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This study investigates the flows of downward intergenerational transfer to adult children of different gender and birth order, and their influence on parental expectations towards old-age care and financial support, using data from the 2015-2016 China Health and Retirement Longitudinal Study (CHARLS). Based on the analytic sample of 1218 parents and 3237 adult children, we found that in multi-child families, sons are more likely to be expected by their parents as future caregivers if both they and their siblings received parental housing support, while it is the case for daughters when only they themselves received parental housing support. Parents' downward housing support shows a stronger effect on care expectations than on expectations of future financial support. This study contributes to our understanding of intergenerational transfer norms and expectations from parents' perspective and has important implications for old-age care policies in contemporary China.

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This research examines patterns of intergenerational digital contact before and during the COVID-19 pandemic in England, using data from the English Longitudinal Study of Ageing (ELSA) Wave nine and the first Wave of the ELSA COVID-19 Sub-study. Multivariate binary logistic regressions were applied to assess the determinants of frequent intergenerational digital communication. The findings indicate that when the pandemic began, many older persons shifted towards more frequent intergenerational digital contact, but a small minority shifted away. As a result, the pre-existing gender gap amongst older people in the use of digital communication technology narrowed, as did the disparity associated with family relationship closeness. However, pre-pandemic gaps in the intergenerational digital connection between internet users and non-users widened during the pandemic. Overall, the results suggest that the pandemic resulted in more frequent digitally-mediated social interactions within the family, which may strengthen ties between older and younger family members.

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In resource poor environments, identifying those most in need of limited available resources is challenging. Kenya's older persons cash transfer programme (OPCT) targeted at the most poor used a 2-stage targeting process to identify beneficiaries, combining community-based selection with a proxy means-test. This paper investigates whether the process "correctly" identified targeted vulnerable older people in Nairobi's informal settlements and whether receipt of the OPCT resulted in an improvement in perceived financial wellbeing. Regression results show that individuals with greater need were covered under the OPCT. Using propensity score matching, the paper evidences that the OPCT improved subjective financial wellbeing among beneficiaries.

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Understanding intergenerational relations in China has become increasingly important against a backdrop of rapid social and demographic transitions and an ongoing urban-rural divide. From the parental perspective, this research investigates patterns and determinants of intergenerational relations between middle-aged and older parents and their non-coresident children in urban and rural China using data from the China Health and Retirement Longitudinal Study (2018) (N = 14,616). Latent class analysis revealed three typologies of intergenerational relations found across both urban and rural China - Tight-knit, Support-at-distance and Material-oriented-detached, and one typology particularly for urban China - Staying-in-touch-but-independent. The observed patterns suggest intergenerational bonds remain solid alongside the emergence of new trends, reflecting the modernization process. Multivariate multinomial regression analysis identified determinants for membership of each relationship typology. The findings will inform policy-makers and care professionals, supporting the identification of the vulnerable groups and the design of targeted policies for older parents with different family resources.

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The COVID-19 pandemic has negatively impacted upon sleep health. Relatively little is known about how this may influence the population's health subsequently. This prospective longitudinal study aims to examine the consequences of sleep problems for physical and mental health during the COVID-19 pandemic in the UK, using data from the Understanding Society: COVID-19 Study, a large-scale population-based survey with 12,804 adults aged 16 and above. A measure of sleep problems was derived from Pittsburgh Sleep Quality Index (PSQI) questions, reflecting seven dimensions of sleep quality. Binary logistic regressions were applied to investigate the relationship between sleep problem and the incidence of cardiovascular disease (CVD), hypertension, diabetes, obesity, arthritis and an emotional, nervous or psychiatric problem over the 15 months follow-up period. The analysis confirms that sleep problems are prevalent and vary between sub-groups among adults. Notably, sleep problems are then significantly associated with a higher risk of cardiovascular disease, hypertension, diabetes, obesity, arthritis and emotional, nervous or psychiatric problems, independent of demographic, socioeconomic, familial and health confounders. Our findings suggest promoting good sleep hygiene should be prioritised during the pandemic, and more generally as part of wider programmes aimed at promoting good physical and mental health.

