A selection from Stockholm University publication database

• Effectiveness of interventions designed to mitigate the negative health outcomes of informal caregiving to older adults: an umbrella review of systematic reviews and meta-analyses

  2023. Mariam Kirvalidze (et al.). BMJ Open 13 (4)

  Article

  Objectives This umbrella review aimed to evaluate whether certain interventions can mitigate the negative health consequences of caregiving, which interventions are more effective than others depending on the circumstances, and how these interventions are experienced by caregivers themselves.

  Design An umbrella review of systematic reviews was conducted.

  Data sources Quantitative (with or without meta-analyses), qualitative and mixed-methods systematic reviews were included.

  Eligibility criteria Reviews were considered eligible if they met the following criteria: included primary studies targeting informal (ie, unpaid) caregivers of older people or persons presenting with ageing-related diseases; focused on support interventions and assessed their effectiveness (quantitative reviews) or their implementation and/or lived experience of the target population (qualitative reviews); included physical or mental health-related outcomes of informal caregivers.

  Data extraction and synthesis A total of 47 reviews were included, covering 619 distinct primary studies. Each potentially eligible review underwent critical appraisal and citation overlap assessment. Data were extracted independently by two reviewers and cross-checked. Quantitative review results were synthesised narratively and presented in tabular format, while qualitative findings were compiled using the mega-aggregation framework synthesis method.

  Results The evidence regarding the effectiveness of interventions on physical and mental health outcomes was inconclusive. Quantitative reviews were highly discordant, whereas qualitative reviews only reported practical, emotional and relational benefits. Multicomponent and person-centred interventions seemed to yield highest effectiveness and acceptability. Heterogeneity among caregivers, care receivers and care contexts was often overlooked. Important issues related to the low quality of evidence and futile overproduction of similar reviews were identified.

  Conclusions Lack of robust evidence calls for better intervention research and evaluation practices. It may be warranted to avoid one-size-fits-all approaches to intervention design. Primary care and other existing resources should be leveraged to support interventions, possibly with increasing contributions from the non-profit sector.

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• Job Quality in the Late Career in Sweden, Japan and the United States

  2023. Loretta G. Platts (et al.). Research on Aging 45 (3-4), 259-279

  Article

  Increasing numbers of older workers continue to work after being eligible to claim a state pension, yet little is known about the quality of these jobs. We examine how psychosocial and physical job quality as well as job satisfaction vary over the late career in three contrasting national settings: Sweden, Japan and the United States. Analyses using random effects modelling drew on data from the Swedish Longitudinal Occupational Survey of Health (n = 13,936–15,520), Japanese Study of Ageing and Retirement (n = 3704) and the Health and Retirement Study (n = 6239 and 8002). Age was modelled with spline functions in which two knots were placed at ages indicating eligibility for pensions claiming or mandatory retirement. In each country, post-pensionable-age jobs were generally less stressful, freer and more satisfying than jobs held by younger workers, results that held irrespective of gender or education level.

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• Estimating pairwise overlap in umbrella reviews: Considerations for using the corrected covered area (CCA) index methodology

  2023. Mariam Kirvalidze (et al.). Research Synthesis Methods 14 (5), 764-767

  Article

  Umbrella reviews (reviews of systematic reviews) are increasingly used to synthesize findings from systematic reviews. One important challenge when pooling data from several systematic reviews is publication overlap, that is, the same primary publications being included in multiple reviews. Pieper et al. have proposed using the corrected covered area (CCA) index to quantify the degree of overlap between systematic reviews to be pooled in an umbrella review. Recently, this methodology has been integrated in Excel- or R-based tools for easier use. In this short letter, we highlight an important consideration for using the CCA methodology for pairwise overlap assessment, especially when reviews include varying numbers of primary publications, and we urge researchers to fine-tune this method and exercise caution when review exclusion decisions are based on its output.

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• Does Bridge Employment Mitigate or Exacerbate Inequalities Later in Life?

