 13(2), pp. 145–157. doi: 10.1007/s10433-016-0367-2

Galenkamp, H., Gagliardi, C., Principi, A. et al. (2016) ‘Predictors of social leisure activities in older Europeans with and without multimorbidity’, European Journal of Ageing, 13(2), pp. 129–143. doi: 10.1007/s10433-016-0375-2

Golinowska, S., Sowa, A., Deeg, D. et al (2016) ‘Participation in formal learning activities of older Europeans in poor and good health’, European Journal of Ageing, 13, pp. 115–127. doi: 10.1007/s10433-016-0371-6

Galenkamp, H. and Deeg, D. J. H. (2016) ‘Increasing social participation of older people: are there different barriers for those in poor health? Introduction to the special section’, European Journal of Ageing, 13, pp. 87–90. doi: 10.1007/s10433-016-0379-y

Principi, A., Galenkamp, H., Papa, R. et al. (2016) ‘Do predictors of volunteering in older age differ by health status?’, European Journal of Ageing, 13, pp. 91–102. doi: 10.1007/s10433-016-0377-0

Schmidt, A. E., Ilinca, S., Schulmann, K. et al (2016) ‘Fit for caring: factors associated with informal care provision by older caregivers with and without multimorbidity’, European Journal of Ageing, 13, pp. 103–113. doi: 10.1007/s10433-016-0373-4

Policy Brief

MoPAct Policy Brief 4 – Health and well-being (PDF, 2.8MB)