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Health and health-care utilisation in old age: the case of older men living alone

Published online by Cambridge University Press:  19 October 2020

Kristian Park Frausing Open the ORCID record for Kristian Park Frausing [Opens in a new window] ,
Michael Smærup ,
Per Lindsø Larsen ,
Kirsten Maibom ,
Knud Juel  and
Karen Pallesgaard Munk
Kristian Park Frausing*
Affiliation:
Research Centre for Health and Welfare Technology, Programme for Research in Aging, VIA University College, Holstebro, Denmark
Michael Smærup
Affiliation:
Research Centre for Health and Welfare Technology, Programme for Research in Aging, VIA University College, Holstebro, Denmark
Per Lindsø Larsen
Affiliation:
Independent, Aarhus, Denmark
Kirsten Maibom
Affiliation:
Research Centre for Health and Welfare Technology, Programme for Research in Aging, VIA University College, Holstebro, Denmark
Knud Juel
Affiliation:
National Institute of Public Health, University of Southern Denmark, Odense, Denmark
Karen Pallesgaard Munk
Affiliation:
Department of Culture and Society, Aarhus University, Aarhus, Denmark
*
*Corresponding author. Email: [email protected]
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Abstract

A growing number of older men are living alone. They are often referred to as an at-risk group in health-care systems. The purpose of this article is to establish an overview of these men's health and health-care utilisation. We do so by drawing on three sources: an online survey with health-care professionals, data from a national self-report health study and register-based data on health-care utilisation. The results show that older men living alone generally have lower health scores than older men co-habiting and that, among older men living alone, lower educational level is associated with lower health scores but also a greater use of free-of-charge health-care services. Health-care professionals conducting preventive home visits consider older men's social needs the most pronounced problem for the men's wellbeing and call for new services to be custom made for them. In this article, we discuss differences between older men living in rural and urban areas and between those who are single, divorced or widowed. We conclude that health and social care systems must differentiate between sub-groups of older men living alone when developing new services and that free-of-charge services, such as general practitioners and home care, should be considered as vehicles for addressing health inequities.

Keywords

ageinghealthhealth inequityhealth-care utilisationmen's healthgenderliving alone
Type
Article
Information
Ageing & Society , Volume 42 , Issue 6 , June 2022 , pp. 1252 - 1279
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

Baes-Jørgensen, J (2019) Enker og enkemænd lever i gennemsnit 15 år alene. Momentum. Available at https://www.kl.dk/nyheder/momentum/2019/nr-7/enker-og-enkemaend-lever-i-gennemsnit-15-aar-alene/.Google Scholar
Baker, DP, Leon, J, Smith Greenaway, EG, Collins, J and Movit, M (2011) The education effect on population health: a reassessment. Population and Development Review 37, 307–332.CrossRefGoogle ScholarPubMed
Casey, MM, Call, KT and Klingner, JM (2001) Are rural residents less likely to obtain recommended preventive healthcare services? American Journal of Preventive Medicine 21, 182–188.CrossRefGoogle ScholarPubMed
Cohen, S, Kamarck, T and Mermelstein, R (1983) A global measure of perceived stress. Journal of Health and Social Behavior 24, 385–396.CrossRefGoogle ScholarPubMed
Cohen, D, Manuel, DG and Sanmartin, C (2016) Do rural patients in Canada underutilize preventive care for myocardial infarction? AMI preventive care by rural–urban status. Journal of Rural Health 32, 345–352.CrossRefGoogle Scholar
Courtenay, WH (2000) Constructions of masculinity and their influence on men's well-being: a theory of gender and health. Social Science & Medicine (1982) 50, 1385–1401.CrossRefGoogle ScholarPubMed
Covinsky, KE (2013) The differential diagnosis of living alone. JAMA Internal Medicine 173, 321.CrossRefGoogle ScholarPubMed
Danish Health Authority [Sundhedsstyrelsen] (2014) Danskernes sundhed: Den Nationale Sundhedsprofil 2013. Copenhagen: Sundhedsstyrelsen.Google Scholar
