Later-life participation is often studied in terms of maintenance or decline of individual activities, leaving less clear whether broader configurations of everyday engagement shift uniformly towards more home-centred patterns or undergo more differentiated forms of change. We analysed French data from the Survey of Health, Ageing and Retirement in Europe (SHARE), waves 5-9, to identify configurations of reported activities among adults aged ≥ 50 years and examine their longitudinal transitions. Baseline profiles were derived at wave 5 (N = 4505) using Partitioning Around Medoids with Gower distance and assigned at waves 6–9 using fixed medoids. Transition matrices, sequence indicators, GEE logistic models and multinomial models described trajectories and associations with concurrent health and life-course changes.Five profiles were identified: Home-centred (73.2%), Family-oriented (9.8%), Community (3.8%), Diversified (7.6%) and Social engagement (5.6%). Home-centred engagement was the most stable profile and the most frequent transition destination. Increased ADL and IADL limitations were associated with higher probabilities of Home-centred engagement. In contrast, retirement was associated with lower Home-centred and higher Community and Diversified engagement, while household-size changes were associated with several profile differences.Later-life participation therefore did not show a uniform shift towards more home-centred engagement. Instead, different functional and life-course changes were concurrently associated with different multidomain engagement configurations. Home-centred engagement should not be interpreted as evidence of reduced engagement, as the available measures cannot distinguish continuity, adaptation, preference or constraint.
Identifying determinants of late-life disease and pathology, ascertaining when they exert their greatest impact (e.g., childhood, adolescence, midlife), and understanding how these factors accumulate and interact over time to shape disease development are central goals of lifecourse research. However, data availability, especially for early-life risk factors, is often an obstacle to the identification of lifecourse determinants of late-life health outcomes and impedes understanding of how they influence risk over time. To guide researchers in designing studies of the effects of early-life exposures on late-life health, here we review key data sources and approaches for obtaining early-life exposure information. We first consider birth cohort studies—in which exposures and outcomes may be prospectively observed in the same participants across the lifecourse—and then review alternative approaches for recovering or integrating early-life information when it is not directly available within a study, including data linkages, retrospective data collection, and synthetic cohorts. We discuss the benefits and disadvantages of each approach, emphasizing their tradeoffs and the importance of matching the research question to the selected data. To aid in researcher decision-making, we also discuss the types of research questions each approach is best suited to address, present examples of successful implementation, and provide a decision flowchart with critical questions to guide selection of the optimal approach for obtaining early-life data for one's study. Careful attention to these tradeoffs and considerations when undertaking lifecourse research will help advance understanding of how exposures over the lifecourse broadly shape late-life health.
Longitudinal evidence on how caregivers' own childhood abuse and neglect (CA&N) is associated with children's development remains limited in low- and middle-income countries, where grandparents often serve as primary caregivers. Using five waves (2015–2024) of data from 1243 children in rural western China, we examined associations between caregiver CA&N and children's cognitive and social-emotional development, as well as statistical mediation through parenting practices, using mixed-effects models and bootstrap mediation analyses. Children whose caregivers reported CA&N showed persistently lower cognitive performance and greater social-emotional difficulties, with cognitive disparities widening over time. Physical neglect was associated with both developmental domains, whereas emotional neglect was primarily associated with social-emotional outcomes, with suggestive evidence that cognitive disparities emerged gradually over time. Statistical mediation was limited mainly to social-emotional outcomes, where indirect associations ran chiefly through neglectful parenting; there was little evidence of mediation for cognitive outcomes. Associations did not differ significantly between parental and grandparental caregivers, although point estimates were larger for parents. Neglectful parenting may be one route through which caregiver CA&N is linked to children's social-emotional difficulties, which points to the value of supporting caregivers with a history of CA&N.
Policies to combat COVID-19 were often implemented without a systematic assessment of trade-offs with other public objectives. This approach implicitly assumed that these policies would do little harm to other aspects of public health. Recently published evaluations of pandemic-era policies have also largely avoided cost-benefit (or harm-benefit) analysis in public health decision-making. This is likely due to a narrow framing of their analyses to the possibility of underreaction to the pandemic. We argue that a disproportionate policy response framework can offer a valuable toolkit to understand the policy choices to combat the pandemic. This article first reviews The Lancet COVID-19 Commission and The BMJ COVID-19 series evaluating policies implemented during the pandemic in Canada, the United States, and the United Kingdom. We suggest that these documents, likely motivated by concern with underreacting to the pandemic, fall short in evaluating the trade-offs between the harms and benefits of COVID-19 policies to ensure that they are of net benefit to the public. We further argue that the failure to address these trade-offs contributed to an erosion in public trust in health authorities and the unequal impacts of the global COVID-19 response, especially among low-income countries.
China’s 2016 long-term care insurance (LTCI) pilots represent one of the world’s largest social-care policy experiments. Using the five waves of the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020, we examine how access to LTCI affects the physical and mental health of informal caregivers. We distinguish between spousal caregivers and adult-child caregivers. The latter provide nearly half of all informal care yet have received little attention in the literature. Using a staggered difference-in-differences design, we find that LTCI reduces physical pain for both groups of caregivers, although its effects on their mental health are limited. Our findings highlight the uneven health benefits of social-care reform and underscore the need for policies that provide stronger mental health support for caregivers in ageing societies.
