Josephine Heap. Photo: Eva Dalin
Josephine Heap. Photo: Eva Dalin

Link to abstract (DiVA)

Link to the disseration (DiVA)


The aim of this thesis was to analyse coexisting disadvantages in the older Swedish population. Coexisting disadvantages are those that occur simultaneously in various life domains. A person who simultaneously experiences several disadvantages may be particularly vulnerable and less well-equipped to manage daily life and may also need support from several different welfare service providers. Concerted actions may be needed for older people who experience not only physical health problems and functional limitations, but also other problems. Research that encompasses a wide range of living conditions provides a basis for setting political priorities and making political decisions.

The studies in this thesis used data from two Swedish nationally representative surveys: the Level of Living Survey, which includes people aged 18 through 75, and the Swedish Panel Study of Living Conditions of the Oldest Old, which includes people aged 77 and older.

Study I showed that the probability of experiencing coexisting disadvantages was higher in people 77 and older than in those aged 18 through 76. These age differences were partly driven by a high prevalence of physical health problems in older people. In all age groups, coexisting disadvantages were more common in women than men.

The longitudinal analyses in Study II indicated that coexisting disadvantages in old age persist in some people but are temporary in others. Moreover, the results suggested a pattern of accumulating disadvantages: reporting one disadvantage in young old age (in particular, psychological health problems) increased the probability of reporting coexisting disadvantages in late old age.

Study III showed that physical health problems were a central component of coexisting disadvantages. The results also showed that being older; female; previously employed as a manual labourer; and divorced/separated, widowed or never married were associated with an increased probability of experiencing coexisting disadvantages. However, the experience of coexisting disadvantages differed: the groups associated with coexisting disadvantages tended to report different combinations of disadvantage.

Study IV showed that the prevalence of coexisting disadvantages in those 77 and older increased slightly between 1992 and 2011. Physical health problems became more common over time, whereas limited ability to manage daily ac-tivities (ADL limitations), limited financial resources and limited political resources became less common. Associations between different disadvantages were found in all survey years, but certain associations changed over time. The results suggest that in general, the composition of coexisting disadvantages in the older population may have altered over time.

In sum, results showed that coexisting disadvantages were associated with specific demographic and socio-economic groups. Physical health problems and psychological health problems were of particular importance to the accu-mulation and coexistence of disadvantages in old age.

Heap, J. (2016). Living conditions in old age. Coexisting disadvantages across life domains. Doctoral dissertation. Stockholm: Department of Social Work, Stockholm University.

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