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Grandparenting and health in Europe: a longitudinal analysis Di Gessa G, Glaser K and Tinker A Institute of Gerontology, Department of Social Science,

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Presentation on theme: "Grandparenting and health in Europe: a longitudinal analysis Di Gessa G, Glaser K and Tinker A Institute of Gerontology, Department of Social Science,"— Presentation transcript:

1 Grandparenting and health in Europe: a longitudinal analysis Di Gessa G, Glaser K and Tinker A Institute of Gerontology, Department of Social Science, Health & Medicine, King’s College London United Kingdom

2 Outline Background Aim and objectives Data and Methods Results Conclusion

3 Background Grandparents play crucial role in family life Evidence of the impact of childcare on grandparents’ health is mixed:  Custodial/Primary grandchild carers experience poorer health;  Higher quality of life, lower depression and loneliness among grandparents providing grandchild care (vs no care).

4 Background /2 Most studies are cross-sectional and samples consist mostly of US grandparents; Focus on primary and custodial care; Few longitudinal studies have explicitly accounted for attrition.

5 Aim and objectives Examine the effects of caring for grandchildren on health among European grandparents. Main objective: to analyse longitudinal associations between grandparental childcare (including stability and change in provision) and self-rated health, ADL limitations, and depression two, and four years later.

6 Data 4 waves of multidisciplinary comparable surveys, representative of individuals 50+ – Survey of Health, Ageing and Retirement in Europe (SHARE) (N~27,000); France, Austria, Germany, Sweden, Denmark, Switzerland, The Netherlands, Italy, Spain, Belgium – Household response rate: 62%, with individual response rates higher than 85%; – First wave collected in 2004/05.  Focus on grandparents

7 Data /2 Waves 1, 2, and 4 provide information on grandparents, including: Demographic and socio-economic characteristics (age, marital status, occupational status, education) Health (depression, self-rated health -SRH, cognitive function, chronic diseases, functional limitations) Household characteristics (wealth, living arrangements, coresidence) Wave 3 only provides info on grandparents’ SRH

8 Methods /1  Using a sample of 14,675 grandparents aged 50+ from SHARE, and controlling for baseline covariates and health we examined: i.The longitudinal relationship between childcare provision at w2, and SRH/functional limitations/depression 2 and 4 years later; ii.The longitudinal relationship between stability and change in childcare provision (w1-w2) and subsequent health (w3, w4).

9 Methods /2 Provision of grandchild care « During the last 12 months, have you looked after your grandchild[ren] without the presence of the parents? » If so, i) « how often ?» [daily, weekly, monthly, less often] ii) « about how many hours ?» Intensive grandparental childcare if grandchildren were looked after by grandparents on a daily basis or at least 15 hours per week

10 Methods /3 Self Rated Health (SRH), validated global measure of general health which predicts outcomes such as quality of life and mortality; Functional disability (1+ ADL limitations) is associated with increased morbidity, mortality and health care use; Depression is associated with increased risk of coronary artery disease, cardiovascular death, and worsened quality of life.

11 Methods /4 STEP 1: Analyses were firstly restricted to participants with complete data [N~6,200 by w3; N~5,300 by w4]. STEP 2: Multiple imputations under the Missing At Random (MAR) assumption were used to explore the effects of missing data. STEP 3: Sensitivity analyses were used to assess whether different ‘arbitrary’ assumptions about the missing data mechanism affected the results. – We assumed that drop-outs were more likely to rate their health as poor or fair/to be depressed/ to report 1+ ADL limitations by 20% and 33%.