  2022. Kevin E. Cahill (et al.). Work, Aging and Retirement

  Article

  Most older Americans with career employment change jobs at least once before retiring from the labor market. Much is known about the prevalence and determinants of these bridge jobs, yet relatively little is known about the implications of such job changes—compared to direct exits from a career job—upon economic disparities in later life. In this article, we use 26 years of longitudinal data from the Health and Retirement Study to document the various pathways that older Americans take when exiting the labor force, and examine how bridge employment affects nonhousing wealth and total wealth, including the present discounted value of Social Security benefits. We find that gradual retirement in the form of bridge employment neither exacerbates nor mitigates wealth inequalities among Americans who hold career jobs later in life. That said, we do find some evidence that wealth inequalities grow among the subset of older career workers who transition from career employment to bridge employment at older ages. One policy implication of our article is that it provides evidence that might allay concerns about the potential for disparate financial impacts associated with the gradual retirement process. 

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• Changes in Job Quality as People Work Beyond Pensionable Age in Sweden

  2021. Lawrence B. Sacco (et al.). Innovation in Aging 5 (Supplement_1), 414-415

  Article

  This paper uses data from the biennial Swedish Longitudinal Occupational Survey of Health to examine changes in job quality among older workers, controlling for work intensity and employment characteristics. Job quality outcomes included job satisfaction and physical (dangerous, strenuous or unpleasant work) and psychosocial (job strain, effort-reward imbalance, work time control) working conditions. First difference estimation was used to analyze within-individual changes in job quality, as well as changes in hours, employment characteristics (shifting to a non-permanent contract, the private sector and self-employment) and health. Individuals who worked beyond pensionable age experienced statistically significant improvements in job quality, with larger improvements among those who reduced working hours and shifted from permanent to non-permanent contracts, from the public into the private sector, and from wage-and-salary to self-employment. We conclude that work beyond pensionable age is a distinctive period characterized by employment that becomes more flexible and rewarding and less stressful.

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• Changes in Job Quality as People Work Beyond Pensionable Age in Sweden

  2021. Lawrence B. Sacco (et al.). Work, Aging and Retirement

  Article

  Large numbers of people remain in paid work after pensionable age, often in bridge jobs or with reduced working hours. Remarkably, knowledge about the quality of these jobs relative to those taken prior to pension eligibility is very limited. In this paper, we examined changes in job quality among workers in their sixties in the context of contemporaneous changes in work intensity and employment characteristics. This study is based on data from the biennial Swedish Longitudinal Occupational Survey of Health (SLOSH, 2006–2018, n = 1890–3013). Job quality outcomes were physical (dangerous, strenuous or unpleasant work) and psychosocial (job strain, effort-reward imbalance, work time control) working conditions and job satisfaction. First difference estimation was used to observe within-individual wave-to-wave changes in job quality over ages 61/62–69/70. Changes in working hours, employment characteristics (shifting to a non-permanent contract, the private sector and self-employment) and health were included as covariates. The typical individual who worked beyond pensionable age experienced statistically significant improvements in job quality. Improvements in psychosocial working conditions and job satisfaction were larger for those who reduced working hours and shifted from permanent to non-permanent contracts, from the public into the private sector and from wage-and-salary to self-employment. Work beyond pensionable age is a distinctive period, characterized by employment that becomes more flexible and rewarding and less stressful. These improvements are a function of older individuals’ preferences and ability to work fewer hours and transition to new lines of work.

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• Job Quality in the Late Career in Sweden, Japan, and the United States

  2021. Hugo Westerlund (et al.). Innovation in Aging 5 (Supplement_1), 415-415

  Article

  This paper examines job satisfaction and psychosocial and physical job quality over the late career in three contrasting national settings: Sweden, Japan and the United States. The data come from an ex-post harmonized dataset of individuals aged 50 to 75 years constructed from the biennial Swedish Longitudinal Occupational Survey of Health (SLOSH, 2006–2018, n=13936 to 15520), Japanese Study of Ageing and Retirement (JSTAR, 2006–2013, n=3704) and the United States Health and Retirement Study (HRS, 2006–2016, n=6239 and 8002). The job quality outcomes were physical labour, psychosocial working conditions (time pressure, discretion, pay satisfaction, job security) and job satisfaction. Random effects modelling was performed with age modelled with spline functions in which two knots were placed at ages indicating eligibility for pensions claiming or mandatory retirement. Interestingly, in each country, post-pensionable-age jobs were generally less stressful, freer, and more satisfying than jobs held by younger workers.

