“Vivre/Leben/Vivere”: An interdisciplinary survey addressing progress and inequalities of aging over the past 30 years in Switzerland

Highlights

• We present a survey design for the study of life and health conditions in aging.

• The survey is the third survey in a repeated cross-sectional study that began in 1979.

• The survey is based on a model of resource accumulation across the life course.

• The survey is interdisciplinary.

Abstract

In this paper, we present the rationale and the design of “Vivre/Leben/Vivere” (VLV), a large interdisciplinary survey looking at the life and health conditions of individuals who are aged 65 and older and living in Switzerland. VLV is of the third survey of a repeated cross-sectional study, previously conducted in 1979 and 1994 in two French-speaking areas of Switzerland (the cantons of Geneva and Valais). Launched in 2011, VLV extends the original design to additional German and Italian-speaking areas and targets a sample of 4200 individuals. Quantitative data are collected by means of two questionnaires and a life history calendar, assessing current resources in multiple spheres of the individuals’ life (e.g. household conditions, physical and psychological health, social relations, participation, and values) and their accumulation across the life course. The objectives of VLV are twofold: first it aims to provide an updated view of life and health conditions of the population aged 65 and older in Switzerland, with a major concern in assessing diversity and inequalities. Second, VLV aims to compare these conditions to those observed in 1979 and 1994; hence, it aims providing means to question the sustainability of the positive trends, reported in the previous surveys. VLV is a rare opportunity in Europe to acquire exhaustive and cardinal knowledge about the heterogeneity of the life conditions of the aged and their changes over the past 30 years.

Introduction

During the last century, the global population has aged at an accelerating rate. Long-term trends toward lower fertility and greater longevity have generated a growing number of older individuals throughout most of the world. Switzerland, as other Western countries, has witnessed an increase in life expectancy at birth by over 30 years; a threefold increase in the proportion of people aged 65 and older; and an eightfold increase in the percentage of individuals aged 80 and older (Oris & Lerch, 2009). In the upcoming years, these trends are expected to accelerate with the “baby boom” generation reaching the age of retirement.

These demographic changes have been accompanied by tremendous technological advances, significant improvements in medical care, health and sanitary conditions and education. In addition, the economy, job markets, family structures and lifestyles evolve at a very fast pace. Together, these demographic and socio-cultural transformations have continuously presented, and will continue to present, new challenges for aging individuals, who need to adapt in fast-evolving contexts (P. B. Baltes & Baltes, 1990). The changes observed in the last few decades have created important changes in individual opportunities and new possibilities for the political participation, productivity, and social integration of aging adults. In these circumstances, societies that face such socio-demographic challenges need to update their knowledge about the life conditions of aging individuals; these are crucial matters for the objective to maintain health, autonomy, and well-being of the societies’ aging members.

From the 1930s until the 1970s, the growing proportion of old individuals has been perceived as a social threat; aging was very negatively perceived as a one-way road toward senility and loss of autonomy (Bourdelais, 1997). In more recent years, from the accumulation of research in geriatrics, psychology, and social sciences (Bengtson et al., 2009, Binstock and George, 2011, Schaie and Willis, 2010, Settersten and Angel, 2011b, Wilmoth and Ferraro, 2007), these perceptions slowly vanished, providing a subtler picture, mainly carried by the “successful aging” paradigm (Rowe & Kahn, 1998). Indeed, parallel to the increase of the life expectancy at birth, reported in the last decades, social and political perceptions highlighted a growing gap between the “young-old”, the “old-old” (Neugarten, 1974), the “oldest-old” (Suzman, Willis, & Manton, 1992) carrying over the negative aspects of aging from the so-called “third” to the “fourth age” (P. B. Baltes and Smith, 2003, Lalive d’Epinay and Cavalli, 2013). While the life conditions and well-being of the “young-old” have undoubtedly improved, the “old-old” tend to show higher prevalence rates of diseases and co-morbidities (e.g., Robine & Michel, 2004); declines in functional health (e.g., Lalive d’Epinay & Spini, 2008); and cognitive (e.g., P. B. Baltes and Mayer, 1999, Schaie, 1996) and psychological (e.g., Freund & Smith, 1999) functions, which are often accompanied by a pruning of social networks (e.g., Lang & Carstensen, 1994) and a reduction in social participation (e.g., Bukov, Maas, & Lampert, 2002). For these conditions, needless to say, aging studies have to include in their agenda not only a better understanding of the factors that may account for the improvement of life conditions, but also the factors that redefine the “last” (Marshall, 1980) or “closing chapters” (Guilley & Lalive d’Epinay, 2008) of life.

