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With increasing life expectancy, changes in family structure and, most recently, the relaxation of the hitherto strict family planning policies, understanding how mid-life individuals support multiple generations, particularly their older parents and younger grandchildren, is of increasing research and policy significance in China. This paper analyses data from the 2011 China Health and Retirement Longitudinal Study (CHARLS) to examine the characteristics of Chinese mid-life individuals aged 45–64 who are potentially being ‘sandwiched’ between providing care to older parents/parents-in-law and/or younger grandchildren (under age 16). Binary logistic and multinomial regression models shed light on the factors associated with providing support to one generation or multiple generations. The results highlight that amongst the Chinese mid-life sandwich generation, 58 per cent only provide care to their young grandchildren, 23 per cent only provide care to their parents/parents-in-law, whilst 15 per cent are simultaneously supporting both generations. Rather than acting as competing demands upon the mid-lifers’ time, the multivariate analysis provides evidence that the provision of intergenerational care is complementary, with caring for grandchildren increasing the probability of also supporting one's parents/parents-in-law, and vice versa. However, an increase in the number of younger grandchildren has a negative impact on the care provided to older parents/parents-in-law, indicating that at higher care intensities there may be competing demands across the generations.

Background: Previous research has highlighted the importance of accumulated life-course labour market status and the balancing of multiple roles for understanding inequalities in health in later life. This may be particularly important for women, who are increasingly required to balance work and family life in liberal welfare contexts, such as in Britain. Methods: This study analyses retrospective life history data for 2160 women aged 64+ years (born 1909—1943) from the English Longitudinal Study of Ageing, collected in 2006-2007 as part of an ongoing panel study. Optimal matching and cluster analyses are used to produce a taxonomy of women's life-course economic activity trajectories based on their experiences between ages 16 and 64 years. This classification is then used in logistic regression analysis to investigate associations with self-rated health in later life. Results: A set of five trajectories emerge as the dominant patterns of women's economic activity over the life course for those cohorts of English women born prior to 1943: (1) full-time workers; (2) family carers; (3) full-time returners; (4) part-time returners; (5) atypical/inactive. Regression analyses show that women who experience defined periods of full-time work both before and after focusing on family life appear to have the most favourable later life health outcomes. Conclusions: The findings are discussed with reference to the accumulation of social and economic resources over the life course and the balancing of multiple roles in work and family domains. In conclusion, the development of policies that facilitate women, if they wish, to successfully combine paid employment with family life could have a positive impact on their health in later life.

The life course experiences of those born in China from the late 1950s to early 1970s have been very different to those of their predecessors; they may not be able to, or wish to, rely on their family for support in later life in the future. We investigated the attitudes towards current provision of old-age support and preferences for their future old-age living arrangements amongst individuals aged 40-55, representing the next generation of China's older people. Using data from the 2013 Chinese Household Finance Survey, we made multi-variate analyses focussed on understanding the roles of family structure, socioeconomic status, and current patterns of intergenerational support in shaping attitudes and preferences towards old-age support among today's mid-lifers. Attitudes and preferences towards old-age support are shaped by relations within the family, which in turn are affected by broader historical and contemporary social, economic, and cultural conditions. Specifically, the number of children, having a son, Hukou status, and education influence people's attitudes and preferences. The results also point to important gender and cohort differences. One unexpected finding is that around a quarter of Chinese mid-life women living in urban areas and with just one adult child are actively considering the option of institutional care for their own old age, highlighting that social norms around care in later life are shifting.

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.

Little research has examined the cross-national differences in the impact of grandchild care provision on the grandparents’ depression, by taking into account of both macro- and micro-level factors. This study used a unique grandchild caring pattern variable in order to examine the effect of the changes in the intensity of grandchild caring on the grandparents’ depressive symptoms in European countries, and whether the grandparents’ country level economy influenced such effect. Longitudinal data derived from the Survey of Health, Ageing, and Retirement in Europe 2010–2018 covered 13 countries and 24,656 grandparents aged 50–90. Multi-level linear regression analyses with REML estimation were used. This study found that providing grandchild care had a protective effect against grandparents’ depressive symptoms in both lower and higher income countries. Moreover, providing more intensive grandchild care reduced the grandparents’ depressive symptoms to a greater extent in lower income countries than higher income countries. In addition, grandmothers benefited more from grandchild caring than grandfathers, and the gender gap in the effects of grandchild care provision on one’s depressive symptoms was wider in lower income countries than higher income countries in Europe. Future research can further investigate the mechanisms behind such results. The research findings can be used to develop targeted interventions aimed at grandparents providing childcare of different intensity.

Background Previous studies have found that the duration since a union dissolution and the number of union dissolutions are associated with psychological well-being. However, these two aspects of partnership history have rarely been considered jointly in models of mental health. This study aims to investigate how the time since the most recent union dissolution and the number of union dissolutions are related to two indicators of psychological well-being—life satisfaction and the General Health Questionnaire—among middle-aged solo-living British men and women. Methods Data from the United Kingdom Household Longitudinal Study from 2009 to 2010 are analysed for 1201 50–64 year olds who were living alone and have ever been in a co-resident union (472 men and 729 women). Logistic regression analysis is used to investigate how life satisfaction and General Health Questionnaire 12 (GHQ-12) caseness are associated with partnership characteristics. Results GHQ-12 caseness is significantly and positively associated with the number of union dissolutions and negatively with the duration since the most recent union dissolution. This is the case among both genders, in models in which these partnership characteristics are entered separately and jointly, and in models controlling for parenthood status, socioeconomic status and physical health. Conclusions The results suggest that there is a short-term deterioration in mental health after a partnership break-up and that experiencing multiple union dissolutions is detrimental for psychological well-being. The association between partnership characteristics and the two measures of psychological well-being differs, which is in line with previous research showing that negative affect and life satisfaction are two separate constructs.