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• Pathways of participation in paid and unpaid work in mid to later life in the United Kingdom

  2021. Lawrence B. Sacco (et al.). Ageing & Society

  Article

  Policy responses to population ageing have focused on lengthening working lives, overlooking inequalities in older adults’ participation in unpaid activities. This paper examines participation in paid and unpaid activities between the ages of 55 and 70 to answer two questions: how do people navigate pathways of paid work, informal care, volunteering, civic participation and housework in mid to later life?; and how do these pathways relate to gender, socio-economic and health inequalities? Two-staged latent class analysis was used to identify activity pathways using data from the British Household Panel Survey (1996–2008). Multinomial logistic models assessed associations between latent pathways and socio-demographic and health characteristics. Three pathways were observed: full-time work to low activity (49%), part-time and in-home work (34%) and multiple activities (16%). Aside from retirement from full-time work, the pathways of participation in paid and unpaid activities were characterised by continuity; substitution between different forms of paid and unpaid work was not observed. Participation in multiple paid and unpaid activities was more common for respondents in better health and of higher socio-economic status. Since the promotion of paid work and volunteering in later life may mainly benefit individuals in advantaged circumstances, policies should avoid taking a blanket approach to encouraging participation in multiple activities, a key component of active ageing.

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• Effectiveness of interventions to address the negative health outcomes of informal caregiving to older adults

  2021. Amaia Calderón-Larrañaga (et al.). BMJ Open 11 (11)

  Article

  Introduction Informal (unpaid) caregivers play an essential role in caring for older people, whose care needs are often not fully met by formal services. While providing informal care may be a positive experience, it can also exert a considerable strain on caregivers’ physical and mental health. How to best support the needs of informal caregivers remains largely debated. This umbrella review (review of systematic reviews) aims to evaluate (1) whether effective interventions can mitigate the negative health outcomes of informal caregiving, (2) whether certain types of interventions are more effective than others, (3) whether effectiveness of interventions depends on caregiver/receiver, context or implementation characteristics and (4) how these interventions are perceived in terms of acceptability, feasibility and added value.

  Methods and analysis We will include systematic reviews of primary studies focusing on the effectiveness of interventions (public or private, unifaceted or multifaceted, delivered by health or social care professionals or volunteers) aimed at reducing the impact of caregiving on caregivers’ physical or mental health. This will also include quantitative and qualitative syntheses of implementation studies. The literature search will include the following databases: Medline, CINAHL, PsycINFO and Web of Science. A key informant-guided search of grey literature will be performed. Quality appraisal will be conducted with the AMSTAR-2 checklist for quantitative reviews and with an ad hoc checklist for qualitative syntheses. Narrative and tabular summaries of extracted data will be produced, and framework synthesis will be employed for weaving together evidence from quantitative studies in effectiveness reviews with findings on implementation from qualitative studies.

  Ethics and dissemination This umbrella review will use data from secondary sources and will not involve interactions with study participants; it is thus exempt from ethical approval. Results will be presented at international conferences and will be published in a peer-reviewed journal.

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• Omvärdera synen på de äldres livsvillkor under pandemin

  2020. Loretta G. Platts, Lawrence B. Sacco, Boo Johansson. Läkartidningen

  Article

  Rekommendationen att alla äldre personer ska hålla sig hemma är ett uttryck för negativa stereotyper som utgår ifrån att äldre är passiva, sårbara och beroende av andra. Den riskerar att ytterligare begränsa personlig frihet och förstärka den sociala, ekonomiska och politiska marginaliseringen. Åtgärder för att skydda äldre från covid-19 behöver inriktas på hur vi kan främja ett aktivt, meningsfullt och tillfredsställande liv trots pandemin. Bättre kunskap om äldres livsvillkor behövs alltså som grund för nya rekommendationer. Vi föreslår att

  • äldre engageras (enskilt eller via pensionärsorganisationer) i diskussioner om hur man realistiskt och varaktigt kan skydda sig utan att behöva vara isolerad
  • äldre människors olika livsvillkor och levnadsförhållanden beaktas i nya och hälsofrämjande rekommendationer
  • nya rekommendationer måste stärka de äldres egen handlingskraft
  • nya rekommendationer ger bättre underlag för att väga riskerna för covid-19 mot ett hälsofrämjande socialt och fysiskt aktivt liv.

