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University of Gothenburg
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The program focuses on analyses of older generations in historical and socio-economic contexts that will increase understanding of the major societal changes that occurred during the 20th century and how these affected older people in a life course perspective. This will give new insights into the dynamics of ageing, both as a social and an individual phenomenon.

Large societal changes occurred during the last century in areas such as perinatal care, urbanization, education, working life, retirement, housing, hygiene, dietary habits, health care services, and survival. Many of these changes are due to macro level influences.
Our access to data on elderly persons collected over 40 years in longitudinal population studies of different birth cohorts makes it possible to study changes in capability and its determinants over the past four decades. The Swedish censuses, the H70 and H85 studies, the SOM-institute data and PSAE will be used. Changes in retirement patterns and wellbeing, independent living, ability/disability, mental and physical health will be related to changes in welfare state policies and laws in general.
We will use a multilevel approach, i.e. macro level variations will be directly linked to micro level and meso level outcomes. In reality, causation is complex and dynamic as macro level aspects (e.g. laws, allocation of economic resources) often develop in response to prevailing living conditions. We will also study how social patterns demonstrate both continuity and change across generations and birth cohorts.

Several aspects will be taken into account, including historical context (social structures, economic cycles, and technological innovations), social networks, and variation in class, gender, ethnicity and economy. Changes and variations in older people's living conditions (e.g. possibilities for independent households, intergenerational housing, retirement homes) and quality of life and its effect on capability will be examined.

A major research question is whether increased life expectancy leads to compression or extension of morbidity, and its health economic implications.
By analyzing the interplay between living conditions, historical context, and the individual's social context and socio-economic conditions, participants in the population studies will be placed in a larger context. Time-trends in media representation of older people will be examined with qualitative analyses of media content from 1994, 2004 and 2014.

Coordinators
Ulrika Lagerlöf Nilsson (Faculty of Arts, Department of Historical Studies)
Annika Bergström (Faculty of Social sciences, Department of Journalism, Media and Communication)

Involved Faculties and Institutions

Faculty of Social sciences
Faculty of Humanities 
School of Business, Economics and Law
Sahlgrenska Academy
Faculty of Fine, Applied and Performing Arts
Institute of Medicine, Department of Public Health and Community Medicine)
Department of Psychology
Department of Political Science
Department of Journalism, Media and Communication
Department of Historical Studies
Department of Swedish 
Department of Law
Institute of Health and Care Science
Institute of Neuroscience and Physiology

 

Work and retirement and capability

Increasing life expectancy has led to a need for an extended working life to ensure a sustainable pension system, labor availability and effective use of the human capital possessed by older workers. At the meso and macro level, we will study what employers, work places and organizations do for older workers regarding e.g. working conditions and rehabilitation, and how government policies and regulations are implemented.
Strategic work places will be identified. Fieldwork comprises interviews with work place actors (e.g. managers, employees, HR- specialists, trade union representatives), complemented with internal documentation. We will also study the organizational conditions and practices that promote and hamper delayed retirement, activities initiated at workplaces to delay retirement and allow longer work lives, and to test and implement organizational changes. These organizational activities ("age management") may involve adapting the work environment, management, or job content, or modification of norms on ageing and retirement.

Studies will include surveys, in-depth case studies (car industry, hospital), and interventions. At the micro level, we will examine the transition from working life to retirement, which may impose life style changes that affect health and well-being. Factors that affect causes and timing of retirement, changes in physical, mental and cognitive health and their determinants before and after retirement in the context of adaptive/coping processes will be identified. The Swedish pension system imposes strong economic incentives to work longer, which may result in increased economic and health inequalities among older people.

The Swedish labor market is also highly gender segregated. We will thus analyze post-retirement inequalities and link these to life trajectories and work life history, and how these correspond to different types of welfare regimes. We will identify how types of retirement transitions corresponds to welfare regime, i.e., how welfare and labor market polices affects retirement patterns. Initial steps will investigate retirement transition pathways, and physical and psychosocial working conditions among older workers using longitudinal data. We have access to data that makes it possible to analyze preferences before retirement decisions and capability sets after retirement. The new population-based HEARTS study employs a longitudinal design from pre-retirement, over retirement, into post-retirement life in persons aged 60-66 at baseline, focusing on moderators and mediators of change and stability in psychological health and adaptive processes before and following retirement.

