We examined sociodemographic, clinical, and functional characteristics influencing avoidable and unavoidable hospital admissions in older adults over 15 years. The study included 3166 participants aged 60+ years from the Swedish National Study on Aging and Care in Kungsholmen. Hospital admissions were identified through national registers and classified as avoidable using official Swedish criteria. Multistate models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for both admission types. During the 15-year follow-up, the incidence rates of avoidable and unavoidable hospital admissions were, respectively, 5.74 and 35.17 per 100 person-years. Avoidable admissions due to chronic conditions were more common than those due to acute conditions (3.94 vs. 1.80 per 100 person-years over 15 years). Women had lower risk of both avoidable and unavoidable admissions compared to men (HRs range 0.46–0.76), while being unpartnered increased the risk for both hospitalization types (HRs range 1.13–1.33). Receiving formal care lowered the risk of unavoidable admissions (HR 0.78, 95% CI 0.73–0.84), whereas informal care increased the likelihood of avoidable admissions due to chronic condition (HRs range 1.17–1.34). Multimorbidity, slow gait speed, and polypharmacy associated strongly with avoidable admissions (HRs range 1.41–2.50). Conversely, cognitive impairment and disability lowered risk of avoidable admissions for chronic conditions (HRs range 0.62–0.83). Multimorbidity, slow gait speed, and polypharmacy predicted higher risks for avoidable admissions from chronic conditions, while disability and cognitive impairment showed lower risks. These findings underscore the need for timely and comprehensive evaluation strategies to reduce the burden of avoidable hospital care.

We aimed to identify short and long-term trajectories of self-rated health (SRH) and physical working capacity during the retirement transition, and investigate whether work-related factors and social class predict belonging to these trajectories. We used the representative, biennial Swedish Longitudinal Occupational Survey of Health (SLOSH) 2006–2018. We applied group-based trajectory modeling with B-spline smoothers to model trajectories of SRH (n = 2,183) and physical working capacity (n = 2,152) during the retirement transition. Multinomial logistic regression analyses were conducted to investigate trajectory belonging by work-related factors and social class. There was a small “honeymoon effect” in SRH for the total sample. We found four trajectories of SRH and five of physical working capacity. The large majority sustained excellent or good SRH and physical working capacity throughout the study period. Almost 6% had Fairly poor SRH and physical working capacity starting from years before retirement, which remained throughout the study period. High job demands, low job control, adverse physical working conditions, and being in manual occupation increased the likelihood of belonging to the trajectory groups Deteriorating or Fairly poor when compared with the Excellent trajectory group for both SRH and physical working capacity. Our findings suggest that for most people health status is already established some years’ preretirement and maintained for years after retirement, except a short improvement in SRH in accordance with a honeymoon effect. In order to improve health and employability, interventions focusing on working environment should be aimed at younger and midlife employees as well as older workers.

Objective: This study describes how subjective frequency of contact with friends changes over the lifespan, whether it has increased across cohorts, and if later-born cohorts maintain this contact into older ages.

Methods: Cross-sectional data from individuals aged 15–97 collected between 1968 and 2021 were used to create an age pattern, analyse changes within age groups, and compare self-reported age trajectories of frequent contact with friends across birth cohorts.

Results: Reported frequency of contact with friends follows a clear age pattern: decreasing from young adulthood, plateauing in midlife, and decreasing again in older age. Later-born cohorts are more likely to report frequent contact with friends, but this difference converges in older age. There is no strong evidence that later-born cohorts maintain frequent contact with friends into old age, though upcoming cohorts may show changes in this trend.

Discussion: As life expectancy and overall health in older age improve, understanding the role of contact with friends in supporting well-being becomes increasingly important. The convergence of the frequency of contact with friends across cohorts in older age could lead to unmet expectations of social contact in upcoming cohorts. Therefore, continued research and proactive measures to support social interactions throughout the ageing process could enhance social connectedness in ageing populations.

Despite the universal social policies of Sweden’s welfare state, recent decades have seen decreasing public benefits and increasing socio-economic disparities, affecting the financial wellbeing of older adults and their younger family members. This repeated cross-sectional study explores the development of intergenerational financial transfers in Sweden over the past two decades, examining transfers involving older parents and their children and grandchildren, and patterns related to gender and social class. It utilises data from the Swedish Panel Study of Living Conditions of the Oldest Old, from 2002 to 2021, along with descriptive statistics and logistic regression models, to study shifts in donor–receiver proportions and gender/social-class disparities. The findings revealed that approximately one in four parents provided financial support to younger generations, while very few received such support. Downward financial transfers increased over time, with growing focus on grandchildren. No significant gender differences in providing were identified; however, women’s contributions increased in frequency and amount, compared to previous cohorts of women. Men’s contributions remained relatively stable over time. Parents in higher social classes were more inclined to provide financial support than parents in lower classes; this difference grew over time. Additionally, parents in higher social classes more frequently provided higher amounts than their counterparts. In conclusion, this study underscores changing gender and social-class patterns in financial contributions made by parents to their children and grandchildren in contemporary Sweden. Understanding these levels and subgroup differences is crucial for shaping policies and mitigating the potential growth of socio-economic inequality in future generations.

