Psychiatric care in Sweden is jointly organized by psychiatric practice and municipal social services. To determine who is entitled to support from the municipalities, the concept of “psychiatric disability” was created in connection with psychiatric reform in 1995. Psychiatric disability is a poorly identified concept and in Sweden, a person has severe mental illness (SMI) if they have difficulties in carrying out activities in crucial areas of life, these difficulties are caused by a mental disorder, and they are prolonged. Internationally, SMI is often synonymous with psychosis, but in Sweden other severe psychiatric conditions are included, but not dementia. Both practically and ethically, the unclear definition of SMI is a problem because it determines whether a person is granted interventions and what forms the interventions take. We investigated similarities and differences in people defined as SMI, divided into two groups, psychosis (Nf222) and non-psychosis (Nf253). Adults with SMI aged 65 or over (in 2016) have been assessed using data from four surveys carried out between 1996 and 2011, as well data available from national registers. People with psychosis had worse functional levels on the Global Assessment of Functioning and more unmet needs, according to Camberwell Assessment of Needs. However, differences between psychosis and non-psychosis groups varied across measures (e.g., education, income, living situation) and results differed depending on age at onset, year of first admission to a mental hospital, and length of institutionalization. These variables had a greater impact on the similarities and differences between measures than the diagnosis itself.

Health care in Sweden usually focuses on single diseases and is less prepared to treat people with multimorbidity. Combining different national quality registries (NQR) can provide a broader picture of health care, preventive care, and health-promoting care of older people with multimorbidity. The aim of this study was to explore how NQRs can be used in gerontological health care research. A descriptive mixed-method study, including a case report and statistical analysis, was performed. Nine National Quality Registries, three health registries and a social care registry maintained by the Swedish government were individually matched to an older population (birth year 1896 to 1958) in the Swedish Twin Registry (n≈44000). Factor analysis demonstrated the people tended to fall into one of 4 clusters of registries: stroke/dementia/hip, heart/diabetes, arthritis-related, and other. Men were more highly represented in the heart/diabetes cluster. People in the arthritis cluster had the lowest mean age; people in the stroke/dementia/hip cluster had the highest mean age. 161 people were identified as “most ill elderly” (according to the definition by the Swedish government). Two of them were randomly selected for case reports. Each case appeared in 6–7 of the health quality registries, providing sufficient information to track their progression through the health care system until the point of death. The results highlight both pros and cons of using the quality registries as the basis for analysis and “registry-enriched” research designs, but more research needs to be performed to understand how NQRs can be used in gerontological research.

Older individuals may have discrepancies between self-reported and performance-based abilities on activities of daily living (ADL). We examined objective and self-reported fine motor abilities (FMA). FMA are required for many ADLs, but are examined less frequently than gross-motor tasks in this population. We used two waves of the population-based OCTO-Twin study including mono-/dizygotic Swedish twins, aged 80+. One twin was randomly selected for analyses (baseline N=262; wave 2 N=198; Meanage =83.27; SDage=2.90; 66.4% female). Participants self-reported their ability to manipulate things with hands (cannot do, some problem, no problem) and completed a timed FMA assessment including five everyday tasks (e.g. inserting a key in a lock). Slow performance was coded as 1+ SD from the mean (=80+ seconds). At baseline, 65.8% of slow performers reported ‘no problems’ with hand manipulation. Over two waves (two years), a two-factor ANOVA (including slowness-by-perception interaction) supported a significant difference in total motor task performance between slow performers reporting ‘no problems’ and fast performers reporting ‘no problems’, for both rate of change (diff = -26 seconds, p<.0001) and wave 2 level (diff = 50 seconds, p < .0001). 82% of slow performers at wave 2 reported ‘no problems’, which is surprising given that they had become even slower over the past two years. Findings suggest that objective FMA measures are needed, as self-report is inaccurate and not prognostic. Future work will examine if discrepancies in performance/perceived FMA predict poorer outcomes, and/or if reporting ‘no problems’ despite slower performance is protective against cognitive adaptation to slowing.