Danish Health Authority [Sundhedsstyrelsen] (2015) Forebyggelse på ældreområdet: håndbog til kommunerne. Copenhagen: Sundhedsstyrelsen.Google Scholar
Danish Health Authority [Sundhedsstyrelsen] (2017) Opsporing af ældre i særlig risiko for nedsat funktionsevne: en guide til kommuner vedrørende forebyggende hjemmebesøg. Copenhagen: Sundhedsstyrelsen.Google Scholar
Danish Health Authority [Sundhedsstyrelsen] (2019) Ældres sundhed og trivsel: Ældreprofilen 2019. Copenhagen: Sundhedsstyrelsen.Google Scholar
Danish Health Authority [Sundhedsstyrelsen] (2020) Forebyggende hjemmebesøg til ældre: vejledning. Copenhagen: Sundhedsstyrelsen.Google Scholar
de Jong-Gierveld, J, Tilburg, TG van and Dykstra, PA (2018) New ways of theorizing and conducting research in the field of loneliness and social isolation. In Vangelisti, A and Perlman, D (eds), The Cambridge Handbook of Personal Relationships (Cambridge Handbooks in Psychology). Cambridge: Cambridge University Press, pp. 391–404.Google Scholar
Deloitte (2013) Analyse af de medicinske afdelinger: En kortlægning og vurdering af potentialerne ved bedre kapacitetsudbyttelse. Available at https://www.sum.dk/~/media/Filer%20-%20Publikationer_i_pdf/2013/Analyse-af-de-medicinske-afdelinger/Analyse-af-medicinske-afdelinger.pdf.Google Scholar
Djernes, JK (2006) Prevalence and predictors of depression in populations of elderly: a review. Acta Psychiatrica Scandinavica 113, 372–387.CrossRefGoogle ScholarPubMed
Dreyer, K, Steventon, A, Fisher, R and Deeny, SR (2018) The association between living alone and health care utilisation in older adults: a retrospective cohort study of electronic health records from a London general practice. BMC Geriatrics 18, 269.CrossRefGoogle ScholarPubMed
Economic Council of the Labour Movement [Arbejderbevægelsens Erhvervsråd] (2016) De længst uddannede lever 6 år mere end de ufaglærte. Copenhagen: Arbejderbevægelsens Erhvervsråd.Google Scholar
Ennis, SK, Larson, EB, Grothaus, L, Helfrich, CD, Balch, S and Phelan, EA (2014) Association of living alone and hospitalization among community-dwelling elders with and without dementia. Journal of General Internal Medicine 29, 1451–1459.CrossRefGoogle ScholarPubMed
Enroth, L, Raitanen, J, Hervonen, A and Jylha, M (2013) Do socioeconomic health differences persist in nonagenarians? Journals of Gerontology: Psychological Sciences and Social Sciences 68B, 837–847.CrossRefGoogle Scholar
Eskildsen, A, Dalgaard, VL, Nielsen, KJ, Andersen, JH, Zachariae, R, Olsen, LR, Jørgensen, A and Christiansen, DH (2015) Cross-cultural adaptation and validation of the Danish consensus version of the 10-item Perceived Stress Scale. Scandinavian Journal of Work, Environment & Health 41, 486–490.CrossRefGoogle ScholarPubMed
Fors, S, Lennartsson, C and Lundberg, O (2007) Health inequalities among older adults in Sweden 1991–2002. European Journal of Public Health 18, 138–143.CrossRefGoogle ScholarPubMed
Frausing, KP, Smærup, M, Maibom, K and Munk, KP (2020) Succesfuld aldring: også for enlige mænd? Gerontologi 36, 14–19.Google Scholar
Gandek, B, Ware, JE, Aaronson, NK, Apolone, G, Bjorner, JB, Brazier, JE, Bullinger, M, Kaasa, S, Leplege, A, Prieto, L and Sullivan, M (1998) Cross-validation of item selection and scoring for the SF-12 health survey in nine countries: results from the IQOLA Project. Journal of Clinical Epidemiology 51, 1171–1178.CrossRefGoogle ScholarPubMed
Gopinath, B, Rochtchina, E, Anstey, KJ and Mitchell, P (2011) Living alone and risk of mortality in older, community-dwelling adults. JAMA Internal Medicine 173, 320–321.CrossRefGoogle Scholar
Greiner, KA, Li, C, Kawachi, I, Hunt, DC and Ahluwalia, JS (2004) The relationships of social participation and community ratings to health and health behaviors in areas with high and low population density. Social Science & Medicine 59, 2303–2312.CrossRefGoogle ScholarPubMed
Hansen, EB and Greve, J (2016) Enkestand – hvad fører det med sig? Sociale, helbredsmæssige og psykiske følger af at miste en ægtefælle. Copenhagen: KORA – Det Nationale Institut for Kommuners og Regioners Analyse og Forskning.Google Scholar
Hansen, T and Slagsvold, B (2016) Late-life loneliness in 11 European countries: results from the generations and gender survey. Social Indicators Research 129, 445–464.CrossRefGoogle Scholar
