European patterns of intergenerational financial and time transfers

The ageing of the European population is expected to strongly influence both the structure of family relations and the pattern of private transfers between generations. Using data from the Survey of Health, Ageing and Retirement in Europe conducted from the perspective of adults aged 50 and above in ten European countries, we provide an analysis of financial and time transfers, either given or received. Our results show that cash gifts mainly flow to the younger generations, while time transfers are directed both upwards and downwards. When comparing the countries, we find some remarkable similarity in the pattern of transfers, although there are inter-country differences. These differences sometimes follow the expected north-south European gradient, but not always. The results suggest that the social and demographic transformations currently taking place in Europe often have contradictory and paradoxical effects upon the nature of intergenerational exchanges.

The relation between attachment and intergenerational support

This study investigated the relation between the internal representation of attachment and the perception of the actual exchange of intergenerational support within 100 dyads of adult daughters and their elderly mothers in Germany. Results showed relations between the daughters’ preoccupation and avoidance with their perception of receiving emotional support from their parents and providing instrumental support to them. No relations were found between the mothers’ attachment and the support they provided to the daughters. These results are discussed with respect to different conditions for emotional and instrumental support of adult daughters and their elderly mothers, and a relationship specific approach to attachment.

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A possible innovative association between the concept of inter-generational ambivalence and the emotions of guilt and shame in care-giving

The present article suggests a tentative new theoretical association between the concept of intergenerational ambivalence and the emotions of guilt and shame in care-giving. The article bases the above suggestion on the paradigm of intergenerational ambivalence as well as on existential and psychological emotion theories dealing with guilt and shame. In certain typical care-giving situations (e.g., leading to institutionalization of the elderly) feelings of guilt can mirror personal-subjective ambivalence (micro level ambivalence) while feelings of shame can mirror institutional-structural ambivalence (macro level ambivalence). The article exemplifies this idea, using an empirical study, which was conducted in Israel (1995), about guilt emotions of care-givers in the Kibbutz versus the city, concerning the institutionalization of an elderly parent. In order to support this innovative concept in the gerontological literature, more updated empirical proof is yet needed. Conclusions and implications of the association between guilt, shame and intergenerational ambivalence are discussed, from theoretical and practical perspectives.

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Intergenerational Family Relations and Life Satisfaction Among Three Elderly Population Groups in Transition in the Israeli Multi-cultural Society

The study aims to illuminate the links between personal and familial resources and wellbeing of elders 65+ in three population groups in Israel: kibbutz members, new immigrants from the former Soviet Union and Arabs—all of whom are undergoing different types of personal, social and economic transitions. About 70 respondents in each group were interviewed regarding life satisfaction, familial relations based on the paradigm of intergenerational family solidarity and personal resources (socio-demographic and physical functioning). The main conclusions of this study are: the lives of the elderly immigrants are much more disruptive by the transitional migration processes they are undergoing and this affects their well-being which was much lower than the other two groups. Additionally they received more help from the family. Family solidarity, mainly opportunity structures and emotional bonds were especially strong among the Arabs, with the lowest level of conflict. The Arab elderly were also different from the other two groups in the lower level of help they provided to their adult children, probably due to their more limited level of personal resources and the differing social expectations. The majority of respondents acknowledged some degree of filial obligations, although much lower among kibbutz members. Personal resources (physical functioning and financial adequacy) had the strongest effect on life satisfaction in all three groups. The dimensions of family solidarity played a less dominant role. The discussion highlights the distinctive family culture of the three groups, the transition they face, and their differential resources with some policy recommendations.

Understanding Aging in a Middle Eastern Context: The SHARE-Israel Survey of Persons Aged 50 and Older

This article describes the development of SHARE-Israel, the survey of persons aged 50 and older in Israel, and preliminary results from an early data release. The introduction of an HRS-inspired computer-based survey into a Middle East country required linguistic and cultural adaptations of the survey mechanisms that had not been previously experienced in other countries. Preliminary findings showed that the majority group of veteran Jewish-Israelis aged 50 and over is in a favorable position in terms of health, employment status and household income compared to Arab-Israelis and to new immigrants to Israel from the Former Soviet Union. Arab-Israelis aged 50 and over are at greater risk due to greater disability and lower incomes. Recent immigrants from the former Soviet Union are at greatest risk. They report having the highest degree of depression, long term problems and activity limitation, the fewest children, low rates of home ownership and low incomes. Comparing the older Israeli population with their European counterparts revealed that Israelis are more depressed; more Israeli women are employed, and fewer Israeli men are retired; and household income in Israel is lower, but rises relatively when correcting for purchasing power parity. These trends point to several areas that will require attention in the formulation of public policy on behalf of the aging population in Israel.