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It is well established that there is a socioeconomic gradient in adult mental health. However, little is known about whether and how this gradient has been exacerbated or mitigated by the COVID-19 pandemic. This study aims to identify the modifiable pathways involved in the association between socioeconomic position (SEP) and mental health during the COVID-19 pandemic. The analysis included 5107 adults aged 50+ living in England and participating in the English Longitudinal Study of Ageing Wave nine (2018-2019) and the COVID-19 study (June 2020). Mental health was measured using a shortened version of the Centre for Epidemiologic Studies Depression scale. Path analysis with multiple mediator models was used to estimate the direct effect of SEP (measured by educational qualification and household wealth) on mental health (measured by depression), along with the indirect effects of SEP via three mediators: COVID-19 infection symptoms, service accessibility and social contact. The results show that the prevalence of depression for the same cohort increased from 12.6% pre-pandemic to 19.7% during the first wave of the pandemic. The risk of depression increased amongst older people who experienced COVID-19 infection, difficulties accessing services and less frequent social contact. The total effects of education and wealth on depression were negatively significant. Through mediators, wealth and education were indirectly associated with depression. Wealth also directly affected the outcome. The findings suggest that the socioeconomic gradient in depression among older people may have deteriorated during the initial phase of the pandemic and that this could in part be explained by increased financial hardship, difficulties in accessing services and reduced social contact.

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BACKGROUND AND OBJECTIVES: Social distancing measures aimed at controlling the spread of coronavirus disease 2019 (COVID-19) are likely to have increased social isolation among those older than 70 instructed to shield at home. This study examines the incidence of loneliness by gender over the first 10 months of the COVID-19 pandemic among persons aged 70 and older in the United Kingdom, and the impact of changing social networks and perceived social support on the new occurrence of loneliness. RESEARCH DESIGN AND METHODS: Participants (N = 1,235) aged 70 and older with no reports of loneliness before the pandemic who participated in 7 rounds of the Understanding Society: COVID-19 Study (April 2020-January 2021) and the main Understanding Society Study conducted during 2019. Cox regression analyzed the time to a new occurrence of loneliness. RESULTS: Among older people who hardly ever/never felt lonely before the pandemic, 33.7% reported some degree of loneliness between April 2020 and January 2021. Living in a single-person household, having received more social support before the pandemic, changes in support receipt during the pandemic, and a deteriorating relationship with one's partner during the pandemic increased the risk of experiencing loneliness. Older women were more likely than older men to report loneliness, even when living with a partner. DISCUSSION AND IMPLICATIONS: During the 3 COVID-19-related lockdowns in the United Kingdom, changes in older people's social networks and support resulted in a significant onset of loneliness. Findings highlight the risks of shielding older persons from COVID-19 in terms of their mental well-being and the importance of strengthening intergenerational support.

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OBJECTIVES: COVID-19 is having a disproportionate impact on Black, Asian and minority ethnic (BAME) groups and women. Concern over direct and indirect effects may also impact on sleep. We explore the levels and social determinants of self-reported sleep loss among the UK population during the pandemic, focusing on ethnic and gender disparities. SETTING: This prospective longitudinal study analysed data from seven waves of the Understanding Society: COVID-19 Study collected from April 2020 to January 2021 linked to prepandemic data from the 2019 mainstage interviews, providing baseline information about the respondents prior to the pandemic. PARTICIPANTS: The analytical sample included 8163 respondents aged 16 and above who took part in all seven waves with full information on sleep loss, defined as experiencing 'rather more' or 'much more' than usual sleep loss due to worry, providing 57 141 observations. PRIMARY OUTCOME MEASURES: Self-reported sleep loss. Mixed-effects regression models were fitted to consider within-individual and between-individual differences. RESULTS: Women were more likely to report sleep loss than men (OR 2.1, 95% CI 1.9 to 2.4) over the 10-month period. Being female, having young children, perceived financial difficulties and COVID-19 symptoms were all predictive of sleep loss. Once these covariates were controlled for, the bivariate relationship between ethnicity and sleep loss (1.4, 95% CI 1.6 to 2.4) was reversed (0.7, 95% CI 0.5 to 0.8). Moreover, the strength of the association between gender and ethnicity and the risk of sleep loss varied over time, being weaker among women in July (0.6, 95% CI 0.5 to 0.7), September (0.7, 95% CI 0.6 to 0.8), November (0.8, 95% CI 0.7 to 1.0) and January 2021 (0.8, 95% CI 0.7 to 0.9) compared with April 2020, but positively stronger among BAME individuals in May (1.4, 95% CI 1.0 to 2.1), weaker only in September (0.7, 95% CI 0.5 to 1.0). CONCLUSIONS: The pandemic has widened sleep deprivation disparities, with women with young children, COVID-19 infection and BAME individuals experiencing sleep loss, which may adversely affect their mental and physical health.