12 Baseline characteristics Gender; Age; Education; Wealth; Possible competing roles (Paid work/ social engagement); Household type; Country; Number & age of grandchildren; Health behaviours (smoking, BMI); Cognitive Function; Diabetes; Stroke. Provision of childcare to grandchildren (w2) Follow-up (w3; w4) SRH as fair or poor 1+ ADL limitations Depression Overview of Analysis SRH as fair or poor 1+ ADL limitations Depression

13 Results – descriptive /1 Distribution of grandparent childcare, by wave and gender Wave 1 Wave 2 GP childcareMWTotal MW Not looking after 52.147.349.3 50.046.748.1 Not intensive37.038.437.8 39.639.7 Intensive10.914.312.9 10.413.612.2 Total 6,1678,39314,560 3,5344,9518,485

14 Results – descriptive /2 Distribution of grandparent’s health, by childcare

15 Results – logistic regressions /1 Odds Ratios from models of SRH (at waves 3 and 4), ADL limitations (wave 4) and depression (wave 4) Women more likely to report depressive symptoms; Age gradient for SRH (w4) and limitations; Respondents in high education, in paid work, socially engaged and in the highest quintiles of wealth were less likely to report poor health (both at w3 and w4) – no similar patterns found for ADL and depression; Age and number of grandchildren not associated with outcome variables.

16 SRH w3SRH w4ADL w4Depressed With adult children0.81 0.92 1.19 1.04 Alone1.02 0.99 1.34** 0.84* Coresiding1.54 1.21 1.26 0.97 Not intensive childcare0.85 0.86* 0.86 0.94 Intensive childcare0.77* 0.89 0.87 0.90 SRH fair/poor5.25** 3.99** 1.99** 1.73** 1+ ADL Limitations1.80** 1.59** 3.81** 1.17 Depressed1.71** 1.80** 1.51** 4.08** Lowest Cognitive function1.06 1.30** 1.63** 1.21 Diabetes1.88** 1.79** 1.56** 1.14 Stroke1.83** 2.08** 2.14** 1.26 Obese1.54** 1.39** 1.83** 0.97 Smoker1.45** 1.39** 1.27 1.30** N6,224 5,381 5,380 5,333 Results – logistic regressions /1 Odds Ratios from models of SRH (at waves 3 and 4), ADL limitations (wave 4) and depression (wave 4) * p<0.05; ** p<0.01

17 MI & Sensitivity analysis The results reported above come from complete-record analyses. Item response was a minor issue: at baseline, about 6% were missing one or more of the variables used; However, sample attrition was quite considerable: ~36% by w2, ~51% by w4; Missing values at follow-up were imputed under MAR and NMAR assumption.

18 SRH w3 SRH w4 ADL w4Depressed w4 MAR 20%33% MAR 20%33% MAR 20%33% MAR 20%33% W/ adult children 0.930.910.89 0.970.950.93 1.35 ** Alone0.960.940.93 0.910.940.93 1.33 ** Coreside1.191.201.22 1.75 ** 1.51 * 1.430.910.950.97 Not intensive 0.86 * 0.85 ** 0.86 * 0.87 * 0.86 * 0.830.870.850.87 0.87 * Intensive childcare 0.83 * 0.860.850.84 0.76 0.78 * 0.79 * 0.82 0.82 * 0.81 * Results – logistic regressions /2 Odds Ratios from fully adjusted logistic regression with imputed datasets under MAR and MNAR * p<0.05; ** p<0.01

19 Conclusions i)No negative effect of caregiving on health can be found; actually, analyses suggest that provision of childcare –both intensive and non-intensive –is positively associated with good SRH over time; ii)Living together with grandchild is not associated with worse health outcomes once baseline health is controlled for; iii)Attrition should not be ignored as this might affect some longitudinal associations; iv)MI under MAR and NMAR suggest that childcare provision is beneficial also for grandparents’ functional and mental health.

20 Limitations No information on type of childcare provided and its quality; nor on the satisfaction or “obligation” perceived by grandparents in looking after their grandchildren; Childcare and health measurements are self- reported and sensitive to the time frame they refer to; Caution is needed when analysing results from MI as we are imputing half the dataset!

21 Thanks for your attention! Questions, comments and feedback are welcome.


23 Results – descriptive /2 Distribution of changes in grandparent childcare, by gender Wave 1/ Wave 2 GP childcareMenWomenTotal Not childcare at either wave36.534.435.3 No care  Any care 12.09.610.6 Continued not-intensive care26.127.226.7 Continued intensive care5.17.86.7 Stopped care13.512.312.8 Non intensive  Intensive Intensive  Not intensive Total3,5184,932100

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