Quality of life in late adulthood is a function of physical, emotional, and intellectual health, and maintenance of functional ability is central to sustaining independent living. Generational differences in health behaviors and health care may result in differences in how functional ability changes with age. Twenty assessments of functional ability were collected as part of the longitudinal Swedish Adoption/Twin Study of Aging from twins aged 50–88 at the first wave. Participants completed up to 9 assessments covering a 26-year period. Factor analysis was used to create 3 factors: flexibility, fine motor skills, and balance. Individuals born 1900–1924 (N=441) were compared with individuals born 1925–1948 (N=418). Latent growth curve modeling indicated accelerating changes with age for all 3 factors in both cohorts, but difficulties in motor function increased at a significantly slower pace in the later born cohort. Education was added to the LGCM as an indicator of socio-economic conditions: lower education (elementary school) vs. higher education. Sixty-nine percent of the earlier born cohort and 50% of the later born cohort had only elementary school education. Adding education to the LGCM had no impact on rates of change in the early born cohort. In the later born cohort, however, individuals with less education had the same aging trajectories as the earlier born cohort. That is, only later born individuals with higher educational achievement showed the slower rate of aging of functional abilities. Results demonstrate the SES distinction in the impact of health improvements over the 20th century.

The Swedish health care system focuses on allowing older adults to “age in place”; however, that approach assumes that home health services are adequate to support health and prevent unnecessary decline. Data from the Senior Alert national quality register in Sweden were examined to compare the quality of care across care locations. First registration in Senior Alert was available for 2914 adults aged 57–109 (median age = 81): 3.6% dementia unit, 7.8% home health care, 4.4% rehabilitation unit, 62.8% hospital, 21.4% care home. There were significant differences across units in the number of identified risks in 4 categories: falls, malnutrition, oral health, and pressure ulcer. Individuals in rehabilitation units averaged 2.4 risks, individuals in dementia and care homes averaged 2.0 risks, and individuals in home health care and hospitals averaged 1.4 risks. For individuals with identified risks, the differences between planned and performed actions for each risk independently were greatest for those in home health care. Moreover, the correlation between total planned and performed actions in home health care was .79 for adults aged 65–80 years and .39 for adults aged 81 and over. The correlation did not differ across age for the other care units. Results suggest that individuals most in need of actions to address health risks (older adults in home health care) are least likely to have the actions performed. Training and support of workers responsible for home health care need to be improved if the “age in place” policy is to continue.

Long-term stress is associated with adverse health outcomes in aging. It is important to identify not only factors that influence functioning in late adulthood, such as accumulated stress, but also the timing of such factors. The aim of the current analysis was to examine how socioeconomic stressors throughout the life course are associated with aging in functional capacity. Data were available from 740 adults ranging in age from 40 to 83 at intake (mean = 62.4, SD = 8.2) who participated in up to 8 waves of data collection (mean = 3.9, SD = 2.4). A Functional Aging Index (FAI) was created by combining measures of sensory, pulmonary, gait, and grip functioning. Both childhood and adulthood measures of objective socioeconomic position (SEP) and perceived SEP (financial strain) were available. Latent growth curve models (corrected for twinness) were used to estimate the trajectory of change in FAI over age and the impact of child and adult SEP measures on the trajectories. Results indicated that both childhood and adult objective SEP independently influenced rates of change in FAI in adulthood: higher SEP was associated with higher mean functioning and slower rates of decline. In combination, model fitting indicated that if SEP is above the median in adulthood, then childhood SEP has no impact on FAI trajectories; however, if SEP is below the median in adulthood, then childhood SEP can play a role. In addition, results indicated possible long-term effects of childhood financial strain on rates of change in FAI in adulthood.

