JPI MYBL - European Welfare Models and Mental Wellbeing in Final Years of Life

The main aim of the EMMY project was to contribute to the development of good welfare policies which support mental wellbeing (MWB) in oldest-old age. Oldest old age is defined as 80 years and over, and is a growing age demographic globally today. This demographic transition may require new policy development which builds on mental wellbeing. Mental wellbeing is a multidimensional concept centring around three separate domains; evaluative wellbeing which relates to satisfaction with life, hedonic wellbeing which is linked to positive and negative emotions or affect, and eudaimonic wellbeing with a focus on positive functioning, self-realisation and meaning. The mixed methods study used qualitative methods to explore what people aged 80 and over themselves define as important for their mental wellbeing, and quantitative methods to analyse components of mental wellbeing in oldest old age using existing data from the European Social Survey (ESS). Furthermore, a policy analysis mapped out how policy development tin the four partner countries (Finland, Italy, Norway and Spain) support mental wellbeing in oldest old age. A total of 117 participants from all four countries were included in the focus group study. Participants were recruited from senior community centres, adult day care centres, and nursing homes. Data was assessed using qualitative content analysis. Participants? perspectives on MWB were collated along four dimensions: functional, social, personal and environmental. Staying healthy and maintaining independence, having close relationships with others, and insightful experiences with friends positively contributed to MWB. Additionally, engagement in fruitful or inspiring activities contributed to enhance personal development, which, in turn, had beneficial effects on MWB. Having a positive outlook was also found to be associated with MWB. The results reinforce the dynamic and multidimensional nature state of MWB. Supporting the social and physical environment as well as strengthening personal capabilities and self-esteem, can foster MWB among the oldest old population. Quantitative analyses were based on data from Round 6 (2012) of the European Social Survey (ESS) which includes a broad range of items related to MWB. To increase comparability, data from the 24 countries belonging to either the European Union (EU) or the European Free Trade Association (EFTA) participating in ESS is used. To explore MWB dimensions in old age Exploratory Structural Equation Model (ESEM) was performed based on initial results of Exploratory Factor Analysis (EFA). Results from the ESEM analyses were used to construct MWB measures providing the basis of analyses of welfare system impact on MWB. Results indicate that high level of formal support and gender equality are beneficial for both subjective and psychological aspects of MWB. Furthermore, social trust, reduced income inequalities and long duration of labour market participation increased life satisfaction and happiness in the oldest old population. The most important aspects of welfare state for MWB included ability to cope on own income, physical health and place in society, social trust and social interaction, learning new things and having an appreciation for ones surroundings. Developing policies which support mental wellbeing also in the oldest old age group can harness existing resources such as MWB.

Prosjektet har bidratt til økt tverrfaglig og internasjonalt forskningssamarbeid omkring psykisk velvære for de eldste eldre. Dette er et forskningsfelt som har hatt, relativt sett, lite oppmerksomhet hittil. Både psykisk velvære og de eldste eldre, hver for seg, er forskningsområder som har hatt økende oppmerksomhet i de senere årene. EMMY-prosjektet har bidratt til å øke kunnskapen både om hva psykisk velvære betyr for de eldste eldre, hvordan det kan måles, hvilke faktorer som påvirker psykisk velvære, betydningen av velferdssystemer, og eksisterende politikk på feltet. Resultatene vil kunne bidra til fremtidig kunnskapsbasert politikk utforming.

Mental wellbeing is core component of general wellbeing at all ages. In old age, it provides the basis for a high level of functioning and active ageing. Mental wellbeing is a result of social capital, empowerment and participation. Welfare models across Europe differ, and their effects on mental wellbeing in end of life are not known. The EMMY Project is an interdisciplinary and mixed methods comparative study on impact of welfare systems on mental wellbeing among the oldest old in Finland, Italy, Norway and Spain. The project will delineate the concept of mental wellbeing at old age by qualitative methods, it will dissect the links between welfare systems and mental wellbeing by quantitative methods, it will support exchange of good policies between EU Member States by performing case studies of existing welfare policies and systems in the four participating countries and it will develop a new research-based tool for assessing the mental wellbeing impact of welfare policies in old people. The EMMY project will bring clarity to the concept of mental wellbeing at old age by participatory research methods. Furthermore, it will harness the diversity found in four different social welfare systems, and allow for the investigation of equity, social inclusion, empowerment and participation in different welfare systems. Results will include case studies of welfare systems in the four countries, a tool for policy impact assessment, and an indicator set for monitoring of mental wellbeing at old age. The project will use mixed methods. It will also make use of the comprehensive existing population datasets when identifying and comparing the factors associated with mental wellbeing in the oldest population groups in four different countries: Finland, Norway, Spain and Italy. The project will support development of social welfare models in order to incorporate a change of focus from mental disorders to mental wellbeing among old people. This is important, not only because of Project web-page: https://www.sintef.no/en/projects/european-welfare-models-and-mental-wellbeing-in-fi/