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BACKGROUND: The outbreak of Covid-19 in the UK has seen many families unexpectedly brought back together. The circumstances and stories of individual families have been picked up in the press focussing on the difficulties of people adjusting to their changed living arrangements. Yet, there have been few empirical analyses on how such changes might influence people's health and wellbeing. Therefore, this study explored the changing patterns of perceived stress by living arrangements change during the first wave of the Covid-19 pandemic in 2020. METHODS: The data used relates to 12,532 cohort members in the special Covid-19 surveys conducted with the participants of the 1958, 1970, 2000-01 British birth cohorts and Next Steps (born in 1989-90) in May 2020. Probit regression models were used to assess the chance of reporting increased stress amongst those who had experienced changes in living arrangements during the pandemic compared to those who had not. RESULTS: The results provide strong evidence that those individuals whose living arrangements changed during the Covid-19 pandemic have a higher likelihood of reported increased stress than those whose living arrangements remained unchanged. This was most clearly seen for older cohorts. Increased interpersonal conflict plays a role in mediating the association, especially for the younger cohort. CONCLUSIONS: The findings confirm that during the first lockdown, changing living arrangements were negatively associated with individuals' mental wellbeing. As prolonged periods of stress can lead to serious health problems and policymakers need to be mindful that services may need to take these new, albeit for many temporary, forms of living arrangements into account.

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Inequalities in the labour market are recognised as presenting a major impediment to extending the working lives of older adults in China as part of any proposed reforms of the public pension system against the background of population ageing. While a growing body of literature has paid attention to understanding this issue within the wider international context, there remains a dearth of research on work histories in China. This research which is crucial for the understanding of inequalities in later life. This paper provides a unique evidence on the work experiences over the life course of 7281 Chinese individuals aged 60 and over (born between 1930-1954), using retrospective life history data from the China Health and Retirement Longitudinal Study. With the application of sequence analysis and cluster analysis, results reveal a picture of significant social heterogeneity within work trajectories between urban and rural areas and between men and women. Such differences are largely shaped by the wider economic and institutional context, as well as by key personal characteristics such as educational attainment. More importantly, cohort comparisons highlight how different groups of current Chinese older alduts have been affected by changes in the labour market and the public pension system over the past sixty years. Whilst it is to be expected that younger cohorts amongst today's older population will have experienced some de-standardisation of work trajectories following the opening up of the economy since the 1980s, the heterogeneity in work trajectories across different social groups within and between cohorts is notable. These findings emphasise the importance of ensuring policy design that delivers equitable pension entitlements and supports flexible working patterns in order to reduce inequalities in the labour market between rural and urban residents and between men and women.

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OBJECTIVES: To examine Chinese middle-aged women's health and wellbeing and the associated biosocial correlates. STUDY DESIGN: This study used a cross-sectional design, including selected retrospectively collected information on the final menstrual period, drawn from the 2013 wave of the China Health and Retirement Longitudinal Study (CHARLS). Women aged 45 to 59 were selected. MAIN OUTCOME MEASURES: Factor analysis of 16 menopausal symptom ratings yielded four different and independent measures of pre-/peri-menopausal and early postmenopausal women's health. These were: negative mood (feel frustrated, sad, lonely, worried, bored, angry, tired and stressed), positive emotions (feel enthusiastic, content and happy), musculoskeletal pain (shoulder/neck pain, knee and other joint pain, and back pain), and sleep and memory problems (trouble sleeping and poor memory). RESULTS: Menopausal status was positively associated with sleep and memory problems, whilst the number of years since the final menstrual period was positively associated with musculoskeletal pain. In contrast, lifestyle activities and social participation were linked to positive emotions. The association between selected biosocial factors and negative mood was not significant after controlling for other demographic and social background factors. CONCLUSIONS: Musculoskeletal health as well as sleep and memory problems are positively associated with menopausal biological factors amongst Chinese mid-life women. Maintaining active social engagement contributes to positive wellbeing among middle-aged women.