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• Informal Caregiving and Quality of Life Among Older Adults

  2020. Lawrence B. Sacco (et al.). Social Indicators Research

  Article

  Providing unpaid informal care to someone who is ill or disabled is a common experience in later life. While a supportive and potentially rewarding role, informal care can become a time and emotionally demanding activity, which may hinder older adults’ quality of life. In a context of rising demand for informal carers, we investigated how caregiving states and transitions are linked to overall levels and changes in quality of life, and how the relationship varies according to care intensity and burden. We used fixed effects and change analyses to examine six-wave panel data (2008–2018) from the Swedish Longitudinal Occupational Survey of Health (SLOSH, n = 5076; ages 50–74). The CASP-19 scale is used to assess both positive and negative aspects of older adults’ quality of life. Caregiving was related with lower levels of quality of life in a graded manner, with those providing more weekly hours and reporting greater burden experiencing larger declines. Two-year transitions corresponding to starting, ceasing and continuing care provision were associated with lower levels of quality of life, compared to continuously not caregiving. Starting and ceasing caregiving were associated with negative and positive changes in quality of life score, respectively, suggesting that cessation of care leads to improvements despite persistent lower overall levels of quality of life. Measures to reduce care burden or time spent providing informal care are likely to improve the quality of life of older people.

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• Informal care and sleep disturbance among caregivers in paid work

  2018. Lawrence B. Sacco, Constanze Leineweber, Loretta G. Platts. Sleep 41 (2), 1-10

  Article

  Study objectives

  To examine cross-sectionally and prospectively whether informal caregiving is related to sleep disturbance among caregivers in paid work.

  Methods

  Participants (N=21 604) in paid work from the Swedish Longitudinal Occupational Survey of Health. Sleeping problems were measured with a validated scale of sleep disturbance (Karolinska Sleep Questionnaire). Random-effects modelling was used to examine the cross-sectional association between informal caregiving (self-reports: none, up to 5h per week, over 5h per week) and sleep disturbance. Potential socio-demographic and health confounders were controlled for and interactions between caregiving and gender included. Longitudinal random-effects modelling of the effects of changes in reported informal caregiving upon sleep disturbance and change in sleep disturbance were performed.

  Results

  In multivariate analyses controlling for socio-demographics, health factors and work hours, informal caregiving was associated cross-sectionally with sleep disturbance in a dose-response relationship (compared to no caregiving, up to 5h of caregiving: β = .03; 95% CI: .01; .06, over 5h: β = .08; 95% CI: .02; .13), results which varied by gender. Cessation of caregiving was associated with reductions in sleep disturbance (β = -.08; 95% CI: -.13; -.04).

  Conclusions

  This study provides evidence for a causal association of provision of informal care upon subjective sleep disturbance. Even low intensity care provision was related to sleep disturbance among this sample of carers in paid work. The results highlight the importance of addressing sleep disturbance in caregivers.

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• Reconsolidation of a well-learned instrumental memory

  2014. Marc T. J. Exton-McGuinness (et al.). Learning & memory (Cold Spring Harbor, N.Y.) 21 (9), 468-477

  Article

  Once consolidated, memories are dynamic entities that go through phases of instability in order to be updated with new information, via a process of reconsolidation. The phenomenon of reconsolidation has been demonstrated in a wide variety of experimental paradigms. However, the memories underpinning instrumental behaviors are currently not believed to reconsolidate. We show that well-learned lever pressing in rats does undergo reconsolidation, which can be disrupted by systemic administration of the noncompetitive N-methyl-D-aspartate receptor (NMDAR) antagonist (+)-5-methyl-10,11-dihydro-SH-dibenzo[a,d]cyclohepten-5,10-imine maleate (MK-801) when administered prior to a switch to a variable, but not fixed, ratio schedule. Disruption of reconsolidation resulted in a reduction in long-term lever pressing performance and diminished the sensitivity of behavior to contingency change. Further investigation demonstrated that expression of the reconsolidation impairment was not affected by outcome value, implying a deficit in a stimulus–response (S–R) process. The ability to disrupt the performance of well-learned instrumental behaviors is potentially of great importance in the development of reconsolidation-based clinical treatments for conditions that involve compulsive seeking behaviors.

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