Nilsen Charlotta, Celeste Roger K, Lennartsson Carin, McKee Kevin J, Dahlberg Lena
Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden; Institute of Gerontology, Jönköping University, Jönköping, Sweden.
Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
Arch Gerontol Geriatr. 2022 Nov-Dec;103:104760. doi: 10.1016/j.archger.2022.104760. Epub 2022 Jun 27.
Social exclusion threatens quality of life in older age. However, there is a lack of research on social exclusion from life-course and gender perspectives. We investigated early- and midlife risk factors for old-age social exclusion among women and men.
Two individually linked studies of Swedish nationally representative samples provided longitudinal data over a 30-year period on 1,819 people at baseline. Indicators of economic exclusion, leisure/social exclusion, and civic exclusion were assessed at early late life (M=70 years) and late life (M=81). Educational attainment, non-employment, psychological health problems and mobility problems were measured as risk factors at midlife (M=54) and late midlife (M=61). Path analysis derived a model of old-age social exclusion.
Exclusion on a domain in early late life led to exclusion on the same domain in late life, except for the economic domain. Leisure/social exclusion in early late life also led to civic exclusion in late life. Midlife risk factors influenced late-life exclusion almost exclusively through early late-life exclusion. While model fit could not be significantly improved by allowing coefficients to vary freely by gender, there was a stronger effect of non-employment on exclusion in women and a stronger effect of psychological health problems on exclusion in men.
This study confirms that old-age exclusion is persistent and dynamic, and influenced by risk factors experienced earlier in life. A holistic approach with integrated efforts across different policy areas is needed to efficiently reduce old-age social exclusion.
社会排斥威胁老年人的生活质量。然而，从生命历程和性别视角对社会排斥的研究尚显不足。我们调查了男性和女性老年社会排斥的早期和中年风险因素。
两项分别关联的瑞典全国代表性样本研究，提供了为期30年的纵向数据，基线样本为1819人。在生命晚期（平均年龄70岁）和老年期（平均年龄81岁）评估经济排斥、休闲/社会排斥和公民排斥指标。将教育程度、非就业、心理健康问题和行动能力问题作为中年期（平均年龄54岁）和中老年期（平均年龄61岁）的风险因素进行测量。路径分析得出老年社会排斥模型。
除经济领域外，生命晚期某一领域的排斥会导致老年期同一领域的排斥。生命晚期的休闲/社会排斥也会导致老年期的公民排斥。中年风险因素几乎完全通过生命晚期的排斥影响老年期排斥。虽然允许系数按性别自由变化并不能显著改善模型拟合，但非就业对女性排斥的影响更强，心理健康问题对男性排斥的影响更强。
本研究证实老年排斥具有持续性和动态性，并受生命早期经历的风险因素影响。需要采取一种跨不同政策领域综合施策的整体方法，以有效减少老年社会排斥。