Health care in Sweden is heavily subsidized and costs for the user are small, both for physical consultation and telemedicine, and for public and private health care. It has been argued that telemedicine consultations will increase care consumption, lead to higher costs, and create inequalities. As older people often are less skilled in digital technology, increased digitalization of care might increase inequalities. Telehealth is mainly conducted by private companies. This study is based on all private telemedicine consultations in two regions in southern Sweden 2020-2022, with approx. 656,000 inhabitants. 106,000 persons had 343,000 telemedicine consultations, 3.2 consultations p/p. The number of consultations differed neglectable between age groups, for women median was 2.0 for the age groups (< 65/65-79/80+), and for men it was 1.0. The proportion of people WITH telemedicine consultations differed heavily between the age group as well as months. Total number of telemedicine consultations per month varied 4-8.5 thousand among women, and 2-4 thousand among men. The months with most consultations were March-June 2021. Proportion of telehealth consultations was low in the age group 65-79, and even lower among 80+. The proportion of consultations by people 65-79 years increased steadily and reached its peak July-September 2021 with >20%. After that, it increased rapidly down to < 3% among women and < 4% among men. The pattern was similar among people 80+ with peaks at approx. 2% among women and close to 2% among men. The conclusion is that there is still a huge age difference in the use of telehealth consultations.

Although genetic factors significantly contribute to variation in body-mass index (BMI), the effects appear to differ with age. To investigate this, we applied polygenic methods to longitudinal data from the Swedish Twin Registry where BMI was available for age categories ranging from 20–35 to above 80. Using GCTA, a polygenic method to estimate heritability, we showed that heritability explains around 20% of the variability in BMI across age categories. However, a polygenic risk score based on the largest GWAS of BMI (PRSBMI) explained 4–6% of the variation in BMI before 65, but less than 0.5% after age 65. This indicates that while there is substantial heritability of BMI across adulthood and late-life, the genetic variants identified in GWAS mainly predict BMI before age 65. Hence, more work is warranted studying the genetics of BMI in late-life, to better understand its biology and what distinguishes it from BMI earlier in adulthood.

Sense of coherence (SOC) reflects the coping capacity to deal with everyday life stressors and consists of comprehensibility, manageability and meaningfulness. Meaningfulness is the motivational component and sometimes considered the most important part in SOC. Meaningfulness is about the extent to which a person feels that life has an emotional meaning. Meaningfulness is important in aging since many old people suffer from health problems and meaningfulness is important for coping. We examine which factors that are important for the feeling of meaningfulness in a nationally representative random sample of 777 Swedes aged 76-101 years. Meaningfulness is measured with a single item question “Do you usually feel that your daily life is a source of personal satisfaction?”. 11% answered “no”, 20% “yes, sometimes”, 59% “yes, often”. Analyzed with ordered logistic regressions. Control variables: sex, age, education, frailty index, mobility, and psychological wellbeing. Mobility and psychological wellbeing were significant and kept in the analyses, The main independent variables were having a faith (or philosophy), cultural, intellectual, outdoor activities and the social variables loneliness, social contacts outside home, social relations to relatives and friends, contact with children/grandchildren, and phone contacts with children/grandchildren. The social variables were analyzed simultaneously. Loneliness, social relations to relatives and friends, phone contacts with children/grandchildren were significant as well as all other main independent variables. Analyzed simultaneously, controlled for each other, mobility and psychological wellbeing, faith, loneliness, social relations to relatives/friends, and contacts with children/grandchildren were significant. This indicates that these factors are important for meaningfulness in old age.

In accordance with ‘aging in place’ policy, older persons in Sweden are increasingly encouraged to continue living at home and if necessary be supported by home care service (HCS). Studies have examined whether the work environment of staff has an impact on the experiences and the wellbeing of the older persons in nursing homes, but few have examined such associations in HCS. The setting was 16 HCS work units. Two surveys were sent, one to staff on psychosocial working conditions, one to care recipients on care satisfaction. For each work unit, data on individual recipient satisfaction was matched to average values on psychosocial work conditions. Outcomes analyzed with linear regressions were overall recipient satisfaction, based on one question, and indexes on: assessment of implementation of services, contact with staff, and sense of security. Index on treatment by staff was analyzed with ordered logistic regressions due to skewed distribution. We used cluster correlated standard errors (clustering on work units). Results showed that good working conditions are important for recipient satisfaction, specifically overall recipient satisfaction, treatment by staff, and sense of security. Psychosocial work factors most important were work group climate, overall job strain, sense of mastery, job control, frustrated empathy, balancing competing needs, balancing emotional involvement, and lack of recognition. Having more home help hours was associated to stronger relation between working conditions and recipient satisfaction, especially with overall recipient satisfaction and treatment by staff as outcomes.

