1. Old, Sick and Alone ? Living arrangements, health and well- being among older people RGS-IBG Annual International Conference London, 2006 Harriet Young and Emily Grundy London School of Hygiene and Tropical Medicine

2. Background  Demographic changes over the last century have led to older age structures throughout Europe.  Declines in the proportions of older people living with children and increases in proportions living alone.

3. Background What are the implications for health and well-being ? Research to date: Those living with spouse are the most healthy Those living with spouse are the most healthy Contradictory evidence for those not living with spouse: more healthy living with other relatives or living alone ? Contradictory evidence for those not living with spouse: more healthy living with other relatives or living alone ? Mor et al (1989), Grundy (2001)Mor et al (1989), Grundy (2001) Selection effects Selection effects Effects vary according to cultural and socio- economic context Effects vary according to cultural and socio- economic context

4. Research Objectives  Describe the magnitude of differences in living arrangements of those aged 60+ between regions of Europe  Analyse associations between living arrangements, health and happiness among older people For all countries together For all countries together Examine variations between regions Examine variations between regions

5. Dataset: European Social Survey (ESS)  Two cross-sectional rounds of data – 2002 and 2004  Using data from 18 countries – Excluded 5 countries with response rates below 50% (Italy, France, Czech, Lux, Switz) Excluded 5 countries with response rates below 50% (Italy, France, Czech, Lux, Switz) 3 additional countries (Ireland, Iceland, Israel) 3 additional countries (Ireland, Iceland, Israel)  Sample size 17,208 people aged 60+

6. Country groupings NordicWestSouthEast SwedenNorwayFinlandDenmarkGermanyBelgiumUKAustriaNetherlandsPortugalGreeceSpainPolandSloveniaSlovakiaHungaryUkraineEstonia N=3621N=5867N=3857N=3863 Total population size=17,208

7. Variables  Health and well-being: Self-rated health Self-rated health Happiness scale (0-10) Happiness scale (0-10) Satisfaction with life (0-10) Satisfaction with life (0-10)  Living arrangements: MARRIED: spouse only, spouse only, spouse and other, spouse and other, NOT MARRIED: Children or others only, Children or others only, Alone Alone  Other variables Age Gender Region Marital status Socio-economic status Social contacts

8. Analysis  Carry out all analyses separately by gender  Descriptive analyses  Logistic regression with binary outcome (1st objective): Married: Married: living with spouse and others versus spouse only; living with spouse and others versus spouse only; Non-married: Non-married: living with non-spouse others versus living alone living with non-spouse others versus living alone  Logistic regression with ordinal outcome (2nd objective) poor, fair, good health poor, fair, good health happiness scale happiness scale

9. Results: Objective 1

10. Table 1: Adjusted odds ratios from logistic regression of region on living arrangements for women, ESS * Married: Spouse + others v spouse only OR Not married: With others v alone OR OR Region (reference: Nordic) West2.4***2.9*** South9.8***26.2*** East13.9***34.2*** * Model also controls for age, income, feelings about income, educational qualifications, health, and whether currently widowed for the non-married. ** p<0.01 *** p<0.001

11. Results: Objective 2

13. Self rated health OR (l ower OR= less healthy) Happiness score OR ( lower OR= less happy) Living arrangements (ref: spouse only) Spouse & other 0.91.0 Alone0.90.5*** Other only 1.20.9 Table 2: Adjusted odds ratios from ordinal logistic regression of living arrangements on health and happiness for women, ESS* * Model also controls for age, region, indicators of socio-economic status, indicators of social contacts, and whether currently widowed ** p<0.01 *** p<0.001

14. Self rated health OR (l ower OR= less healthy) Happiness score OR ( lower OR= less happy) Living arrangements (living with non-spouse other vv alone) All countries 1.251.7*** * Model also controls for age, region, income, education, feelings about income, indicators of social contacts, whether currently widowed, & region for Europe- wide model ** p<0.01 *** p<0.001 Table 3: Odds ratios from ordinal logistic regression of living arrangements & other factors on health and happiness for non-married women, ESS*

15. Self rated health OR (l ower OR= less healthy) Happiness score OR ( lower OR= less happy) Living arrangements (living with non-spouse other vv alone) All countries 1.251.7*** By region: Nordic1.161.2 West1.232.1*** South1.162.0** East1.311.4 * Model also controls for age, region, income, education, feelings about income, indicators of social contacts, whether currently widowed, & region for Europe- wide model ** p<0.01 *** p<0.001 Table 3: Odds ratios from ordinal logistic regression of living arrangements & other factors on health and happiness for non-married women, ESS*

16. Limitations  Varying response rates for different countries may introduce bias.  Exclusion of institutional population.  In the ESS there are no objective health measures. Only self-rated measures.  Cross-sectional analysis so unable to control for selection effects.  Small samples sizes in some analyses.

17. Conclusions  Region strongly associated with living arrangements after control for other factors.  Regional gradient for self-rated health & happiness: (worst) East–South–West–Nordic (best)  HEALTH: No significant associations between living arrangements and health, except in Nordic region: living alone less healthy.  HAPPINESS: Women least likely to be happy living alone, significantly so for South and West.

18. Acknowledgements  This research is funded by the ‘Understanding Population Trends and Processes’ (UPTAP) programme of the ESRC.  If you would like more information, do get in touch: Harriet.young@lshtm.ac.uk THANK YOU