As increasing numbers of people reach advanced ages, it is to be expected that there are changes in how women and men age and how they meet key lifecourse transitions typical for old age. Traditionally, there has been a dominant focus on transitions to adulthood. Transitions in later life more often involve loss of roles, are largely unwanted or difficult to prepare for. The aim of TRILL was to map key transitions in the second half of life and to study their importance for opportunities to age well. Of particular importance is to explore whether exposure to, and the consequences of, these transitions vary across groups of older adults, as this may lead to new patterns of social inequality in ageing. Updated knowledge about the prevalence and consequences of transitions in later life is crucial for the planning of health and social care services and for the design of preventive measures aimed at promoting more healthy and active years and reducing social health inequalities.
TRILL highlights three main research questions: (i) To what extent does the exposure to transitions in later life vary between women and men and across socioeconomic status?; (ii) Do the consequences of these transitions for health and quality of life vary among different groups of older adults?; and (iii) How do older women and men adapt to vulnerable transitions? These questions were analyzed with data from two large longitudinal population studies: the Norwegian study of life course, aging, and generations (NorLAG) and the Tromsø Study. In both studies, survey data have been linked to annual registry information from Statistics Norway. Additionally, we conducted in-depth interviews with thirteen participants from the Tromsø Study, aged 71 to 87 years.
TRILL examines transitions referring to changes and losses that are typical in later life, i.e., retirement, changes in health (both own and that of partners), housing adaptations and relocations, and bereavement. A key finding is that the number of transitions and their timing vary across social groups. Women experience more transitions in later life than men, largely due to gender differences in health trajectories and mortality rates. Gender differences in the number of transitions increase with age. Those with lower education experience more transitions than those with higher education. Additionally, older individuals with higher wealth appear to "postpone" transitions that are typical for later life until a later age. Such differences in exposure suggest that opportunities for ageing well are not equally distributed, which can contribute to increased social inequalities in later life.
Not only are individuals with fewer resources (education, income, and wealth) more exposed to vulnerable transitions typical of older age, but the consequences of this exposure also contribute to unequal opportunities for ageing well. The transition from active employment to life as a retiree and the significance of loss in close relationships (not just a spouse, but also adult children, parents, and siblings) have been highlighted in several TRILL publications. Findings from NorLAG indicate a consistent overall life satisfaction despite experienced loss in close relationships. However, closer analyses reveal that this does not necessarily apply to all groups: women, particularly those with low education, experience a reduction in satisfaction after losing two or more close relationships. When it comes to depressive symptoms, the consequences of a partner's death are significant. Individuals with low education are more vulnerable than those with higher education, which can be linked to access to resources that may help when dealing with loss. Conversely, for physical and cognitive function, the loss of a spouse does not appear to have any long-term consequences (analyses based on longitudinal data from the Tromsø Study).
The in-depth interviews with older respondents from the Tromsø Study show that although the transitions in later life do not significantly impact quality of life or health, they involve changes in life that make it important to maintain stability. When older individuals face vulnerable transitions, they actively work to preserve or restore continuity in their daily lives. This effort, which takes many forms and is adapted to given resources and contexts, appears to be an important premise for ageing well. A recommendation from the project is therefore that interventions and strategies should assist older women and men in their efforts to create continuity in their lives in the face of vulnerable life course transitions in old age.
TRILL involved extensive collaboration between researchers from the Health Services Research Unit at Akershus University hospital, NOVA at OsloMet, the National Institute of Public Health, the German Centre of Gerontology in Berlin, Aging Research Center ved Karolinska Institutet in Stockholm and Amsterdam UMC/VUmc.