Perceived Risks of HIV/AIDS and First Sexual Intercourse among Youth in Cape Town, South Africa

The ‘Health Belief Model’ (HBM) identifies perception of HIV/AIDS risks, recognition of its seriousness, and knowledge about prevention as predictors of safer sexual activity. Using data from the Cape Area Panel Survey (CAPS) and hazard models, this study examines the impact of risk perception, considered the first step in HIV prevention, set within the context of the HBM and socio-economic, familial and school factors, on the timing of first sexual intercourse among youth aged 14–22 in Cape Town, South Africa. Of the HBM components, female youth who perceive their risk as ‘very small’ and males with higher knowledge, experience their sexual debut later than comparison groups, net of other influences. For both males and females socio-economic and familial factors also influence timing of sexual debut, confirming the need to consider the social embeddedness of this sexual behavior as well as the rational components of decision making when designing prevention programs.

A new comprehensive and international view on ageing: introducing the ‘Survey of Health,Ageing and Retirement in Europe’

This paper introduces the ‘Survey of Health, Ageing and Retirement in Europe’ (SHARE) to researchers on ageing. SHARE provides an infrastructure to help researchers better understand the individual and population ageing process: where we are, where we are heading to, and how we can influence the quality of life as we age, both as individuals and as societies. The baseline wave in 2004 provides data on the life circumstances of some 27,000 persons aged 50 and over in 11 European countries, ranging from Scandinavia across Western and Central Europe to the Mediterranean. SHARE has made great efforts to deliver truly comparable data, so we can reliably study how differences in cultures, living conditions and policy approaches shape the life of Europeans just before and after retirement. The paper first describes the SHARE data. In order to demonstrate its value, it then presents highlights from the three main research areas covered by SHARE, namely economics, sociology, and health.

Staying Connected: The Lived Experiences of Volunteers and Older Adults

Many housebound older adults lack meaningful social relationships. In this study we explore the phenomenon of social connectedness in the volunteer-older adult relationship through the experiences of frail and isolated older adults and volunteers. We conceptualise this relationship as a journey whereby each traveller plays an active role in its direction and outcome. The emergent phenomenological essence of social connectedness from these dyad’s narratives provides meaning for both differences and similarities into the way the construct is conceptualised. When volunteers maintain the boundaries of the relationship through structured conversation and visits, it is described as friendly. Transgressing the boundaries involves doing extra for the elder and is both a function of the dyad’s compatibility, and the volunteer’s sense of ongoing agency and lack of elder expectations. The sense of social connectedness inherent in these relationships often feels like that of friendship or family, and these relationships are perceived as meaningful and close for both parties. Social connectedness in family-like relationships is a function of the playing out of an otherwise missing family role. However, if volunteer volition is compromised, this results in feelings of obligation and responsibility, similar to the dynamic between blood relatives. Participants’ narratives suggest that when the boundaries of the relationship are mutually negotiated, this serves to strengthen the relationship’s socioemotional quality, and potential for the continuity of the unique sense of social connectedness that has already been established.

Effects of Therapy for Dysphagia in Parkinson’s Disease: Systematic Review

This systematic review explores the effects of dysphagia treatment for Parkinson’s disease. The review includes rehabilitative, surgical, pharmacologic, and other treatments. Only oropharyngeal dysphagia is selected for this literature search, excluding dysphagia due to esophageal or gastric disorders. The effects of deep brain stimulation on dysphagia are not included. In general, the literature concerning dysphagia treatment in Parkinson’s disease is rather limited. Most effect studies show diverse methodologic problems. Multiple case studies and trials are identified by searching biomedical literature databases PubMed and Embase, and by hand-searching reference lists. The conclusions of most studies cannot be compared with one another because of heterogeneous therapy methods and outcome measures. Further research based on randomized controlled trials to determine the effectiveness of different therapies for dysphagia in Parkinson’s disease is required.