Background: Health literacy refers to an individual’s ability to access, understand, and use information to promote and maintain good health. The importance of a health-literate population has been highlighted during COVID-19 when health authorities pleaded with the public to be responsible and adhere to rules and recommendations. This study investigates the relationship between health literacy levels and older people’s understanding of and adherence to COVID-19 recommendations.

Methods: The data for this study were obtained from the 2021 Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), which exclusively includes individuals aged ⩾77 years. Health literacy was assessed utilising the Communicative and Critical Health Literacy (C&CHL) scale. Using logistic regression, we evaluated the association between C&CHL and vaccination coverage, as well as the comprehension of and adherence to health recommendations and the avoidance of healthcare services due to apprehension related to COVID-19.

Results: The findings showed that 90% of the study population understood the COVID-19 guidelines, and 63% adhered to them to a large extent. Further, 98% got vaccinated. Although limited C&CHL was statistically associated with a lower ability to understand information (odds ratio: 2.20), it was not related to following recommendations, being vaccinated, or refraining from health or dental care.

Conclusions: Regardless of individual health literacy level, most older people understood and followed COVID-19 recommendations, and nearly everyone was vaccinated. The findings indicate that the information about Swedish COVID-19 recommendations and vaccination information was tailored to meet the needs of different health literacy levels.

Many countries, including Norway, are implementing policies to delay retirement and encourage older workers to remain in the labour market. Improving psychosocial working conditions may motivate older workers to continue working. While research has linked psychosocial working characteristics to retirement intentions and work exit, there is a knowledge gap regarding gender and socioeconomic differences in these influences. This study investigates the impact of psychosocial working characteristics on employment exit among older workers, examining variations by gender and educational attainment. Data were drawn from the Norwegian Life Course, Ageing, and Generation study (NorLAG) collected in 2007 and 2017 (N = 2,065) linked to income register data for four subsequent years. Time-to-event analyses revealed that poorer psychosocial working environment increased the likelihood of employment exit. For women, low autonomy was significant, while for men significant associations were found for high job stress, low job variety, lack of appreciation, limited learning opportunities, accumulation of poor job resources, and job strain. Interaction analysis showed only significant gender differences for few learning opportunities and poor job resources. Separate analyses stratified by educational attainment showed no significant association for those with compulsory education, while those with higher levels of education were more likely to retire if faced with low job variety, low autonomy, and poor job resources–yet interaction analysis showed no significant differences. These findings suggest that interventions aimed at delaying retirement should consider gender and socioeconomic differences, providing older workers with more control over their tasks and equitable access to learning opportunities and resources.

Objective: We aimed to investigate the association of sociodemographic, clinical and functional characteristics with the volume of transitions and specific trajectories across living and care settings.

Methods: Using data from the Swedish National Study on Aging and Care in Kungsholmen study, we identified transitions across home (with or without social care), nursing homes, hospitals and postacute care facilities among 3021 adults aged 60+. Poisson and multistate models were used to investigate the association between sociodemographic, clinical and functional characteristics and both the overall volume and hazard ratios (HRs) of specific transitions.

Results: Over 15 years, 720 (23.8%) participants experienced between 5 and 10 transitions, and 816 (26.7%) experienced >10 transitions across living and care settings. A higher number of transitions was observed in older participants with multimorbidity and slower walking speed. In contrast, cognitive impairment and disability were associated with a lower number of transitions. After hospital and postacute discharge, each additional year of age (HR range 1.06–1.08) and being a woman compared with being a man (HR range 1.35–4.38) increased the likelihood of discharge to home care. Multimorbidity (HR range 1.14–1.23) and slow gait speed (HR range 1.11–1.50) increased the risk of hospitalisation and home care after hospital discharge. Cognitive impairment raised the hazard of nursing home placement (HR range 1.99–2.15). Disability was associated with a higher hazard of nursing home placement after hospital discharge (HR range 2.57–3.07).

