Ageing, frailty, and life-course health
Short description
Populations are ageing rapidly worldwide. By 2050, two billion people will be over the age of 60, reshaping health systems in both low- and middle-income countries and welfare states such as Sweden. This research stream examines how social, economic, and biological conditions across the life course influence health, frailty, mental health, and care needs in older age. We combine longitudinal cohort analyses, intersectional methods, and implementation research with partners across Asia, Africa, and Europe. Our current portfolio includes WHO World Health Survey Plus, BRIDGE-CARE on frailty and continuity of care in Sweden, ENTITLED on inequalities in mental health and substance use services, and CONNECT4HEALTH on integrated care for non-communicable diseases and comorbid mental health conditions in Ethiopia, Indonesia, Nepal, and Uganda.
Background
Most early research on ageing originated in high-income countries, including SHARE in Europe, HRS in the United States, and ELSA in England. To address the evidence gap in low- and middle-income countries, the World Health Organization launched the Study on Global AGEing and Adult Health (SAGE) in 2007 across China, Ghana, India, Mexico, Russia, and South Africa. Other longitudinal studies followed, including CRELES in Costa Rica, KLoSA in South Korea, LASI in India, CHARLS in China, and IFLS in Indonesia. In 2021, the WHO launched the World Health Survey Plus (WHS+), its flagship household survey programme designed to strengthen national survey systems and generate data for monitoring population health, the health-related Sustainable Development Goals, and WHO strategic priorities.
Our research draws on these cohorts alongside Swedish register data to address key questions. How do conditions in midlife shape health in later life? How do health systems respond to multimorbidity and the mental health needs of ageing populations? Where are the gaps in care, and who is left behind?
Four active projects anchor this work.
Using WHS+ data from Cambodia, our research group investigates a range of public health issues, including access to and utilisation of healthcare among older adults, care cascades for diabetes and hypertension, abortion knowledge and practices, food insecurity and migration, and depression and unmet healthcare needs. We are also conducting cross-national analyses using WHS+ data from Cambodia, Nepal, Bangladesh, Tajikistan, and Sri Lanka to examine non-communicable diseases (NCDs) and ageing across these settings.
BRIDGE-CARE (https://www.gu.se/en/research/bridge-care) addresses the reality that socioeconomically disadvantaged older adults often experience fragmented care, leading to accelerated frailty and poorer health outcomes. Using Swedish register data and Experience-Based Co-Design with formal carers, informal carers, and care recipients, the project examines how midlife living conditions shape frailty transitions after the age of 70 and how continuity of care can be improved for those most at risk.
ENTITLED (https://www.gu.se/en/research/entitled) is grounded in the principle that health is a fundamental human right, in line with SDG 3.8 and the commitment to leave no one behind. Despite Sweden's universal healthcare system, common mental disorders and substance use disorders remain unequally distributed, and unmet needs persist among vulnerable populations. ENTITLED examines trends from 2015 to 2024, identifies inequalities across social groups using intersectional analyses, and explores the facilitators of and barriers to accessing adequate mental health and substance use services.
CONNECT4HEALTH addresses fragmented care in low- and middle-income countries, where older adults increasingly live with multiple non-communicable diseases alongside mental health conditions. Through implementation research in Indonesia, Nepal, Uganda, and Ethiopia, the project adapts and evaluates a digitally enabled integrated care platform, with country partners leading implementation in their own settings. The University of Gothenburg serves as the Scientific Coordinator and co-leads exploratory research on care fragmentation and health system readiness.
Research themes
- Frailty trajectories and care continuity — Identifying patterns of frailty progression, their life-course determinants, and the role of care continuity in mediating outcomes, primarily through BRIDGE-CARE in Sweden and parallel cohort analyses in China and Southeast Asia.
- Multimorbidity, healthcare utilisation, and unmet needs — Examining how multimorbidity shapes healthcare costs, catastrophic expenditure, and unmet care needs among older adults in Indonesia (IFLS), India (LASI), Cambodia (WHS+), and Sweden. (ENTITLED and BRIDGE-CARE)
- Mental health and intersectional inequalities in later life — Studying depression, substance use, social isolation, and access to adequate services, with ENTITLED examining unmet needs in mental health and substance use care in Sweden using intersectional (MAIHDA) methods.
- Integrated care for NCDs and comorbid mental health — Through CONNECT4HEALTH, generating evidence on care fragmentation, assessing health system readiness, and co-developing an Integrated Logic Model to guide implementation of digitally enabled integrated care across Indonesia, Nepal, Uganda, and Ethiopia.