Background Despite the severe impact of HIV in sub-Saharan Africa, the health of older people aged 50+ is often overlooked owing to the dearth of data on the direct and indirect effects of HIV on older people’s health status and well-being. The aim of this study was to examine correlates of health and well-being of HIV-infected older people relative to HIV-affected people in rural South Africa, defined as participants with an HIV-infected or death of an adult child due to HIV-related cause. Methods Data were collected within the Africa Centre surveillance area using instruments adapted from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE). A stratified random sample of 422 people aged 50+ participated. We compared the health correlates of HIV-infected to HIV-affected participants using ordered logistic regressions. Health status was measured using three instruments: disability index, quality of life and composite health score. Results Median age of the sample was 60 years (range 50–94). Women HIV-infected (aOR 0.15, 95% confidence interval (CI) 0.08–0.29) and HIV-affected (aOR 0.20, 95% CI 0.08–0.50), were significantly less likely than men to be in good functional ability. Women’s adjusted odds of being in good overall health state were similarly lower than men’s; while income and household wealth status were stronger correlates of quality of life. HIV-infected participants reported better functional ability, quality of life and overall health state than HIV-affected participants. Discussion and conclusions The enhanced healthcare received as part of anti-retroviral treatment as well as the considerable resources devoted to HIV care appear to benefit the overall well-being of HIV-infected older people; whereas similar resources have not been devoted to the general health needs of HIV uninfected older people. Given increasing numbers of older people, policy and programme interventions are urgently needed to holistically meet the health and well-being needs of older people beyond the HIV-related care system.

Objectives The aim of this study was to characterize the descriptive epidemiology of insomnia in midlife and explore the relative importance of different occupational risk factors for insomnia among older workers. Methods A questionnaire was mailed to all adults aged 50-64 years registered with 24 English general practices. Insomnia was defined as having at least one of four problems with sleep severely in the past three months. Subjects were also asked about employment conditions, feelings concerning work, and their health. Associations were assessed by logistic regression and population attributable fractions (PAF) calculated. Results Analysis was based on 8067 respondents (5470 in paid work), 18.8% of whom reported insomnia. It was more common among women, smokers, obese individuals, those living alone, and those in financial hardship, and less prevalent among the educated, those in South-East England, and those with friendships and leisure-time pursuits. Occupational risk factors included unemployment, shift working, lack of control and support at work, job insecurity, job dissatisfaction and several of its determinants (lacking a sense of achievement, feeling unappreciated, having difficult work colleagues, feeling unfairly criticized). Population burden of insomnia was associated more strongly with difficulties in coping with work demands, job insecurity, difficult colleagues, and lack of friendships at work [population attributable fraction (PAF) 15-33%] than shift work and lack of autonomy or support (PAF 5-7%). It was strongly associated with seven measures of poorer self-assessed health. Conclusions Employment policies aimed at tackling insomnia among older workers may benefit from focusing particularly on job-person fit, job security and relationships in the workplace.

ObjectivesDemographic changes are requiring people to work longer. Labour force participation might be promoted by tackling sources of job dissatisfaction. We aimed to describe the epidemiology of job dissatisfaction in older British workers, to explore which perceptions of work contribute most importantly, and to assess possible impacts on health.MethodsParticipants aged 50–64 years were recruited from 24 English general practices. At baseline, those currently in work (N=5437) reported on their demographic and employment circumstances, overall job satisfaction, perceptions of their work that might contribute to dissatisfaction, and their general health, mood and well-being. Associations of job dissatisfaction with risk factors and potential health outcomes were assessed cross-sectionally by logistic regression, and the potential contributions of different negative perceptions to overall dissatisfaction were summarised by population attributable fractions (PAFs).ResultsJob dissatisfaction was more common among men, below age 60 years, those living in London and the South East, in the more educated and in those working for larger employers. The main contributors to job dissatisfaction among employees were feeling unappreciated and/or lacking a sense of achievement (PAF 55–56%), while in the self-employed, job insecurity was the leading contributor (PAF 79%). Job dissatisfaction was associated with all of the adverse health outcomes examined (ORs of 3–5), as were most of the negative perceptions of work that contributed to overall dissatisfaction.ConclusionsEmployment policies aimed at improving job satisfaction in older workers may benefit from focussing particularly on relationships in the workplace, fairness, job security and instilling a sense of achievement.

Research to-date has examined the impact of intergenerational support in terms of isolated types of support, or at one point in time, failing to provide strong evidence of the complex effect of support on older persons’ wellbeing. Using the Harmonised China Health and Retirement Longitudinal Study (2011, 2013 and 2015), this paper investigates the impact of older people's living arrangements and intergenerational support provision/receipt on their physical and psychological wellbeing, focusing on rural–urban differences. The results show that receiving economic support from one's adult children was a stronger predictor for higher life satisfaction among rural residents compared to urban residents, while grandchild care provision was an important determinant for poor life satisfaction only for urban residents. Having weekly in-person and distant contact with one's adult children reduced the risk of depression in both rural and urban residents. Older women were more likely than men to receive support and to have contact with adult children, but also to report poor functional status and depression. The paper shows that it is important to improve the level of public economic transfers and public social care towards vulnerable older people in rural areas, and more emphasis should be placed on improving the psychological wellbeing of urban older residents, such as with the early diagnosis of depression.