Educational Differences in Self-Rated Health Trends Among Middle-Aged and Older Adults Living Alone, 1972–2018

Objectives: This study examines educational differences in living alone and in self-rated health trends among middle-aged and older adults. Methods: We used logistic regression to analyze data from the 1972–2018 National Health Interview Survey ( n = 795,239 aged 40–64; n = 357,974 aged 65–84). Results: Between 1972–1974 and 2015–2018, living alone became more prevalent, particularly among men and at lower levels of education. Self-rated health trends varied by living arrangement and education. We found self-rated health declines among middle-aged adults having no college degree and living alone, but trends in self-rated health were mostly stable or even improved among middle-aged adults living with others. Among older adults, self-rated health improved over time, but for the least-educated older Americans living alone, the probability of reporting fair or poor health increased between 1972–1974 and 2015–2018. Discussion: The findings suggest growing disparities by social class, in living arrangements and in self-rated health.

Increasing inequalities in disability-free life expectancy among older adults in Sweden 2002–2014

Background: In an aging society with increasing old age life expectancy, it has become increasingly important to monitor the health development in the population. This paper combines information on mortality and disability and explores educational inequalities in disability-free life expectancy in the aging population in Sweden, and to what extent these inequalities have increased or decreased over time. Methods: A random sample of the Swedish population aged 77 years and above ( n=2895) provided information about disability in the population in the years 2002, 2004, 2011 and 2014. The prevalence of disability was assessed by five items of personal activities of daily living and incorporated in period life tables for the corresponding years, using the Sullivan method. The analyses were stratified by sex and educational attainment. Estimates at ages 77 and 85 years are presented. Results: Disability-free life expectancy at age 77 years increased more than total life expectancy for all except men with lower education. Women with higher education had a 2.7-year increase and women with lower education a 1.6-year increase. The corresponding numbers for men were 2.0 and 0.8 years. The educational gap in disability-free life expectancy increased by 1.2 years at age 77 years for both men and women. Conclusions: While most of the increase in life expectancy was years free from disability, men with lower education had an increase of years with disability. The educational differences prevailed and increased over the period as the gains in disability-free life expectancy were smaller among those with lower education.

Other Considerations

This chapter examines further considerations derived from the research.Institutional factors related to religion exert a stronger structural and long-term influence on prosperity (competitiveness and corruption) than the cultural influence of religion (adherents).Prosperity and educational differences between Protestants (higher) and Roman Catholics (lower) are still evident in Germany and Switzerland. Such differences are even more prominent comparing national levels (cross-country) throughout Europe and the Americas.Thousands of years of hegemony characterise the Roman Catholic Church as a global political-religious institution. The associated corruption in all the countries under its influence may well be related to the corrupt fruits for which “we shall know them” in the parable of Jesus (King James Bible, 1769, Matthew 7:15–23). Among others, these fruits have also been the abuse scandals, maintenance of ignorance, and persecution of God’s Word, in the name of Jesus Christ.The results of this study open up various avenues for future research. The QCA evidence generated here allows further analysis of every country in Europe and the Americas. Future research might also continue to apply the vast amount of information collected and already codified in this study.

Is Living in an Ethnic Enclave Associated With Better Cognitive Health of Older Immigrants? Results From PINE

This study addressed three questions: 1) Is living in Chinatown associated with better cognition among Chinese older immigrants? 2) Is the association moderated by education, acculturation level, and social engagement? 3) Does the association vary by preferred language (Mandarin, Cantonese, Taishanese), an important indicator of heterogeneity among Chinese immigrants? Data were derived from the Population Study of Chinese Elderly in Chicago (N = 3,055). Results showed that Chinese older immigrants who lived in Chinatown had significantly poorer cognition than those who didn’t, and such a difference was largely due to educational differences between the two groups. Higher education or acculturation buffered the influence of Chinatown residence on cognitive health, but only among those who speak Mandarin. The findings indicate that living in an ethnic enclave may have a negative impact on cognitive function of Chinese older immigrants. The findings also reveal the sources of heterogeneity within the population.

Loneliness at Older Ages in Japan: Variation in Lonely Life Expectancy and the Role of Social Isolation

Despite growing media, policy, and research attention to loneliness, it remains an understudied dimension of inequality in demography. Additionally, research on loneliness often fails, both methodologically and conceptually, to distinguish loneliness from social isolation. This is an important limitation given the positive correlation between measures of these two distinct concepts, a relationship that may be particularly relevant in collectivistic societies. This study focuses on Japan, describing the synthetic cohort duration of exposure to loneliness at older ages, with and without adjusting for the correlation between loneliness and social isolation. Combining life tables from the Human Mortality Database with individual data from the National Survey of Japanese Elderly, we calculated isolation-adjusted lonely life expectancies. We also evaluated regional and educational differences in isolation-adjusted lonely life expectancies. Results showed significant differences in lonely life expectancy before and after adjusting for social isolation; however, the attention to social isolation did little to alter our general understandings of trends and differentials in lonely life expectancy. In contrast to public perceptions of growing loneliness, we find that lonely life expectancy is short among older Japanese and has not increased over time. Additionally, we found no clear regional nor educational differences in isolation-adjusted lonely life expectancy.

