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Grandparenting and health in Europe: a longitudinal analysis

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. Outline. Background Aim and objectives Data and Methods Results Conclusion.

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Grandparenting and health in Europe: a longitudinal analysis

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  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: • The longitudinal relationship between childcare provision at w2, and SRH/functional limitations/depression 2 and 4 years later; • 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. Overview of Analysis 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 SRH as fair or poor 1+ ADL limitations Depression

  13. Results – descriptive /1 Distribution of grandparent childcare, by wave and gender

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

  15. Results – logistic regressions /1Odds 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. Results – logistic regressions /1Odds 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. Results – logistic regressions /2Odds Ratios from fully adjusted logistic regression with imputed datasets under MAR and MNAR * p<0.05; ** p<0.01

  19. Conclusions • No negative effect of caregiving on health can be found; actually, analyses suggest that provisionof childcare –both intensive and non-intensive –is positively associated with good SRH over time; • Living together with grandchild is not associated with worse health outcomes once baseline health is controlled for; • Attrition should not be ignored as this might affect some longitudinal associations; • 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.

  22. Results – descriptive /2 Distribution of changes in grandparent childcare, by gender

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