A new study with focus on retirement patterns among industrial employees in the public sector will also be conducted, with special focus on female workers. Findings will be related to data on retirement in the H70-studies, European SHARE and the US HRS studies. In addition, a nested case-control study comparing people who still work with those who do not will be performed using mailed questionnaires in a random general population sample aged 67 years, with information also from at age 64. The JP is anchored in the capability model as it focuses on how rules and regulations at the macro level influences meso and micro levels.

Coordinators
Ewa Wikström (School of Business, Economics and Law, Department of Law)
Kjell Torén (Salgrenska Academy, Institute of Medicine, Department of Public Health and Community Medicine)

Involved Faculties and Institutions

Faculty of Social sciences
Faculty of  Humanities
School of Business, Economics and Law
Sahlgrenska Academy
Department of Law
Department of Business Administration
Department of Economy and Society
Institute of Medicine, Department of Public Health and Community Medicine
Department of Sociology and Work Science
Department of Psychology
Department of Political Science
Institute of Health and Care Science
Department of Literature, History of Ideas, and Religion
Institute of Neuroscience and Physiology
Centre for Interdisciplinary Gender Research

Participation, representation and self-determination and capability

Visibility, participation and self-determination are important aspects of capability in older people. At the macro level, the lack of voice of old people in the media limits both public debate and knowledge about older people’s experiences and opinions, leading to a democratic deficit and decreased visibility of older people.

The media representation of ageing, which influences self-images at the micro level and societal attitudes at the macro level, has been examined using analyses of media content from 1994-2014 to identify denominators for the representation of elderly people in news, feature, advertising and fiction. We will examine what older people are allowed to talk about in media and in which arenas they are present. In addition, we will study how digital media have influenced visibility of old people, how older people use digital media, and how digital divide influences old people. To enhance representation and participation of older people, we will implement a co-design project, where older people together with design researchers and other AgeCap researchers, will develop new representational methods and media practices where the older people themselves can affect the representation of old age. This could be connected to the Critical Exhibition Studies at HDK, who works closely with various museums in the region, and lead to an exhibition presenting diverse representations of older people. It could also be linked via pilot projects and seminars with the Academy of Music and Drama, and Academy Valand.

At the micro-macro level, political engagement among old people and how this is shaped by socio-economic factors (gender, education, income, ethnicity), vulnerability, personality traits, and internal efficacy influence will be analyzed with focus on trust in political institutions, political activity, political interest, news media use, and satisfaction with democracy using data in different socio-political macro-level contexts conducted over time (national SOM surveys) and across countries (European Social Survey, World Value Survey, QoG institute).

Older adults in Sweden are expected to make more decisions about their own service and old-age care, empowered at the macro level by the proposed LOV-bill (“Act on Free Choice Systems”). Recent studies indicate that this right is not fully respected. Self-determination, i.e. participation in decision-making without control by others, will be examined using the capability model to focus on how rules and regulations implemented at the macro level are operationalized in the everyday context, and how it is affected by an increasing dependence in daily activities in older persons followed from the independent to the dependent stage. We will also examine how self-determination is related to treatment adherence and health literacy, i.e. the ability to access, read, understand, communicate, make use of health information and technical and medical language, and navigate in the health care system, including access and skills to use internet.

Personal control and autonomy, and other prerequisites for decision-making, will be studied in cognitively non-compromised persons in need of home-help service or relocation to sheltered housing in a time when these possibilities are reduced due to political decisions.
Focus is on how autonomy and control are affected at the macro and meso level by elder care policies, organization, priorities of family and friends, and available information. Factors and interventions to support a good ageing at home, including at the individual level (e.g. participation and engagement in daily activities, work and leisure activities, functional, and physiological determinants), meso level (environmental factors, organizational factors, everyday technology, family support), and macro level (political decisions) will be studied. Case studies on 85-year-olds aging in their own home, their next of kin, and any formal helper, as well as on how self-determination is affected by becoming dependent on others will be done.

We will also study how caregiving of a close relative affects an older person’s capability and how it is influenced by micro, meso and macro level factors. Both experimental and explorative mixed method designs will be used, as well as case study methods and full-scale implementation research using information from clinical databases, the population studies, from a new study in older home living persons aged 80 years and above, and the Gothenburg MCI study. The intention is to design and test support systems to improve decision-making. We will also examine the effects of motivational programs based in the Self-Determination Theory in various interventions, and how to develop digitally supported interventions.