Educational level, attention problems, and externalizing behaviour in adolescence and early adulthood: the role of social causation and health-related selection—the TRAILS study

Social causation and health-related selection may contribute to educational differences in adolescents’ attention problems and externalizing behaviour. The social causation hypothesis posits that the social environment influences adolescents’ mental health. Conversely, the health-related selection hypothesis proposes that poor mental health predicts lower educational attainment. From past studies it is unclear which of these mechanisms predominates, as attention problems and externalizing behaviour have the potential to interfere with educational attainment, but may also be affected by differences in the educational context. Furthermore, educational gradients in mental health may reflect the impact of ‘third variables’ already present in childhood, such as parental socioeconomic status (SES), and IQ. We investigated both hypotheses in relation to educational differences in externalizing behaviour and attention problems throughout adolescence and young adulthood. We used data from a Dutch cohort (TRAILS Study; n = 2229), including five measurements of educational level, externalizing behaviour, and attention problems from around age 14–26 years. First, we evaluated the directionality in longitudinal associations between education, externalizing behaviour, and attention problems with and without adjusting for individual differences using fixed effects. Second, we assessed the role of IQ and parental SES in relation to attention problems, externalizing behaviour, and educational level. Attention problems predicted decreases in education throughout all of adolescence and young adulthood. Differences in parental SES contributed to increases in externalizing behaviour amongst the lower educational tracks in mid-adolescence. Childhood IQ and parental SES strongly predicted education around age 14. Parental SES, but not IQ, also predicted early adolescent attention problems and externalizing behaviour. Our results provide support for the health-related selection hypothesis in relation to attention problems and educational attainment. Further, our results highlight the role of social causation from parental SES in determining adolescent educational level, attention problems, and externalizing behaviour.

Our Floating Commonwealth

Drawing on personal diaries, correspondence, and printed sources, this chapter offers a history of reading on seaborne journeys to emigrant destinations in the nineteenth century. It explores the distinction between official sources, such as church and emigrant recruitment agencies, and the everyday experiences of emigrants themselves, as well as the cultural and educational differences that helped define them. Examining the different conditions between classes on board emigrant ships, it offers several personal accounts of the difficulties faced by reading at sea. The publication of shipboard newspapers, in both manuscript and print, provided a means of entertainment but also assisted social order on board many voyages. The deprivations of many, contrasted with the social advantages of the few, indicate that distinctions on land could be even more marked on the high seas. Nevertheless, the use of print and manuscript by representatives of almost all classes in the nineteenth century allowed for the imagination of cultural connection and the exercise of cultural memory far from home.

Educational differences in long-term care use in Sweden during the last two years of life

Background: In old age, many people experience a period of functional decline and require long-term care. Sweden has a universal largely tax-financed health and social care system that is used by all societal groups. However, few studies have investigated if educational groups use publicly paid long-term care equitably. The aim of this study was to explore educational differences in the use of long-term care, including both home care and institutional care, during the last two years of life in Sweden. Methods: We used linked register data on mortality and long-term care use, including all adults aged ⩾67 years who died in Sweden in November 2015 ( N=6329). We used zero-inflated negative binomial regression models to analyse the number of months with long-term care by educational level, both crude and adjusted for age at death and cohabitation status. Men and women were analysed separately. Results: People with tertiary education died more commonly without using any long-term care compared to primary educated people (28.0% vs. 18.6%; p<0.001). In the adjusted model, educational differences in the estimated number of months with long-term care disappeared among men but remained significant among women (primary educated: odds ratio=17.3 (confidence interval 16.8–17.7); tertiary educated: odds ratio=15.8 (confidence interval 14.8–16.8)). Conclusions: Older adults spend considerable time in their last two years of life with long-term care. Only minor educational differences in long-term care use remained after adjustment for cohabitation status and age at death. This suggest that Sweden’s publicly financed long-term system achieves relatively equitable use of long-term care at the end of life.

Rethinking the education potential of older adults to delay the onset of dementia

This paper demonstrates the effects of education on cognitive functioning which could serve as an alternative preventive method to halt or delay cognitive decline in older adults. The purpose of this proposal is to discuss and illustrate the benefits of improving cognitive ability through continuing education. As such, taking advantage of educational programmes that are already in place would not only provide mental stimulation for older adults, but would be a source for social networking, as well as technology training and physical education activities. To establish a link between cognition and education, this paper provides examples from a number of studies as well as a review of a longitudinal study on educational differences in the prevalence of dementia. The findings of this systematic review revealed a connection between cognitive decline and education after considering regions and economic status. Suggestions from these reviews imply that keeping one’s mind stimulated could be influential in delaying the onset of dementia resulting in possibly extending the time older adults are independent.