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Les études sur les évolutions de la santé cherchent à démontrer comment et pourquoi celle-ci change au fil du temps et à prévoir les besoins de santé à venir. L'un des moyens d'étudier ces évolutions est de comparer différentes cohortes de naissance sur plusieurs années. Cette étude porte sur un échantillon national représentatif de Suédois proches de la retraite, entre 50 et 64 ans. Quatre vagues d'enquêtes ont été menées, entre 1968 et 2000, et pour lesquelles des variables d'ordre sanitaire et para-sanitaire ont été utilisées. Les résultats liés à la santé sont variés, dépendant de l'indicateur. La mobilité et la santé dentaire ont connu des améliorations jusqu'à l'enquête de 1991, tandis que les problèmes d'audition, le diabète et le surpoids sont devenus plus répandus. Les résultats présentaient des différences liées à l'âge et au sexe. Le pourcentage de personnes concernées, diplômées ou employés de bureau, a augmenté avec le temps, tout comme le pourcentage de personnes allant chez le médecin et chez le dentiste. Le tabagisme a diminué chez les hommes, mais il a augmenté chez les femmes. Bien que les résultats suggèrent que les cohortes plus récentes qui approchent l'âge de la retraite sont en meilleure santé, ils montrent aussi que ces cohortes présentent plus de problèmes de santé chroniques nécessitant des soins médicaux et qu'elles feront plus appel aux aides à la personne. Les résultats sont présentés dans le cadre de la problématique de prolongation de la vie active et l'augmentation des coûts financiers pour la prise en charge des personnes âgées handicapées.

Background: In old age, many people experience a period of functional decline and require long-term care. Sweden has a universal largely tax-financed health and social care system that is used by all societal groups. However, few studies have investigated if educational groups use publicly paid long-term care equitably. The aim of this study was to explore educational differences in the use of long-term care, including both home care and institutional care, during the last two years of life in Sweden. Methods: We used linked register data on mortality and long-term care use, including all adults aged > 67 years who died in Sweden in November 2015 (N=6329). We used zero-inflated negative binomial regression models to analyse the number of months with long-term care by educational level, both crude and adjusted for age at death and cohabitation status. Men and women were analysed separately. Results: People with tertiary education died more commonly without using any long-term care compared to primary educated people (28.0% vs. 18.6%; p<0.001). In the adjusted model, educational differences in the estimated number of months with long-term care disappeared among men but remained significant among women (primary educated: odds ratio=17.3 (confidence interval 16.8-17.7); tertiary educated: odds ratio=15.8 (confidence interval 14.8-16.8)). Conclusions: Older adults spend considerable time in their last two years of life with long-term care. Only minor educational differences in long-term care use remained after adjustment for cohabitation status and age at death. This suggest that Swedens publicly financed long-term system achieves relatively equitable use of long-term care at the end of life. ; Funding Agencies|Swedish Research Council for Health, Working Life and WelfareSwedish Research CouncilSwedish Research Council for Health Working Life & Welfare (Forte) [2016-00197]; Swedish Research CouncilSwedish Research CouncilEuropean Commission [2016-01072_6]

PurposeDriven by the aim to increase the participation of older people in the labour force and to extend people's working lives, the Swedish Parliament passed a bill in 1998 to increase the pension eligibility age from 60 to 61 years and establish a notional defined-contribution (NDC) plan. In this article, the authors investigate the impacts towards the prolongation of working lives expected from such an intervention.Design/methodology/approachThe authors apply a multinomial probabilistic model based on Swedish registry data on the birth cohorts 1937–1938 (n = 102,826) and observe differences in exit behaviour between eligible and non-eligible individuals.FindingsThe authors find that the cohorts eligible to the pension reform exit the labour market at a later age compared to non-eligible cohorts at the 61-years cut-off. The authors also find that the effect persists in the long term. Furthermore, the authors find that both men and women are equally struck by the reform.Originality/valueWhile there exist many descriptive reports and theoretical analyses on the costs and benefits of pension reforms, this study is the first one to empirically analyse the effect of the first European NDC pay-as-you go pension plan on the potential exclusion of old-aged workers.

Abstract
Retirement is a major life transition that involves changes to everyday routines, roles, and habits. Previous studies suggest that retirement may influence drinking habits. Many natural inhibitors of alcohol consumption disappear with the removal of work constraints. The potential impact depends on both individual and contextual factors. Women in the cohorts undergoing retirement now have been more active on the labor market, including the occupation of higher status jobs, which indicates more financial resources as well as a larger role loss after retirement. Also, the current cohorts who retire have had more liberal drinking habits throughout their lives compared to previous cohorts. We therefore examined changes in alcohol consumption surrounding retirement in different education groups among women and men undergoing retirement using annual data from the Health, Aging and Retirement Transitions in Sweden (HEARTS) study, a longitudinal national study of 60- to 66-year-olds (n = 5,913), from 2015 to 2018. Latent growth curve models were used to estimate trajectories of alcohol consumption. Results showed that those who retired during the follow-up increased their usual weekly alcohol consumption while those who worked or were retired throughout the period had stable drinking habits. Those who were retired reported the highest alcohol consumption. The increase surrounding retirement was driven by people with higher education. Women with tertiary education and men with intermediate or tertiary education increased their weekly alcohol intake after retirement, while those with low education had unchanged drinking habits. Mechanisms and motivations that may fuel increased alcohol intake among people with higher education should be further investigated.

PurposeIn this paper, the authors attempt to understand how labour market attachment during the ages of 30–59 influences individuals' transition out of the labour market.Design/methodology/approachUsing high-quality Swedish register data, the authors follow individuals born in 1950 and observe their labour market attachment during mid-life and their exit from the labour market.FindingsThe authors find evidence that labour market attachment in different stages of the career is differently related to exit from the labour market. At the age of 30, as well as between the ages 50–59, low attachment is related with earlier exit from the labour market. On the contrary, low labour market attachment during the ages 40–49 is related with later exit from the labour market. However, regardless of age, lower labour market attachment increases the risk of work-related benefit receipt in the exit year. The authors also find evidence that gender, migration status and childhood socioeconomic disadvantages may represent obstacles to longer working lives, while high education is a consistent factor in avoiding early exit from the labour market.Originality/valueThis study provides insights on the link between labour market attachment in different stages of the career and the exit from the labour market as well as work-related benefits dependency in the year of exit.

Introduction The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction. Methods and analysis In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire. Ethics and dissemination Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.

INTRODUCTION: The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction. METHODS AND ANALYSIS: In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire. ETHICS AND DISSEMINATION: Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models. TRIAL REGISTRATION NUMBER: NCT03180606.

Introduction The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction. Methods and analysis In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire. Ethics and dissemination Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models. ; Funding Agencies|County Council of Ostergotland; Linkoping University [2016186-14]