Coordinators
Maria Edström (Faculty of Social sciences, Department of Journalism, Media and Communication)
Isabell Ottenvall Hammar (Sahlgrenska Academy, Institute of Neuroscience and Physiology/Health and Care Science)

Involved Faculties and Institutions
Faculty of Social sciences
Faculty of Humanities 
School of Business, Economics and Law
Sahlgrenska Academy
Department of Sociology and Work Science
Department of Psychology
Department of Political Science
Department of Journalism, Media and Communication
Department of Historical Studies
Department of Swedish 
Department of Law
Institute of Health and Care Science
Institute of Neuroscience and Physiology

Cognition and capability

At the micro level, cognitive function and dementia are crucial determinants for capability in older people, and also important for all other JPs, as it influences both macro and meso level conditions. The prevalence of dementia increases from 1% at age 70 to 20-25% after the age of 80. It is also an area where UGOT has a long research tradition. The examination of cognitive change and stability in old age, and its relation to capability, necessitates longitudinal studies operating over long time periods. Recent developments in statistical theory and computational power now allows for more sophisticated analytical techniques for longitudinal studies.

The variability in rate of decline in old age general populations will be explained by identification of interactions between genetic, socio-economic and life-style factors that operate over the life course and result in accumulation of neurodegenerative changes and ultimately dementia. Genetic diversity in the population may influence capability in different ways. For example, the apoE4 allele, which is a vulnerability factor for Alzheimer’s disease, is also a vulnerability factor for other conditions. We will do genetic testing and DNA processing on blood samples from the populations and clinical samples in collaboration with Professor John Hardy, London. We will also study how biological markers in cerebrospinal fluid (CSF), blood, brain imaging and body composition examinations are related to cognitive decline and dementia. The population studies and the MCI study include measures of these biological markers. Studies have consistently found an increase in CSF T-tau, and reduction in CSF Aβ42 in individuals with Alzheimer’s disease and mild cognitive impairment (MCI). It is now also possible to measure synapse proteins (neurogranin, synaptotagmin) in CSF. Recent developments in ultrasensitive measurement techniques have given methods to quantify neuronal injury markers in serum. Preliminary data from our studies suggest that levels of CSF Aβ42 is reduced up to 18 years before dementia onset. An important task is to examine very early Alzheimer’s disease using the multidisciplinary approach of AgeCap.

One unique aspect is to examine how diachronic, linguistic analyses of peoples’ writing or speech may serve as an early complementary marker for various types of cognitive decline. Methods from computational linguistics and natural language processing may provide new insights by applying and exploring automatic linguistic analysis and comparison of language samples (e.g., for feature extraction and language modeling). Language in this context represents various forms of spoken or written language production, e.g. transcripts of audio-recorded utterances (storytelling, spontaneous speech), accessible language-based interaction through the web (digitally generated captured information from a person’s digital life or beyond), and measures from an eye tracker device. The effect of resilience in ageing, i.e. a socio-emotional reserve model, will be investigated by studying the protective effects of psychological well-being and social support on cognitive functioning in the presence of abnormal biomarkers of Alzheimer neuropathology. The health economic implications of cognitive dysfunction will also be examined. The aims are to inform policy makers and public on how to prevent intellectual dysfunction and delay onset and progression of dementia in future generations, and how to identify strategies to enhance care for older people with dementia both at the individual and organizational level. This JP will use information from the Swedish Twin Registry, the PPSW, H70, H85 and 95+, the Gothenburg MCI Study, and a new study specifically examining language in early dementia. Cognitive function, neurobiological and genetic factors are also important for other JPs.

Coordinators
Linda Hassing (Faculty of Social sciences, Department of Psychology)
Silke Kern (Sahlgrenska Academy, Institute of Neuroscience and Physiology)

Involved Faculties and Institutions
Faculty of Social sciences
Sahlgrenska Academy
Faculty of Humanities 
School of Business, Economics and Law
Department of Psychology
Institute of Neuroscience and Physiology
Institute of Health and Care Science
Department of Business Administration
Department of Swedish 