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OBJECTIVES: This study aims to investigate the impact of the menopausal transition and severe symptoms on changes in employment. STUDY DESIGN: This longitudinal prospective study analysed data from a population-based cohort study, the UK National Child Development Study Wave 8 and Wave 9, when the cohort was aged 50 and 55 respectively. The analytical sample comprised 3109 employed women at age 50. MEASURES: The outcome variable was the employment change from age 50 to age 55, with three categories: i) continued employed without reduced working time; ii) continued employed with reduced working hours; and iii) exit employment. The employment dynamics of women were compared using multinomial logistic regression modelling. Key independent variables included menopausal transition status and severe menopausal symptoms experienced. RESULTS: 53.5 % of employed women at age 50 reported at least one severe menopausal symptom. Women experiencing severe menopausal symptoms had a higher chance of employment exit or reducing their working hours. The odds ratios contrasting severely symptomatic women with those with no severe symptoms were 1.43 (95 % CI = 1.11-1.84) between exiting employment vs continued employment without reducing working hours, and 1.23 (95 % CI = 1.02-1.48) between reducing working hours vs continued employment without reducing working hours. The strength of the association between women's severe menopausal symptoms and the risk of employment exit or reducing working hours varied according to their HRT usage and their partner's economic activity. CONCLUSIONS: Menopausal symptoms can pose obstacles to some middle-aged women in terms of remaining in employment or maintaining their number of working hours.

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A growing number of low and middle income countries have introduced social pension programs for older people. Research has highlighted that the impact of such programs can extend beyond the primary recipient when funds are shared. It less clear the extent to which such redistribution persists in the lowest resource settings. Using data from a survey conducted in 2016, this paper examines how recipients of the Kenyan Older Persons Cash Transfer Program (OPCTP) living in two slum communities in Nairobi reallocate their social pension by examining the characteristics of older people who are more likely to share their cash and identifying secondary beneficiaries. Findings suggest that 40% of beneficiaries re-allocate some or all of the cash received. The majority of secondary beneficiaries are either grandchildren or children of the primary beneficiary. Overall, a higher proportion of the total cash is shared with secondary beneficiaries living in rural Kenya, as compared to those living in the same household. This highlights the role played by older people, even the most vulnerable, in providing support to wider kin networks; reinforcing the argument that investing in social pensions has much broader potential societal impact than the intended aims of reducing recipient household poverty. By enhancing economic opportunities and investments in human capital more broadly, societies that invest in social pension programs may improve the overall living conditions and experiences of ageing in their countries at a critical moment of global population ageing.

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AIMS: The purpose of this study is to analyze the internal consistency, factor structure, and external validity of the 12-item General Health Questionnaire (GHQ-12) among older adults in India. SETTINGS AND DESIGN: This study analyzes data collected as part of the UNFPA "Building Knowledge Base on Ageing in India (BKPAI)" project. The BKPAI Survey was conducted in 2011 in seven major demographically advanced states of India - Himachal Pradesh, Punjab, West Bengal, Odisha, Maharashtra, Kerala, and Tamil Nadu. MATERIALS AND METHODS: A community-based representative sample of 9692 respondents aged 60 and above from seven Indian states was employed. The GHQ-12 questionnaire was administered. STATISTICAL ANALYSIS: The Cronbach's alpha was calculated to analyze internal consistency. Factor analysis was applied to explore the factor structure of GHQ-12, and then correlation coefficients were calculated to examine the external validity of the measurement. RESULTS: The Cronbach's alpha of the GHQ-12 is 0.9. Factor analysis reveals two significant components which accounted for 59% of the variance. The correlation between the overall score of GHQ-12 and the subjective well-being inventory (SUBI) is 0.58. CONCLUSIONS: The GHQ-12 shows adequate reliability among the older population in India.