The Lived Experience of Mothers of Children with Chronic Feeding and/or Swallowing Difficulties

The purpose of this phenomenologic study was to describe the lived experiences of seven mothers who were providing home-based care for their children with feeding and/or swallowing difficulties. Data were collected using semistructured interviews and were analysed as per Colaizzi’s method of inductive reduction. Results suggest that the mothers’ experiences can be understood as two continuing journeys that were not mutually exclusive. The first, “Deconstruction: A journey of loss and disempowerment,” comprised three essences: (1) losing the mother dream, (2) everything changes: living life on the margins, and (3) disempowered: from mother to onlooker. The second journey was “Reconstruction: Getting through the brokenness” with the essences of (4) letting go of the dream and valuing the real, (5) self-empowered: becoming the enabler, (6) facilitating the journey, and (7) the continuing journey: negotiating balance. The phenomenon of being the mother of a child with chronic feeding and/or swallowing difficulties continued to be a transformative experience in which personal growth emerged along with chronic sorrow and periodic resurgence of struggle and loss. Implications call for healthcare professionals to incorporate maternal meanings and needs in providing appropriate family-focused intervention.

Esophageal Adenocarcinoma: Pseudo-Nutcracker Esophagus

Pseudoachalasia due to adenocarcinoma is well known. We report a case of nutcracker esophagus in the setting of outflow obstruction from esophageal adenocarcinoma. Endoscopy is warranted to exclude similar lesions in patients with “pseudo-nutcracker esophagus”.

The influence of living arrangements, marital patterns and family configuration on employment rates among the 1945–1954 birth cohort: evidence from ten European countries

As they approach retirement, Europeans in mid-life display a range of living arrangements and marital patterns. These configurations influence labour force participation for men and women in different ways and these differences are accentuated between countries. Using data from the first Wave (2004) of the Survey on Health, Ageing and Retirement in Europe (SHARE), the paper examines the relationship between living arrangements, marital patterns, family configurations and participation in the labour force for the birth cohort of 1945–1954. The data show that the probability of being in paid employment was higher for respondents living in a couple in northern Europe than in southern Europe. In all countries, men in a couple had significantly higher employment rates than women in a couple, but employment rates of women in a couple differed significantly between countries. Multivariate analysis with country effects confirmed the negative influence of age, poor health, lower levels of education and household income on the probability of being in paid employment, but the effect of variables concerning living arrangements, marital patterns and family configurations varied according to country. A multilevel analysis showed that the between country variance of being in paid employment could not be explained by individual characteristics alone, that a large part of the country variance could be explained by the country specific effect of women in a couple, and that the level of ‘modern’ life styles in each country (rates of cohabitation outside marriage, divorce or separation and recomposed families) had a significant effect on employment rates, especially for women in a couple.

Age effects in prospective memory performance within older adults: the paradoxical impact of implementation intentions

This study investigated age effects in prospective memory performance within older adults. The first aim was to explore this issue by examining event- and time-based prospective memory performance in two age groups: young-old (60–75 years) and old-old adults (76–90 years). Moreover, this study for the first time investigated whether forming implementation intentions could be used to improve prospective memory in young-old and old-old adults. Results showed a general effect of age in prospective memory performance for both task types. In addition, no general effect of implementation intentions in prospective memory performance across both task types and age groups was found. However, testing implementation intention effects separately for both age groups revealed that the formation of implementation intentions enhanced prospective memory only for the young-old adults, but did not substantially affect the performance in the time-based task and even impaired it in the event-based task for the old-old adults. Findings indicate that the formation of implementation intentions might be a powerful memory strategy for young-old adults, but not for the very old.