Conclusions: Accounting for older adults’ whole journey across living and care settings, we identified transition-specific predictors and potential triggers that could be timely leveraged to better tailor care to older adults’ needs.

Objectives: Loneliness arises from a discrepancy between the relationships one desires and those one experiences. This study examines the relative importance of relationship quantity and quality for loneliness in older adults.

Method: The study was a cross-sectional, representative survey of 474 adults aged 77 and above living in Dalarna, Sweden. Loneliness was measured using the three-item UCLA Loneliness Scale. Four ordinal logistic regression models of loneliness were developed: one for quantity of relationships and three for quality of relationships (closeness; conflict; closeness and conflict combined). Perceived social support was included in the quality models.

Results: The quality models explained the most variance in loneliness and had better model fit. Having a partner was associated with less loneliness, even when there was conflict. Having a close relationship with children was associated with less loneliness, but a lack of closeness or the presence of conflict was associated with more loneliness. Perceived social support was associated with less loneliness.

Conclusion: Quantity and quality of relationships are both associated with loneliness in older adults, but relationship quality appears to have greater importance. Specific types of relationships are also relevant, highlighting the need to consider relationship dynamics when designing interventions to reduce loneliness.

Aims: To investigate 20-year trends in social participation among the oldest old (77+ years) in Sweden and assess the extent to which changes in educational attainment and functional abilities explain these trends. Methods: Seven waves of the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) spanning 2002–2021 were used with a repeated cross-sectional design. To analyse the association between time and social participation we employed the Karlson–Holm–Breen method of decomposition. The study focused on informal social participation (contact with friends and family), leisure participation (public or semi-public gatherings), and formal participation (organisational engagement and study circle attendance). Results: Both leisure and informal participation peaked in 2014 and declined in 2021, influenced by the COVID-19 pandemic, whereas formal participation showed a slight increase in 2021. Total participation increased at least until 2011. Overall, older adults have increased their levels of social participation in recent decades, disregarding the influence of the pandemic. Decomposition analysis revealed that population-level changes in educational attainment and functional abilities explained a substantial portion of the observed trends. Conclusions: As the proportion of older adults continues to rise, it becomes increasingly important to understand the developments and drivers of behavioural change in the older population. As more people are socially active, there may be increasing differences between those participating and those not – which could lead to increased inequalities. The observed trend in increasing participation, influenced by changes in education and health, emphasises the importance of fostering age-friendly environments and addressing potential social inequalities among older adults.

Objectives: This study aims to investigate the relationship between frailty and avoidable hospitalization risk, and the moderating role of sociodemographic, clinical, and care-related factors.

Design: Longitudinal population-based cohort study.

Setting and Participants: A total of 3168 community-dwelling individuals, aged ≥60 years, from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K).

Methods: We operationalized physical frailty using baseline SNAC-K data (2001-2004). In line with the Swedish Board of Health and Welfare and Association of Local Authorities and Regions, avoidable hospitalizations were considered those that could have been prevented through proper and timely outpatient care and identified through the Swedish National Patient Register. Participants were followed from baseline until first avoidable hospitalization, death, drop out, institutionalization, or maximum 12 (median 7.6) years. The association between frailty and avoidable hospitalization was explored through flexible parametric survival models, with stratified analyses to investigate age, gender, education, civil status, multimorbidity, cognitive status, and informal and formal care as potential modifiers.

Results: The adjusted 12-year cumulative incidence of avoidable hospitalization was significantly higher for frail persons (cumulative incidence 33.2%, 95% CI 28.9%-38.1%) than for prefrail (cumulative incidence 26.6%, 95% CI 24.5%-29.0%) and nonfrail (cumulative incidence 25.2%, 95% CI 22.5%-28.3%) individuals. In addition, prefrailty [hazard ratio (HR) 1.21, 95% CI 1.00-1.45] and frailty (HR 1.91, 95% CI 1.47-2.50) were associated with increased avoidable hospitalization hazards. Furthermore, the association between frailty and avoidable hospitalization was stronger in older adults aged <78 years (HR 3.12, 95% CI 1.99-4.91) and those with relatively fewer chronic diseases (HR 3.88, 95% CI 1.95-7.72), whereas provision of formal social care (HR 1.15, 95% CI 0.77-1.72) seemed to act as a buffer.

Conclusions and Implications: Our results indicate that older community-dwelling adults with prefrailty and frailty are at increased risk of experiencing avoidable hospitalizations, highlighting a need for better care of these individuals at the outpatient level. Formal social care services and close monitoring of particularly vulnerable subgroups of frail persons may mitigate this risk.