As a matter of fact, advancing age is not from far the sole factor that accounts for differences in life conditions, functional health, and well-being among aging adults. Data show that some categories of individuals appear to be more fragile and vulnerable than others. Among these are women (Annandale and Hunt, 2000, Arber and Cooper, 1999), individuals with lower socio-economic status (Schöllgen, Huxhold, & Tesch-Römer, 2010), and immigrants (Bolzman, Poncioni-Derigo, & Vial, 2004). Indeed, mobility across countries has drastically increased over the last decades, yielding different waves of migrations in Western Europe. However, too little is known about the conditions in which individuals grow older abroad or outside of their country of origin.

To this day, continuous progresses in health and life conditions have been principally attributed to socio-structural factors. These factors include: better medical and educational systems, better labor conditions, enhanced socio-professional structures, and technological advances. Furthermore, these factors are meant to be efficient resources that individuals can make use of to compensate for losses, inherent to the aging process (P. B. Baltes & Smith, 2003). However, cardinal questions remain unanswered. First, the differential availability and use of resources, among aging individuals, must be inquired and updated, considering the actual socio-demographic challenges and opportunities. Second, the impact of life trajectories on the accumulation of available resources deserves adjusted clarification. Finally, it is currently unclear whether or not the average positive trends reported so far will continue. In fact, recent reports challenge the sustainability of the increase of life expectancy at birth and the continuous improvement of life conditions in aging populations (Olshansky et al., 2001, Olshansky et al., 2005).

From both the life course (Elder, 1998, Elder et al., 2003) and lifespan perspectives (P. B. Baltes, Reese, & Lipsitt, 1980; P. B. Baltes & Smith, 2004), the diversity of individual situations and the heterogeneity in life and health conditions are results of in past life trajectories and past experiences. At the sociological level, differential aging has been assumed as being associated with social structures during lifelong processes of accumulating (dis)advantages, which reach their apex at old age (Dannefer, 1987, Dannefer, 2003); this leads to an increase in the variety of life trajectories (Cavalli, 2007). Similarly, at the psychological level, individual capacities are built up through a lifelong process of a dynamic interplay between social and biological factors (Ludwig and Chicherio, 2009, Staudinger et al., 1993), which is assumed to account for the age-related increase in inter-individual variability (Li, 2002). Finally, it may be important to acknowledge that while the life course and the lifespan perspectives debate various explanatory principles of development (Dannefer and Daub, 2009, Mayer, 2003, Oris et al., 2009, Settersten, 2009), both perspectives agree on the general claim that development consist of continuously achieving the most efficient balance between gains and losses in a variety of interplaying “resources”, whether they are structural, social, physical, or psychological.

The numerous demographic and socio-cultural transformations that have been reported in the last decades yield a “democratization of aging”; this refers to a vast majority of human beings’ access to larger social opportunities, as well as to longer, healthier, wealthier and more satisfactory living conditions, than those in the preceding decades. Still, such democratization does not negate the fact that several populations remain at higher risks of frailty, poverty, social isolation, and physical and psychological burdens (Lalive d’Epinay and Spini, 2008, Pilgram and Seifert, 2009, Wanner and Gabadinho, 2008). These risks threaten autonomy, as well as social and individual well-being.

The fact that cohorts with newly defined characteristics and life experiences reach old age creates a need to explore once again the last stages of the life course, with consideration of these historical matters (Settersten & Martin, 2002). With this aim, studies on aging first need to question the most recent trends of the transformations reported so far. A comparison with the data collected in previous surveys, as well as an account of different cohort characteristics, will be of great interest in achieving this goal. Second, studies need to investigate the heterogeneity of aging by identifying the conditions and factors that contribute to these variations (Kelley-Moore & Lin, 2011). An interdisciplinary approach, based on a shared resource framework, should provide a means to grasp the multiple determinants of the variability for aging conditions. Finally, it seems to be a cardinal concern to find out how current resources are constituted and how they are actually used. To address these issues, a developmental perspective must be adopted, with consideration of the current life conditions as the result of lifelong dynamics of (dis)advantages accumulation processes.