There is substantial evidence that work plays a significant role in post-retirement health. Yet little is known about its role in when late-life dependency may occur. We examined associations between job strain and the risk of entering late-life dependency. Individually linked nationwide Swedish registers were used to identify people 70+ alive in January 2014, and who did not experience the outcome (late-life dependency) during two months prior to the start of the follow-up. Late-life dependency was operationalized as use of long-term care. Information about job strain was obtained via a job exposure matrice and matched with job titles. Cox regression models with age as time-scale (adjusted for living situation, educational attainment, country of birth, and sex) were conducted to estimate hazard ratios (HR) for entering late-life dependency during the 24 months of follow-up (n=993,595). Having an initial high starting point of job strain followed by an increasing trajectory throughout working life implied a 23% higher risk of entering late-life dependency at a younger age, compared with the reference group (low starting point with a decreasing trajectory). High initial starting point followed by a stable trajectory implied a 12% higher risk of entering late-life dependency at a younger age. High initial starting point followed by a decreasing trajectory implied a 10% risk reduction, and a low starting point with a stable trajectory implied a 22% risk reduction, of entering late-life dependency at a younger age. Reducing stressful jobs across working life may contribute to postponing late-life dependency.

Financial stress is an important source of chronic stress and has been associated with cognitive and physical impairments. This study investigates whether midlife financial stress is associated with the combination of cognitive and physical impairment, the role of potentially modifiable factors, and sex differences.

Methods: The Cardiovascular Risk Factors, Aging, and Dementia population-based cohort study from Finland was used (n=1497) (baseline collected 1972-1987, mean age 50 years). There were two late-life re-examinations (mean total follow-up 25 years). Midlife financial stress was measured using two questions on financial situation. Cognitive impairment was based on six cognitive domains. Physical impairment was self-reported. Potential modifying factors investigated were smoking, alcohol, physical activity, cohabiting/not, non-manual work, and sleep disturbances. Sex differences were investigated. We used path analyses with full information maximum likelihood estimation.

Results: Among women and men, midlife financial stress associated with cognitive impairment, physical impairment and their combination. Smoking and sleep disturbances mediated associations between financial stress, physical impairment, and combined impairments. Among men: manual/non-manual work mediated the association to cognitive impairments; cohabitation mediated to cognitive impairment; financial stress was associated with cognitive impairment only among smokers and stress had a stronger association to physical and combined impairments among non-drinkers. Among women, sleep seems to have role in the association between financial stress and cognitive impairment.

Conclusions: Midlife financial stress associates with late-life impairments, and lifestyle/sociodemographic factors may modify these associations. Sex differences were observed. Interventions promoting healthier lifestyle and psychosocial factors may buffer against the deleterious role of financial stress.

Symptoms of dementia change over time, resulting in complex situations that can negatively impact the person with dementia, as well as their relatives, and create challenges for staff members. Behavioral and Psychological Symptoms of Dementia (BPSD), such as delusions, hallucinations, agitation, depression, anxiety, apathy, irritability, aberrant motor behavior, and sleep disturbances, occur in approximately 90% of older people with dementia. The purpose of the study was to identify potential barriers and facilitators prior to introducing a web-based digital tool, the Daily-BPSD. Daily-BPSD is going to be used by staff members for daily registrations of severity levels of BPSD for persons with dementia in nursing home care in Sweden. Qualitative data collection was conducted in co-production with previous users of a similar digital tool in disability care (n = 11) and future users in dementia care (n = 32). The participants were assistant nurses, care managers, nurses, occupational therapists, and relatives. The responses highlight the importance of an accessible and time-effective registration procedure, a manageable number of variables and registrations occasions per day, and ensuring that the same information does not need to be documented in different systems. The findings will be used to tailor Daily-BPSD and adequately prepare staff members for large-scale data collection in the next step of the research project. Daily-BPSD could provide an extended foundation of knowledge of the person with BPSD, which could be used to provide more person-centered and appropriate care.