Health and capability

Mental and somatic health are major micro level determinants for capability among older people. We will examine the whole range of old age psychiatric disorders, including depression, anxiety disorders, and psychotic syndromes. The most common mental disorder is depression, which has several consequences, both at the micro level (social deprivation, loneliness, poor quality of life, disability, cognitive decline, stroke, and an increased non-suicidal mortality), and meso-macro level (increased use of health and home care services). At a global level, it is estimated that depression will be the leading cause of lost healthy years by 2020 according to WHO. Depression is also the most important reason for suicide in old people. Older men have the highest suicide risk in the western world, and suicide rates in older adults are accelerating in emerging economies. One important goal is to increase knowledge regarding the influence of mental health on capability. For this purpose we will use information from the population studies and perform qualitative studies regarding depression in the elderly. A special case regarding mental health in the elderly is loneliness, which is related to risk of depression and suicide. The determinants and consequences of loneliness will be investigated in the population studies. Somatic health is also important for capability. Multimorbidity, or the co-occurrence of multiple health conditions in the same individual, increases risk of death, functional disability, and institutionalization, over and above the risk attributable to individual diseases. Little is known about how diseases distribute and co-occur in the same individual and how social ties, personal and situational antecedents affect capability in these individuals. We will use a Disablement Process Model to delineate the pathway from pathology to various kinds of outcomes and to examine how multimorbidity influences different aspects of capability. Meaning and understanding, and ranking of health outcomes according to personal priorities, will be studied using the Explanatory Model Interview Catalogue. Notably, self-reported health is a stronger predictor for mortality than objective health. Thus, relationships between pathology, illness and impairment can be as much a function of psychosocial characteristics as number of diagnoses or disease severity. The aim is to combine epidemiological methods with qualitative descriptions of meaning and understanding of capability and multimorbidity. Few epidemiological studies combine the insider and outsider perspective, which neglects the complexity of the associations between multimorbidity and capability, and narrows our understanding of relationships between biomedical models and patients’ experiences.

Coordinators
Hanna Falk Erhag (Sahlgrenska Academy, Institute of Neuroscience and Physiology/Health and Care Science)
Anne Ingeborg Berg (Faculty of Social sciences, Department of Psychology)

Involved Faculties and Institutions
Faculty of Social sciences
Faculty of Humanities 
Sahlgrenska Academy
Faculty of Fine, Applied and Performing Arts
Department of Sociology and Work Science
Department of Journalism, Media and Communication
Department of Historical Studies
Institute of Health and Care Science
Institute of Neuroscience and Physiology

Frailty and Capability

Our target group are frail older people. Frailty can be defined as a state of decreased reserve resistance to stressors as a result of cumulative decline across multiple physiological systems.  Frailty can range from mild to severe stages, and it is regarded as being strongly linked to restricted activity and morbidity. The aim of our research programme is to study measures to support ageing well at home - both among older people who are already frail and those with risk of developing frailty - and to improve health and social care, and rehabilitation with and for frail older people, both within the healthcare sector and in the community. We also want to deepen the understanding of how frailty and ageing processes influences activity and participation in daily life. The capability approach is a fundamental part of all projects, which means that focus lies on the real opportunities people have to achieve the things that they have a reason to value, in relation to the resources they have at hand. We have, among other things, developed a short screening instrument to identify older people at risk of being frailt, which has been implemented in acute care units in Gothenburg.

One example of a research project is the FORTE -funded study ” Comprehensive geriatric assessment of frail older people in Swedish acute care -a randomized controlled study” . The purpose of this study is to evaluate if comprehensive geriatric assessment of frail older people in Swedish acute care could lead to maintained independence in everyday activities, functional level, health related quality of life and life satisfaction, as well as to improved satisfaction with care and reduced health care consumption. The study is a randomised controlled trial (RCT) targeting people 75 years of age and older who seek acute care, with follow-ups after one month, six months and one year.

Another project is the FORTE-funded interdisciplinary study "UserAge - Understanding user participation in research on aging and health" and is about research in collaboration with actors outside the academy. The project is carried out in an interdisciplinary research environment and is coordinated by the Center for Aging and Supportive Environments (CASE) at Lund University, with Gothenburg University, Kristianstad University and Linnaeus University as partners. At the University of Gothenburg, the goal is to develop knowledge about collaboration with frail older people to enable them to participate in the design, implementation and evaluation of products and services that affect them and also focuses on innovative methods to involve frail older people in research.