Sip-Sizing Behaviors in Natural Drinking Conditions Compared to Instructed Experimental Conditions

To understand disordered physiology, it is first necessary to determine what constitutes normal function. Liquid sip size during swallowing in healthy individuals has been investigated with varied results. Bolus size is a variable that is manipulated in both research studies and clinical swallowing assessments, so defining normal sip size has relevance in both domains. This study looked at sip size under instruction in experimental tasks and compared it to sip size in free drinking while participants were unaware that drinking was being observed. A statistically significant difference was found in water sip volume between natural drinking (mean = 16 ml) and instructed experimental drinking tasks (mean = 6.6–6.8 ml). This difference far exceeded the magnitude of sip-size variation observed between instructed drinking tasks using different stimuli and as a function of participant’s gender or age group.

Long-term Botulinum Toxin Treatment for Dysphagia Due to Large Epiphrenic Diverticulum in Elderly Patients: A Report of Two Cases

Symptomatic esophageal epiphrenic diverticula are usually repaired with diverticulectomy and esophagomyotomy with substantial morbidity and mortality rates, especially in elderly patients. We describe the cases of two elderly patients who had dysphagia caused by large epiphrenic diverticula. Due to severe comorbid diseases, both patients were unable to withstand surgical intervention; botulinum toxin solution was injected endoscopically at multiple sites in the region of the lower esophageal sphincter and esophageal wall near the diverticulum. Symptoms improved immediately and the beneficial effect of botulinum toxin remained for 5–6 months. During the long-term follow-up, the patients developed symptomatic relapses treated by subsequent botulinum toxin solution reinjections resulting in longer-lasting symptom relief.

The importance of elders: Extending Hamilton’s force of selection to include intergenerational transfers

In classical evolutionary models, the force of natural selection diminishes with age toward zero by last reproduction. However, intergenerational resource transfers and other late-life contributions in social species may select for postreproductive longevity. We present a formal framework for estimating indirect fitness contributions via production transfers in a skills-intensive foraging niche, reflecting kinship and cooperation among group members. Among contemporary human hunter-gatherers and horticulturalists, indirect fitness contributions from transfers exceed direct reproductive contributions from before menopause until ages when surpluses end, around the modal age of adult death (∼70 y). Under reasonable assumptions, these benefits are the equivalent to having up to several more offspring after age 50. Despite early independence, minimal production surplus, and a shorter lifespan, chimpanzees could theoretically make indirect contributions if they adopted reliable food-sharing practices. Our results for chimpanzees hypothetically adopting hunter-gatherer subsistence suggest that a skills-intensive foraging ecology with late independence and late peak production could select for human-like life histories via positive feedback between longevity and late-life transfers. In contrast, life history changes preceding subsistence shifts would not favor further life extension or subsistence shifts. Our results formalize the theory that longevity can be favored under socioecological conditions characterized by parental and alloparental care funded through transfers of mid- to late-life production surpluses. We also extend our analysis beyond food transfers to illustrate the potential for indirect fitness contributions from pedagogy, or information transfers. While we focus mostly on humans, our approach is adaptable to any context or species where transfers can affect fitness.