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BACKGROUND: Population ageing presents considerable challenges for the attainment of universal health coverage (UHC), especially in countries where such coverage is still in its infancy. Ghana presents an important case study on the effectiveness of policies aimed at achieving UHC in the context of population ageing in low and middle-income countries. It has witnessed a profound recent demographic transition, including a large increase in the number of older adults, which coincided with the development and implementation of a National Health Insurance Scheme (NHIS), designed to help achieve UHC. The objective of this paper is to examine the community, household and individual level determinants of NHIS enrolment among older adults aged 50-69 and 70 plus. The latter are exempt from NHIS premium payments. METHODS: Using the Ghanaian Living Standards Survey from 2012 to 2013, determinants of NHIS enrolment for individuals aged 50-69 and 70 plus living in rural Ghana are examined through the application of multilevel regression analysis. RESULTS: Previous studies have mainly focused on the enrolment of young and middle aged adults and considered mainly demographic and socio-economic factors. The novel inclusion of spatial barriers within this analysis demonstrates that levels of NHIS enrolment are determined in part by the community provision of healthcare facilities. In addition, the findings imply that insurance enrolment increases with household expenditure even for those aged 70 plus who are exempt from the NHIS premium payment. CONCLUSION: Adequate and appropriate infrastructure as well as health insurance is vital to ensure movement to UHC in low and middle income countries. Overall, the results confirm that there remain significant inequalities in enrolment by expenditure quintile that future policy reform will need to address.

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BACKGROUND: Ghana is currently undergoing a profound demographic transition, with large increases in the number of older adults in the population. Older adults require greater levels of healthcare as illness and disability increase with age. Ghana therefore provides an important and timely case study of policy implementation aimed at improving equal access to healthcare in the context of population ageing. This paper examines the determinants of National Health Insurance (NHIS) enrolment in Ghana, using two different surveys and distinguishing between younger and older adults. Two surveys are used in order to investigate consistency in insurance enrolment. The comparison between age groups is aimed at understanding whether determinants differ for older adults. Previous studies have mainly focused on the enrolment of young and middle aged adults; thus by widening the focus to include older adults and taking into account differences in their demographic and socio-economic characteristics this paper provides a unique contribution to the literature. METHODS: Using data from the 2007-2008 Study on Global Ageing and Adult Health (SAGE) and the 2012-2013 Ghanaian Living Standards Survey (GLSS) the determinants of NHIS enrolment among younger adults (aged 18-49) and older adults (aged 50 and over) are compared. Logistic regression explores the socio-economic and demographic determinants of NHIS enrolment and multinomial logistic regression investigates the correlates of insurance drop out. RESULTS: Similar results for people aged 18-49 and people aged 50 plus were revealed, with older adults having a slightly lower probability of dropping out of insurance coverage compared to younger adults. Both surveys confirm that education and wealth increase the likelihood of NHIS affiliation. Further, residential differences in insurance coverage are found, with greater NHIS coverage in urban areas. The findings give assurance that both datasets (SAGE and GLSS) are suitable for research on insurance affiliation in Ghana. CONCLUSION: The paper indicates that although the gap in coverage among rich and poor and urban and rural residents appears to have decreased, these factors still determine NHIS coverage of younger and older adults. The same holds for education. Increasing efforts are needed to ensure equal access to healthcare.

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INTRODUCTION: This paper examines the relationship between national health insurance enrolment and the utilisation of inpatient and outpatient healthcare for older adults in rural areas in Ghana. The Ghanaian National Health Insurance Scheme (NHIS) aims to improve affordability and increase the utilisation of healthcare. However, the system has been criticised for not being responsive to the needs of older adults. The majority of older adults in Ghana live in rural areas with poor accessibility to healthcare. With an ageing population, a specific assessment of whether the scheme has benefitted older adults, and also if the benefit is equitable, is needed. METHODS: Using the Ghanaian Living Standards Survey from 2012 to 2013, this paper uses propensity score matching to estimate the effect of enrolment within the NHIS on the utilisation of inpatient and outpatient care among older people aged 50 and over. RESULTS: The raw results show higher utilisation of healthcare among NHIS members, which persists after matching. NHIS members were 6% and 9% more likely to use inpatient and outpatient care, respectively, than non-members. When these increases were disaggregated for outpatient care, the non-poor and females were seen to benefit more than their poor and male counterparts. For inpatient care, the benefits of enrolment were equal by poverty status and sex. However, overall, poor older adults use health services much less than the non-poor older adults even when enrolled. CONCLUSION: The results indicate that NHIS coverage does increase healthcare utilisation among rural older adults but that inequalities remain. The poor are still at a great disadvantage in their use of health services overall and benefit less from enrolment for outpatient care. The receipt of healthcare is significantly influenced by a set of auxiliary barriers to access to healthcare even where insurance should remove the financial burden of ad hoc out of pocket payments.