Coordinators
Katarina Wilhelmson (Sahlgrenska Academy, Institute of Neuroscience and Physiology)Synneve Dahlin Ivanoff (Sahlgrenska Academy, Institute of Neuroscience and Physiology)

Cumulative disadvantage/advantage and capability

We will examine associations between different areas related to capability across the micro, meso and macro levels. For example, those suffering from economic hardship more often have poor somatic, mental and cognitive health. With increasing age, those with more hardships will suffer more adversities, and those with little adversities will suffer less, resulting in increasing health inequalities. The aim is to understand how discrimination or access or lack of resources in one area affects outcomes in other areas. Data from the first wave of PSAE has been used to develop a multidimensional measurement model for wellbeing among older people. The model builds on a latent variable approach, which makes it possible to simultaneously estimate a multidimensional measure of conditions and distinguish its unique components, e.g., between different welfare areas. A full range longitudinal model for the second wave of PSAE, the population studies in Gothenburg, and the European SHARE database will be developed to study how problems accumulate over time, and how vicious and good circles are established. Older people are prone to adjust their preferences, a core part of capability, in order to cope with limited resources. Their perceptions of ‘quality of life’ might also change. Analyses of differences in correlations between different problems in different age groups and over time will provide new insights on adaption of preferences and what older people actually values. We will adopt an intersectional perspective on ageing and capability, e.g. the intersecting power relations (i.e. systems of advantage or disadvantage) among different factors (e.g. age, gender, socioeconomic status). Attempts to explain negative health consequences of social inequality by only focusing on a single demographic factor often fails to explain health disparities. The concept of intersectionality will help us to better understand how macro level conditions affect capabilities and living conditions in old age. We also need to compare between countries and within countries over time, i.e., to what degree differences in welfare state arrangements capture variations in welfare-related events, e.g. retirement, independency, and access to care. Digital inequality may be especially important among older people, and between the older and the younger, as policy makers aim for full digital inclusion. Those who function better in the digital realm and participate more fully in digitally mediated social life enjoy advantages over their digitally disadvantaged counterparts.

Coordinators
Lotta Dellve (Faculty of Social sciences, Department of Sociology and Work Science)

Involved Faculties and Institutions

School of Business, Economics and Law
Faculty of Social sciences
Sahlgrenska Academy
Faculty of Humanities
Department of Law
Department of Business Administration
Department of Economy and Society
Department of Sociology and Work Science
Department of Psychology
Department of Political Science
Institute of Health and Care Science
Department of Literature, History of Ideas, and Religion
Centre for Interdisciplinary Gender Research

Implementation and utilization of research

In line with the public outreach mission of Swedish Universities (Lag 2009:45), the overarching aim with this research program is to study implementation and utilization of research in ongoing projects within AgeCap, and to initiate new projects in collaboration across faculties and institutions at The University of Gothenburg. An additional goal with the program is to participate in the initation of national and international networks for research on ageing and health. Implementation refers to different ways of introducing new methods within an organization. For instance, it could be evidence-based methods to prevent falls in older people’s homes. Utilizing the research-based knowledge on implementation increases the likelihood of improvement projects to continue as planned, and to result in expected effects. Implementation is, however, a lengthy process. It may take several years before a new method has been integrated into daily practice within an organization. Researchers usually refers to two- or four-year-long processes. There are several theoretical models for implementation and the implementation profess, which could be divided into four phases; inventory of needs, initiation, utilization and maintenance. Utilization of research refers to collaboration between researchers and the public, to make research available and utilized outside the academic world. This could involve everything from making research findings available for the public to development of services or organizations based on research findings. Central concepts within the program are; capability, user involvement and person-centredness. This means that focus lies on different person’s real opportunities to live the life they want to live an be the kind of persons they want to be (capabilities). Researchers, target groups and organizations are collaborating to implement research findings, so that they benefit the public (user involvement), and a foundation for this is that all parties are seen and acknowledged as capable persons with important knowledge and expertise (person-centredness). In combination, this is expected to lead to an improved understanding of research on ageing and health, as well as the identification of relevant research questions, richer and deeper data, innovative data analysis dimensions, increased confidence in research in general, and increased dissemination of research findings.

Program coordinators
Susanne Gustafsson (Institute of neuroscience and physiology) 
Qarin Lood (Institute of neuroscience and physiology)

Faculties and institutions at the University of Gothenburg that are included in the program

Department of social work
Department of sociology and work science
Geriatric development centre, Sahlgrenska University hospital
Institute of health and care sciences
Institute of neuroscience and physiology
Grants and innovation office
University of Gothenburg Centre for person-centred care - GPCC
Department of business administration
 

Adult cognitive disorders

Alzheimers disease and cerebrovascular disease are the quantitatively most important causes of cognitive impairment in adults. These, and other similar disorders, such as Lewy body disease and frontotemporal dementia, are the main focus of the research group.

 

Sahlgrenska suicide studies

The Sahlgrenska suicide studies investigate risk factors for suicidal behaviour in the older population using population based studies, registry studies and clinical studies.

Contact: Margda Waern, margda.waern@gu.se