Human life history is distinguished from that of other primates by delayed sexual maturity, long juvenile dependency, high paternal investment and alloparental care, menopause, and extended postreproductive lifespan (1–3). Surplus food production in adulthood subsidizes preadults and arguably plays an important role in the evolution of human adult lifespan (2, 4). Such intergenerational transfers from older to younger generations may also shape mortality in other social species (5, 6). However, W. D. Hamilton’s (7) “force of selection” considers only direct reproductive contributions to fitness. When reproduction declines with age to zero, postreproductive life is rendered vulnerable to harmful mutations. Mutations occurring in this “selection shadow” are invisible to selection and can therefore lead to rapid increases in mortality with age. Such age-related declines in selection intensity underlie most evolutionary theories of senescence (8, 9). The prominence of human menopause combined with postreproductive longevity, unique among primates and unexplained by classical approaches (10), suggests that transfers and other social processes may alter selection in ways overlooked by classic evolutionary models.To extend theories of selection to explain human longevity, we investigate feedbacks between life history and subsistence strategies, showing how indirect fitness contributions from transfers can select for longevity in humans and other social species with cooperative food sharing. Human life histories are “slower” than in other primates in terms of age at maturity and lifespan, but also “fast” due to having short interbirth intervals and high reproductive effort across a shorter portion of the life cycle (11). Survival tradeoffs with high fertility may keep infant mortality high (12), but alloparental care relieves some of the energetic burden of high fertility via in-kind transfers and assistance to mothers and children (1–3, 13). Also, long childhoods allow the cultivation of skills required for extractive foraging, but require transfers to cover the energetic costs of extended dependence. It has been proposed that investment in large brains and social learning are required to develop high-skilled foraging strategies that increase production returns and generate surpluses (2, 14–16). Because intergenerational transfers of adult surpluses can increase the fertility and survival of others (especially the young), these indirect fitness contributions could drive selection for survival well beyond ages of reproductive cessation (4, 17).Here, we contribute to ongoing research investigating the critical role of skills-intensive foraging in modifying the force of selection that shapes the age profiles of survival and fertility that are fundamental to fitness. Somatic and reproductive senescence are largely coupled in nonhuman primates, whereas the extended postreproductive lifespan of humans is unique (18). While human menopause has been theorized to result from life history tradeoffs or intergenerational conflict (19), here we take observed patterns of reproduction as a given and model selection on extended postreproductive lifespan due to food and other transfers. Because transfers in food-limited populations increase fertility and survival of kin, they generate positive selection for longevity well beyond reproductive cessation. While others have recognized and formally modeled how transfers can select for longevity and for other features of human life history (2, 15, 17, 20), evolutionary theories of aging have been guided largely by Hamilton’s force of selection (7), often expressed as elasticities of fitness to age-specific mortality and fertility (21).Our framework extends the force of selection to account for production transfers, even in the absence of reproduction at certain ages. Because transfers generate larger fitness gains when directed to biological kin and cooperating group members who reciprocate and/or adhere to social norms of sharing, our framework incorporates the kinship between donors and recipients of different ages and the reliability of cooperation. If kinship is low and cooperation minimal, even large productive surpluses may not generate fitness advantages to longer life. Indeed, simulations show that indiscriminate sharing in the absence of reciprocity can help decrease juvenile mortality, but does not select for postreproductive longevity (22).If we consider a “focal group” as a kin-structured sharing group, then adults contribute to their own inclusive fitness both directly through reproduction and indirectly via transfers. If production transfers by postreproductive and nonreproducing individuals increase fitness by improving female fertility and offspring survival, then age profiles of skills-intensive production showing peaks in midlife to later life should select for survival at older ages and increase representation of skilled, postreproductive adults. In this paper, we provide “proof of concept” for a hypothesis that late-life production surpluses of skilled foragers and subsistence farmers contribute indirectly to fitness through the nutritional effects of transfers.To put human life history in an evolutionary context, we compare the potential for direct vs. indirect fitness contributions among wild chimpanzees, human hunter-gatherers, and horticulturalists. Chimpanzees are the closest surrogate for the last common chimpanzee–human ancestor 5 to 7 million y ago (23). Chimpanzees are self-sufficient foragers a few years postweaning and generally do not produce large food surpluses or transfers beyond those made to offspring, allies, and mates (2, 24). Chimpanzee feeding ecology is therefore not expected to generate selection pressure for late-adult survival. In contrast, hunter-gatherers rely heavily on others for up to two decades, but then produce surpluses through adulthood and into late life (2, 25). Food sharing is widespread among hunter-gatherers (24), within and between generations, with food directed to family, neighbors, friends, and others in ways that reduce food shortfalls at different timescales (4). Food is not the only type of transfer that impacts fitness: Allocare, conflict resolution, and different forms of information transfer are commonly observed in hunter-gatherers (1, 26). These nonfood transfers made by older adults confer additional fitness benefits, but those benefits can be difficult to measure, especially in observational studies. Despite this methodological limitation, identifying adult ages where net fitness benefits diminish rapidly would help distinguish between different proposals for the evolution of postreproductive lifespan in humans but not in other apes. For example, proposed late-age fitness benefits may only accrue up until a parent’s last child reaches sexual maturity (i.e., “mother hypothesis”) (27) or may include survival advantages from helping young grandchildren (i.e., “grandmother hypothesis”) (11). Also, because some skill-intensive production strategies, including many horticultural tasks, are less dependent on strength and agility, horticulturalists may provide surpluses at later ages than hunter-gatherers (28, 29).Our study builds upon previous work examining feedbacks between life history, food production, and transfers (15, 17, 22, 30). While previous studies generate findings consistent with an altered force of selection on postreproductive survival, they do not permit age-based comparisons of contributions to inclusive fitness or directly model indirect fitness contributions. Our approach models food production, transfers, and vital rate responses explicitly. Given age profiles of production (P_x), caloric demand (D_x), fertility (m_x), and survival (p_x) and flexible assumptions about the nutritional dependence of vital rates, the relatedness, and the degree of reliable cooperation among members within the focal group, our model estimates the potential for inclusive fitness benefits through food transfers between individuals of different ages.We characterize three fitness measures: indirect fitness contributions via production transfers, the fitness elasticity to production, and expected residual fitness contributions from future production transfers (“productive value”). Indirect fitness contributions (Δλ_Px) are the marginal inclusive fitness benefits provided by production transfers from individuals of different ages that would increase the population growth rate λ of a hypothetical focal sharing group (λ = 1 at stationarity). These are comparable to the direct reproductive contributions to λ made by fertility and survival at different ages. Fitness elasticities to production (e_Px) predict the percentage of change in λ due to a 1% change in production P_x and indicate the force of selection for survival on the basis of indirect fitness contributions made via production transfers. Because these elasticities do not sum to unity, these are not directly comparable to survival and fertility elasticities (21), but we compare relative age profiles to identify ages where selection is expected to be stronger than at other ages. Finally, productive value (PV) estimates the expected fitness value of future lifetime production transfers assuming survival to a given age and is comparable to Fisher’s reproductive value (31), which sums the reproductive contributions remaining over the life course after taking future mortality into account. Our flexible but conservative approach examines the fitness value of transfers across a wide range of vital rate responses to food availability across the observed range of mean intragroup relatedness, and with varying degrees of cooperation. Following ref. 32, we also look beyond food production to consider the role of information transfers on fitness via the effect of teaching on lifetime food production.To demonstrate the utility of our approach, we evaluate the force of selection in wild chimpanzees, hunter-gatherers, and horticulturalists. We then employ these results to make inferences about the role of foraging ecology in shaping human life history evolution.     