People living alone are a growing vulnerable population. We aim to see what kind of activities in old age (76+) may enhance survival for people living alone, and determine if these activities have different associations with survival in people not living alone, and whether these associations differ based on socioeconomic position and gender. The Swedish nationally representative SWEOLD study, 2011 and the Swedish cause of death register were used to conduct Cox regression analyses (n = 742). Incident mortality: 35.6%. In our preliminary results, participation in any activities in old age was related to reduced mortality compared to no participation. However, different types of activities seemed beneficial depending on living situation. Interacting with relatives and friends was protective among people living alone, while having hobbies and solving crosswords was protective among those not living alone. Socioeconomic position did not explain these associations. Most results were similar in women and men.

The concept of active ageing has become central to the European policy discourse in recent years. Aiming to optimize opportunities for health, participation and socioeconomic security, active ageing policies suggest that one way that disadvantages in health and living conditions in old age can be mitigated is by fostering older people’s own contributions to the labour market and to society. Crucially, however, the ability to contribute depends on socio-demographic and socioeconomic factors, and the access to resources that these afford. For instance, for women these resources are frequently less readily available, due to their reproductive roles over the life course, and their higher likelihood to become widowed and live alone in older age. To date, research on active ageing has paid little attention to these factors and how they influence the degree to which it is possible to ‘actively’ age for older women and men, and for different socio-economic groups of older people.

This symposium aims to highlight inequalities in the experiences of active ageing from a comprehensive European perspective, as well as focussing in-depth on three countries representing three distinct welfare regimes in Europe: Germany, England and Sweden. The three single-country case studies showcase how inequalities in workability, pension literacy and living situation influence participation in the labour market and in society. In addition, an alternative policy framework is suggested, going beyond aggregated measures of ‘active ageing’ by acknowledging the role of socio-demographic and socioeconomic inequalities across the life course.

Background: Psychosocial working conditions have been associated with cognitive and physical impairment among older adults. However, less is known on whether psychosocial working conditions are associated with a combination of cognitive and physical impairments. The aim of this study was to investigate the associations between midlife psychosocial working conditions and physical and cognitive impairment among older adults, and to assess whether there are sex differences in these associations. Methods: The data were derived from two Swedish nationally representative surveys (n=839) with a follow-up time of 20-24 years. Multinomial and binary logistic regressions were used to assess the associations between work stressors according to the job demand-control model, and a combination of cognitive and physical impairment. Results: Low control jobs were significantly associated with higher odds of both cognitive and physical impairment as well as a combination of cognitive and physical impairment. Passive jobs (low control, low demand) were associated with higher odds of cognitive impairment, and cognitive and physical impairment in combination. Active jobs (high control, high demand) were associated with lower odds of cognitive impairment. Sex-stratified analyses showed stronger associations among men than among women. Among men passive jobs were significantly associated with both cognitive and physical impairment. Low strain jobs were significantly associated with less physical impairment. Conclusions: These results highlight the importance of midlife psychosocial working conditions for late-life physical and cognitive impairment, and especially among men. Jobs characterised by higher control, lower strain and active jobs may promote resilience and cognitive reserve among older populations.

Studies on ageism often deal with negative stereotypes due to increasing age. Seldom studied is the increase in status that seems to occur at the turning point of 100 years. This study explores how centenarians are portrayed in Swedish media texts and relates this to mechanisms of ageism and age coding. We used Retriever database, which is the biggest Nordic database containing news media, to search for press articles concerning 100- to 105-year-olds. Our search resulted in 1468 articles, consisting of both news articles and feature articles. Excluding articles that did not deal with persons, articles with a paywall and redundant articles resulted in 235 articles. We analyzed (1) the contexts in which centenarians appeared, (2) the relevance of the persons’ age to the event and (3) feelings and values evoked in the articles. On the one hand, news reports evoke how centenarians ought to be shielded from harm and emphasize the indignity of even small wrongdoings. On the other hand, feature articles often use superhuman adjectives to describe centenarians, and emphasize their “youthfulness”. In birthday features, there was also an expectation for centenarians to publicize their celebrations and there was a recurrent trope was that centenarians held well-kept secrets about ageing well. Portrayals of centenarians show that they are an esteemed group. However, we also interpret that these portrayals can hide other forms of ageism, particularly compassionate ageism, and a stereotyping of centenarians that play down ill health and emphasize youthfulness at the extremes of old age.