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Although China's family planning programme is often referred to in the singular, most notably the One-Child policy, in reality there have been a number of different policies in place simultaneously, targeted at different sub-populations characterized by region and socioeconomic conditions. This study attempted to systematically assess the differential impact of China's family planning programmes over the past 40 years. The contribution of Parity Progression Ratios to fertility change among different sub-populations exposed to various family planning policies over time was assessed. Cross-sectional birth history data from six consecutive rounds of nationally representative population and family planning surveys from the early 1970s until the mid-2000s were used, covering all geographical regions of China. Four sub-populations exposed to differential family planning regimes were identified. The analyses provide compelling evidence of the influential role of family planning policies in reducing higher Parity Progression Ratios across different sub-populations, particularly in urban China where fertility dropped to replacement level even before the implementation of the One-Child policy. The prevailing socioeconomic conditions in turn have been instrumental in adapting and accelerating family planning policy responses to reducing fertility levels across China.

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This data article presents the UK City LIFE1 data set for the city of Birmingham, UK. UK City LIFE1 is a new, comprehensive and holistic method for measuring the livable sustainability performance of UK cities. The Birmingham data set comprises 346 indicators structured simultaneously (1) within a four-tier, outcome-based framework in order to aid in their interpretation (e.g., promote healthy living and healthy long lives, minimize energy use, uncouple economic vitality from CO2 emissions) and (2) thematically in order to complement government and disciplinary siloes (e.g., health, energy, economy, climate change). Birmingham data for the indicators are presented within an Excel spreadsheet with their type, units, geographic area, year, source, link to secondary data files, data collection method, data availability and any relevant calculations and notes. This paper provides a detailed description of UK city LIFE1 in order to enable comparable data sets to be produced for other UK cities. The Birmingham data set is made publically available at http://epapers.bham.ac.uk/3040/ to facilitate this and to enable further analyses. The UK City LIFE1 Birmingham data set has been used to understand what is known and what is not known about the livable sustainability performance of the city and to inform how Birmingham City Council can take action now to improve its understanding and its performance into the future (see "Improving city-scale measures of livable sustainability: A study of urban measurement and assessment through application to the city of Birmingham, UK" Leach et al. [2]).

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OBJECTIVES: This study examines the association between elder abuse and psychological distress among older adults in India and explores whether this association varies by the level of psychosocial and material resources. DESIGN: The study uses a cross-sectional survey design. SETTING: The data are drawn from a representative sample of 9589 adults aged 60 and above in seven Indian states-Himachal Pradesh, Punjab, West Bengal, Odisha, Maharashtra, Kerala and Tamil Nadu-in 2011. STATISTICAL ANALYSES: Secondary analysis, using bivariate and multivariate logistic regression models, is conducted using the United Nations Population Fund project Building Knowledge Base on Ageing in India survey. Elder abuse (physical and/or emotional) emanating from family members in the previous month before the survey is examined. Multivariate models are run on the total analytical sample and for men and women separately. RESULTS: The overall prevalence of psychological distress among persons aged 60 and over living in the seven Indian States is 40.6%. Among those older persons who experienced some form of physical or emotional abuse or violence in the last month, the prevalence of psychological distress is much higher than that in the general older population, at 61.6% (p<0.001). The results show that the experience of abuse is negatively associated with the mental health of older adults, and this relationship persists even after controlling for demographic and socioeconomic factors (OR=1.60, 95% CI 1.22 to 2.09). The findings also suggest that household wealth has an inverse relationship with mental health, with the association between experiencing elder abuse and reporting poor mental health being strongest among older people in wealthy households. CONCLUSIONS: Elder abuse in India is currently a neglected phenomenon, and greater recognition of the link between abuse and mental health is critical to improve the well-being of vulnerable older adults, some of whom may be 'hidden' within well-off households.

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