Serious health events and their impact on changes in subjective health and life satisfaction: the role of age and a positive view on ageing

Various studies have pointed to the great importance of subjective health as an indicator for mortality in older age, while less is known about factors that contribute to changes of subjective (self-rated) health over time. Based on a nationwide longitudinal survey (German Ageing Survey, N = 1,286; initial age 40–85), two major findings emerged: first, the incidence of a serious health event caused greater changes in subjective health and life satisfaction in middle compared to older age. This was as expected because serious health events are less common in middle age and are correspondingly experienced more often as an “off-time event”. Secondly, the study extended previous findings on the impact of a positive view of ageing on health by showing that this optimistic view positively affects subjective health and life satisfaction even in the face of a serious health event. Overall, the study indicates that a positive view on ageing is an important psychological resource in the case of a serious health event, both when it occurs on-time or off-time from a developmental perspective.

Informal and Formal Long-term Care for Frail Older Adults in Cairo, Egypt: Family Caregiving Decisions in a Context of Social Change

This paper explores the factors that lead family caregivers to place their frail older relatives into long-term care centers in Cairo, Egypt despite norms of family care. Semi-structured interviews were conducted with 18 “case” caregivers who placed their older relatives into long-term care and 17 “control” caregivers who provided for their older relatives at home. Cases and controls differed in their relationship to the older adult, number and proximity of supportive siblings, and perceived health status of the older adult. Caregivers who used long-term care justified their decision by stressing the need for relief from the burden of caregiving, and by conceiving long-term care as part of a broadened definition of family care. Egyptians are devising new strategies of care despite persistent norms of reciprocity among kin. As demographic, epidemiologic, and socioeconomic changes continue, families may adopt new combinations of care to support their frail older relatives. Findings underscore the need for population-based research about strategies of caring for frail older relatives in this context.