Early-life socioeconomic circumstances explain quality of life differences in old age, but not their evolution over ageing

Hedonic and eudemonic well-being

Quality of life is an umbrella term that includes desirable outcomes such as well-being, both in its objective and its subjective dimensions. Objective appraisal is usually measured with indicators such as income, education, health, living area, etc. When entering into the subjective appraisal of well-being, there are two main approaches, namely the hedonic and the eudaimonic ones. Most of the followers of the former type of tradition agree with the steps suggested by Jeremy Bentham and care about “feeling good” whereas the followers of the latter usually tap into the heritage of Aristotle and aim for a “good life”, or the realization of the self. There are multiple measures for both approaches. Life satisfaction measured on a 0-10 scale gathers a wide consensus to measure hedonic well-being whereas eudaimonic measures are much more numerous and scattered. This is partly due to the inherent complexity of the construct and its multidimensionality (autonomy, self-acceptance, environmental mastery, life purpose…). Among the scales developed to assess eudaimonic well-being, one can cite Psychological Well-being (PWB) Scale or the Subjective vitality scale. A scale entitled CASP[1] 19 was used to assess both the eudaimonic and hedonic dimensions of well-being. Moreover, unlike the other scales that are mainly used in the general population, CASP is specifically adapted to assess well-being in the elderly population.

Figure 1. Diagram of the objective and subjective dimensions and measures of quality of life

Early-life socioeconomic circumstances as a predictor of quality of life

The origins of poor quality of life may stem from early-life risk factors, such early-life socioeconomic circumstances (SEC). Studies consistently showed that individuals who experienced poor SEC during childhood had lower levels of health functioning in older age, including physical, mental and social dimensions of health. The picture is blurrier as far as well-being is concerned. Some studies suggest that early-life SEC, social mobility, as well as other measures of opportunity (gender, ethnicity) affect the hedonic well-being of adults, whereas others studies revealed no or small effects.

Various factors may explain previous inconsistencies in the literature. First, studies mainly rely on a unidimensional measure of early-life SEC (for example, focused only on father’s occupational position) or combined different dimensions of early-life SEC into a single score (for example, mixed together material and cultural aspects of socioeconomic disadvantage). Second, very few studies have assessed whether the associations between early-life SEC and well-being are independent from other early-life events likely to co-occur, such as adverse childhood experiences or childhood health problems. Third, when the data were longitudinal, the statistical approach used was not particularly suited to accurately estimate change over ageing.

Therefore, to fill this knowledge gap, the current study aims to determine whether individuals who experienced poor early-life SEC showed lower level of well-being in older age and a steeper rate of well-being decline over ageing.

We used data on more than 23,000 adults in older age from the survey of health, Ageing, and Retirement in Europe (SHARE), a 12-year large-scale longitudinal study with repeated measurement of health indicators of the same participants over time (2004-2015, assessments every 2 years). Number of books at home (0-10 vs. more books at home), overcrowding (more vs. less than one person per room in the household), occupational position of the household’s main breadwinner (first and second vs. higher skills levels of the International Standard Classification of Occupations), and housing quality (absence vs. presence of either fixed bath, cold running water supply, hot running water supply, inside toilet, or central heating) were used as indicators of early-life SEC. A short version (12 items) of the CASP-19 scale was used to assess well-being.

Figure 2. The four dimensions of early-life socioeconomic circumstances

Number of books at home during childhood and well-being

Our results showed that early-life SEC were associated with the level of well-being in both men and women. Specifically, in men, a low number of books at home, a low occupational position of the main breadwinner, and a low housing quality were associated with a lower level of well-being. In women, only a low number of books at home was associated with well-being. The critical role of number for books was confirmed by results obtained from other health-related outcomes (muscle strength, peak expiratory flow, delayed recall, verbal fluency, and depression) showing that this cultural aspect of disadvantage has a wide influence that affect all the dimensions of health. By contrast, our results showed that men and women living in poor early-life SEC (all these indicators) did not experienced stepper decline rate of well-being decline over ageing.

From this study, we can conclude that early-life SEC, especially a cultural aspect of disadvantage (i.e., the numbers of book at home), are associated with the level of well-being in both men and women. Theoretically, this result provides support for the long-lasting influence of early-life SEC on health in older age. By contrast, we did not find evidence of the contribution of these early-life exposures to differences in trajectories of well-being over ageing.  Such inconsistency (between level and trajectories) could contribute to shedding light on other critical predictors of healthy ageing trajectories.

Guest blog by Cheval Boris, Gaël Brulé and Stéphane Cullati.

Cheval, B., Orsholits, D., Sieber, S., Stringhini, S., Courvoisier, D., Kliegel, M., Boisgontier, M.P. and Cullati, S., 2019. Early-life socioeconomic circumstances explain health differences in old age, but not their evolution over time. J Epidemiol Community Health, pp.jech-2019. http://dx.doi.org/10.1136/jech-2019-212110

[1] Control, Autonomy, and Self-realization

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