Herm, A, Anson, J and Poulain, M (2016) Living arrangements and marital status: a register-based study of survival of older adults in Belgium at the beginning of the 21st century. Ageing & Society 36, 2141–2162.CrossRefGoogle Scholar
Hicks, LL (1990) Availability and accessibility of rural health care. Journal of Rural Health 6, 485–506.CrossRefGoogle ScholarPubMed
Hoebel, J, Rommel, A, Schröder, S, Fuchs, J, Nowossadeck, E and Lampert, T (2017) Socioeconomic inequalities in health and perceived unmet needs for healthcare among the elderly in Germany. International Journal of Environmental Research and Public Health 14, 1127.CrossRefGoogle ScholarPubMed
Huisman, M, Kunst, AE and Mackenbach, JP (2003) Socioeconomic inequalities in morbidity among the elderly; a European overview. Social Science & Medicine 57, 861–873.CrossRefGoogle ScholarPubMed
Huisman, M, Read, S, Towriss, CA, Deeg, DJH and Grundy, E (2013) Socioeconomic inequalities in mortality rates in old age in the World Health Organization Europe Region. Epidemiologic Reviews 35, 84–97.CrossRefGoogle ScholarPubMed
Kandler, U, Meisinger, C, Baumert, J and Löwel, H (2007) Living alone is a risk factor for mortality in men but not women from the general population: a prospective cohort study. BMC Public Health 7, 335.CrossRefGoogle Scholar
Kharicha, K, Iliffe, S, Harari, D, Swift, C, Gillmann, G and Stuck, AE (2007) Health risk appraisal in older people 1: are older people living alone an ‘at-risk'group? British Journal of General Practice 57, 271–276.Google Scholar
Klinenberg, E (2012) Going Solo: The Extraordinary Rise and Surprising Appeal of Living Alone. New York, NY: Penguin Press.Google Scholar
Knesebeck, O von dem, Lüschen, G, Cockerham, WC and Siegrist, J (2003) Socioeconomic status and health among the aged in the United States and Germany: a comparative cross-sectional study. Social Science & Medicine 57, 1643–1652.CrossRefGoogle Scholar
Leontowitsch, M, Fooken, I and Oswald, F (2019) The role of empowerment and agency in the lives of older men living alone. European Journal for Research on the Education and Learning of Adults 10, 231–246.Google Scholar
Lund, R, Nilsson, CJ and Avlund, K (2010) Can the higher risk of disability onset among older people who live alone be alleviated by strong social relations? A longitudinal study of non-disabled men and women. Age and Ageing 39, 319–326.CrossRefGoogle ScholarPubMed
Mackenbach, JP, Stirbu, I, Roskam, A-JR, Schaap, MM, Menvielle, G, Leinsalu, M, Kunst, AE and European Union Working Group on Socioeconomic Inequalities in Health (2008) Socioeconomic inequalities in health in 22 European countries. New England Journal of Medicine 358, 2468–2481.CrossRefGoogle ScholarPubMed
Merwin, E, Snyder, A and Katz, E (2006) Differential access to quality rural healthcare: professional and policy challenges. Family & Community Health 29, 186–194.CrossRefGoogle ScholarPubMed
Mikkelsen, HH (2016) Unthinkable solitude: successful aging in Denmark through the Lacanian real. Ethos 44, 448–463.CrossRefGoogle Scholar
Munk, KP, Smærup, M and Hansen, KF (2016) Er ensomhed skæbne ved høj alder? In Beck, AM, Højlund, B and Thomasen, LS (eds), At skabe gode dage: Hverdagsliv i et gerontologisk perspektiv. Copenhagen: Dansk Gerontologisk Selskab, pp. 31–38.Google Scholar
National Social Appeals Board [Ankestyrelsen] (2010) Forebyggende hjemmebesøg til ældre, oktober 2010. Copenhagen: Ankestyrelsen.Google Scholar
Nicolaisen, M and Thorsen, K (2014) Who are lonely? Loneliness in different age groups (18–81 years old), using two measures of loneliness. International Journal of Aging and Human Development 78, 229–257.CrossRefGoogle Scholar
Nilsson, CJ, Lund, R and Avlund, K (2008) Cohabitation status and onset of disability among older Danes: is social participation a possible mediator? Journal of Aging and Health 20, 235–253.CrossRefGoogle ScholarPubMed
Nummela, O (2015) Social capital and self-rated health among ageing people in urban and rural locations in Finland and in Europe. In Nyqvist, F and Forsman, A (eds), Social Capital as a Health Resource in Later Life: The Relevance of Context. Dordrecht, The Netherlands: Springer, pp. 191–205.CrossRefGoogle Scholar
Perlman, D and Peplau, LA (1981) Toward a social psychology of loneliness. In Duck, S and Gilmour, R (eds), Personal Relationships in Disorder. London: Academic Press, pp. 31–56.Google Scholar