TRILLs resultater har blitt formidlet gjennom en rekke vitenskapelige artikler, foredrag, seminar, en policy brief og en egen nettside. Et viktig funn fra prosjektet er at eksponering til og konsekvenser av sårbare overganger i eldre år er relatert til kjønn og sosioøkonomisk status. Etablerte ulikhetsmønstre kan dermed forsterkes i møte med sentrale livsløpsoverganger i eldre år. Det understreker viktigheten av å utvide statistikk om sosiale helseforskjeller til å også inkludere personer 67 år og eldre. Gjennom kvalitative dybdeintervjuer har TRILL kartlagt eldres egne erfaringer med og på denne måten fått økt innsikt i mangfoldet av strategier som brukes til å møte livsløpsoverganger i eldre år og bevare trivsel i alderdommen. Når eldre står overfor sårbare overganger, jobber de aktivt med å opprettholde eller gjenopprette kontinuitet og stabilitet i hverdagen. Dette arbeidet, som tar mange former og er tilpasset ressurser og kontekst, ser ut til å være et viktig premiss for en god alderdom. En anbefaling fra prosjektet er derfor at intervensjoner og tiltak bør bidra til å bistå eldre kvinner og menn i deres arbeid med å skape kontinuitet i livet i møte med sårbare livsløpsoverganger i alderdommen. Funnene fra prosjektet er viktige i forbindelse med nasjonale reformer som retter seg mot å motvirke sosiale forskjeller, øke åpenhet om aldring og eldre år, og sikre trygghet og tilhørighet for alle og de gir input til det lokale arbeidet for levende lokalsamfunn, boligtilpassing og -planlegging og sikring av bærekraftige velferdstjenester. TRILLs funn er også relevante i internasjonal sammenheng, hvor bl.a. Verdens Helse Organisasjon etterlyser identifisering av viktige livsløpsoverganger som en strategi for å iverksette målrettede tiltak for å fremme god og aktiv aldring. TRILL har bidratt til et økt fokus i utdanning og forskning på ulikhet i eldre år gjennom undervisning i en tverrfaglig Master i Folkehelsevitenskap og epidemiologi ved Universitetet i Oslo, og en keynote på Nordic Congress of Gerontology i Stockholm i 2024 som resulterte i en felles vitenskapelig state-of-the art publikasjon: «Ageing in a transforming world: insights for future research and policy from the 27th Nordic Congress of Gerontology». Artikkelen identifiserer sentrale områder for politikkutforming og videre forskning innenfor aldringsfeltet. I tillegg til de tilsiktede substansielle kunnskapsbidrag om sosial ulikhet i eldre år og betingelser for god aldring, har TRILL hatt en rekke metodologiske bidrag i analyse av ikke eksperimentelle longitudinelle data. Utstrakt samarbeid og medforfatterskap i prosjektet har styrket tverrfaglige kontakter mellom forskere fra sentrale miljøer innenfor aldersforskning i Norge, Sverige, Island, Nederland og Tyskland.
The TRILL project addresses the impact of later life transitions on opportunities for ageing well. Sustaining an ageing population calls for increased focus on prolonging good health and wellbeing across the whole life span, including old age, and later life transitions transpire as important windows of opportunity for strengthening the possibilities for ageing well through interventions and policies. Ageing is remarkably unequal, even in a comprehensive welfare state like Norway, and requires attention to key stratifying factors, gender and socioeconomic position (SEP), which are core dimensions in TRILL. The project builds on the lifecourse approach, which strengths are the emphasis on change over time, thereby highlighting possibilities for growth and adaption also in old age, and the importance of significant others (linked lives) and local context in shaping individual life courses. By using theoretical concepts of differential capability and resilience, the project does justice to the substantial heterogeneity among older people, in particular among those with low SEP. Data from two large longitudinal studies (NorLAG, the Tromsø study), combined with register information and qualitative data, enable the disentangling of potentially vulnerable transitions in later life; analyses of the differential effects of transitions on wellbeing and functioning; and assessment of how some older people manage later life transitions well despite low SEP (resilience). TRILL is a collaboration between NOVA OsloMet, the National Institute of Public Health and three leading institutes for ageing research in Europe. By bringing together scholars from different disciplines, the project will contribute to new knowledge at the intersection between health promotion, ageing well and social inequalities. The project will also include a stakeholder group, including representatives from different levels of policymaking, as well as older people themselves.