Pimouguet, C, Rizzuto, D, Schön, P, Shakersain, B, Angleman, S, Lagergren, M, Fratiglioni, L and Xu, W (2016) Impact of living alone on institutionalization and mortality: a population-based longitudinal study. European Journal of Public Health 26, 182–187.CrossRefGoogle ScholarPubMed
Pinquart, M and Sorensen, S (2001) Influences on loneliness in older adults: a meta-analysis. Basic and Applied Social Psychology 23, 245–266.CrossRefGoogle Scholar
Poulain, M, Dal, L and Herm, A (2016) Mortality risk by living arrangements for the elderly Belgian population. Quetelet Journal 4, 29–56.CrossRefGoogle Scholar
Rasmussen, RG (2016) Antallet af enlige, ældre mænd er stærkt stigende. Momentum. Available at https://www.kl.dk/nyhed/2016/september/antallet-af-enlige-aeldre-maend-er-staerkt-stigende/.Google Scholar
Reher, D and Requena, M (2018) Living alone in later life: a global perspective. Population and Development Review 44, 427–454.CrossRefGoogle Scholar
Schön, P, Lagergren, M and Kåreholt, I (2016) Rapid decrease in length of stay in institutional care for older people in Sweden between 2006 and 2012: results from a population-based study. Health & Social Care in the Community 24, 631–638.CrossRefGoogle ScholarPubMed
Shaw, BA, Fors, S, Fritzell, J, Lennartsoon, C and Agahi, N (2017) Who lives alone during old age? Trends in the social and functional disadvantages of Sweden's solitary living older adults. Research on Aging 40, 815–838.CrossRefGoogle ScholarPubMed
Staehelin, K, Schindler, C, Spoerri, A and Zemp Stutz, E (2012) Marital status, living arrangement and mortality: does the association vary by gender? Journal of Epidemiology and Community Health 66, e22.CrossRefGoogle ScholarPubMed
Statistics Denmark [Danmarks Statistik] (2013) Middellevetid, civilstand 2012. Copenhagen: Danmarks Statistik.Google Scholar
Statistics Denmark [Danmarks Statistik] (2015 a) Befolkningens udvikling: vital statistics. Copenhagen: Danmarks Statistik.Google Scholar
Statistics Denmark [Danmarks Statistik] (2015 b) Rekordstort antal enlige voksne. Copenhagen: Danmarks Statistik.Google Scholar
Takeuchi, M, Showa, S, Kitazawa, K and Mori, M (2018) Living alone is associated with an increased risk of institutionalization in older men: a follow-up study in Hamanaka Town of Hokkaido, Japan. Geriatrics & Gerontology International 18, 867–872.CrossRefGoogle ScholarPubMed
Terraneo, M (2015) Inequities in health care utilization by people aged 50+: evidence from 12 European countries. Social Science & Medicine 126, 154–163.CrossRefGoogle ScholarPubMed
Tornstam, L (2011) Åldrandets socialpsykologi, 8th Revised Edn. Stockholm: Norstedt .Google Scholar
Turecki, G and Brent, DA (2016) Suicide and suicidal behaviour. The Lancet 387, 1227–1239.CrossRefGoogle ScholarPubMed
Udell, JA, Steg, PG, Scirica, BM, Smith, SC Jr, Ohman, EM, Eagle, KA, Goto, S, Cho, JI and Bhatt, DL (2012) Living alone and cardiovascular risk in outpatients at risk of or with atherothrombosis. Archives of Internal Medicine 172, 1086–1095.Google ScholarPubMed
van Doorslaer, E, Koolman, X and Jones, AM (2004) Explaining income-related inequalities in doctor utilisation in Europe. Health Economics 13, 629–647.CrossRefGoogle ScholarPubMed
van Doorslaer, E, Masseria, C and Koolman, X (2006) Inequalities in access to medical care by income in developed countries. Canadian Medical Association Journal 174, 177–183.CrossRefGoogle ScholarPubMed
Vass, M, Avlund, K, Kvist, K, Hendriksen, C, Andersen, CK and Keiding, N (2004) Structured home visits to older people: are they only of benefit for women? A randomised controlled trial. Scandinavian Journal of Primary Health Care 22, 106–111.CrossRefGoogle ScholarPubMed
Victor, C, Scambler, S, Bond, J and Bowling, A (2000) Being alone in later life: loneliness, social isolation and living alone. Reviews in Clinical Gerontology 10, 407–417.CrossRefGoogle Scholar
Ware, JE, Kosinski, M and Keller, SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Medical Care 34, 220–233.CrossRefGoogle ScholarPubMed
Weiss, RS (1973) Loneliness: The Experience of Emotional and Social Isolation. Cambridge, MA: MIT Press.Google Scholar
Yousaf, O, Grunfeld, EA and Hunter, MS (2015) A systematic review of the factors associated with delays in medical and psychological help-seeking among men. Health Psychology Review 9, 264–276.CrossRefGoogle ScholarPubMed