Local policy documents play a key role in the provision of social services in decentralised welfare systems. Previous Swedish research shows great municipal variation in local policies for delegation, which determines social workers' legal rights to make decisions about the welfare service given to older people. In this paper, we examine the association between local conditions and the variation of restrictiveness in local policies on delegation for elder care services, by combining data on political rule and economic, demographic, and geographic characteristics of all Swedish municipalities (n = 290), with data on delegation policy. Based on logistic regression models, the results indicate that population density, political rule and average income are correlated with the probability of restrictiveness in delegation. Our findings highlight the importance of understanding local conditions while allocating the responsibility for the provision of welfare in decentralised states with varying local prerequisites. They further highlight the need for studies investigating the consequences of varying local political policies on the outcome of the elder care services provided to older adults.

Participation of older workers in the labor market depends, among other things, on older workers employment chances. This study examines age differences regarding risk of unemployment and reemployment outcomes in late working life in Sweden. Using Swedish registry data, we analyzed the probability of unemployment as well as work-related activity following unemployment (wage- or self-employment; exit; downward mobility) of all people born between 1954 and 1968 (aged 49?63) and registered in Sweden between the years 2012 and 2018. Results show that although risk of unemployment does not differ significantly across age groups, younger age groups are more likely to be reemployed as wage-employed while older age groups are more likely to be reemployed as self-employed or exit working life. After an unemployment period, older employees are more likely to have a lower wage than during their previous employment or become part-time unemployed. We conclude that different age groups have unequal chances in late working life in terms of reemployment, risk of exit, and risk of downward mobility following unemployment. Policies for extending working life and promoting inequality should include measures for increasing employability of older workers such as anti-discriminatory laws and dealing with skills mismatch. Among older people, the risk of unemployment does not differ across age groups.Among older people, reemployment chances decrease by age.After unemployment, the probability of exit or self-employment increases by age among older people.Older employees have higher risk of downward mobility after unemployment.Policies for the demand side and employability of older workers are needed. Among older people, the risk of unemployment does not differ across age groups. Among older people, reemployment chances decrease by age. After unemployment, the probability of exit or self-employment increases by age among older people. Older employees have higher risk of downward mobility after unemployment. Policies for the demand side and employability of older workers are needed.

Background: In old age, many people experience a period of functional decline and require long-term care. Sweden has a universal largely tax-financed health and social care system that is used by all societal groups. However, few studies have investigated if educational groups use publicly paid long-term care equitably. The aim of this study was to explore educational differences in the use of long-term care, including both home care and institutional care, during the last two years of life in Sweden. Methods: We used linked register data on mortality and long-term care use, including all adults aged > 67 years who died in Sweden in November 2015 (N=6329). We used zero-inflated negative binomial regression models to analyse the number of months with long-term care by educational level, both crude and adjusted for age at death and cohabitation status. Men and women were analysed separately. Results: People with tertiary education died more commonly without using any long-term care compared to primary educated people (28.0% vs. 18.6%; p<0.001). In the adjusted model, educational differences in the estimated number of months with long-term care disappeared among men but remained significant among women (primary educated: odds ratio=17.3 (confidence interval 16.8-17.7); tertiary educated: odds ratio=15.8 (confidence interval 14.8-16.8)). Conclusions: Older adults spend considerable time in their last two years of life with long-term care. Only minor educational differences in long-term care use remained after adjustment for cohabitation status and age at death. This suggest that Swedens publicly financed long-term system achieves relatively equitable use of long-term care at the end of life.

Based on Swedish National Registry Data, this paper investigates the social structure of exclusion risks in late working life in Sweden by analyzing exit from working life, employment breaks, and late employment trajectories according to gender and education. Individuals born in 1950 (n = 107,830) are followed between the years 2010 and 2018. Results show that women with low education exit working life earlier and have a higher risk of employment breaks due to reduced working ability, while men with low education have a higher risk of employment breaks due to unemployment. Men in general and people with high education have a higher probability of moving to self-employment in late working life. We conclude that research and social policies require an understanding of multifarious late work trajectories to unearth the inequality of exclusion risks in the late phases of working life and the potential for interventions towards equal and inclusive prolongation.

Much research is conducted to evaluate digital-based solutions for health-care services, but little is known about how such evaluations acknowledge diversity in later life. This study helps fill this gap and analyses participation in the evaluation of a web-based mobile phone system for monitoring the post-operative progress of patients after day surgery. Participation is conceptualised as resulting from three processes: pre-screening, recruitment and self-selection. Based on field information and survey data, this study models (a) the (non-)participation in a sample of 498 individuals aged 60 and older that includes non-screened, non-recruited, decliners and participants in the evaluation, and (b) the individual decision to participate in a sample of 210 individuals aged 60 and older who were invited to take part in the evaluation. Increasing age enhances the likelihood of not being screened, not being recruited or declining the invitation. Those not recruited were most often ineligible because of technology-related barriers. Decliners and participants differed by age, gender, job, health status, digital skills, but not by social participation. Results suggest that highly specific groups of older people are more likely to be involved than others. Old-age diversity is not properly represented in digital health research, with implications for the inclusivity of new digital health technologies. This has implications for increased risks of old-age exclusion and exacerbation of social and digital inequalities in ageing societies.

Purpose In this paper, the authors attempt to understand how labour market attachment during the ages of 30–59 influences individuals' transition out of the labour market. Design/methodology/approach Using high-quality Swedish register data, the authors follow individuals born in 1950 and observe their labour market attachment during mid-life and their exit from the labour market. Findings The authors find evidence that labour market attachment in different stages of the career is differently related to exit from the labour market. At the age of 30, as well as between the ages 50–59, low attachment is related with earlier exit from the labour market. On the contrary, low labour market attachment during the ages 40–49 is related with later exit from the labour market. However, regardless of age, lower labour market attachment increases the risk of work-related benefit receipt in the exit year. The authors also find evidence that gender, migration status and childhood socioeconomic disadvantages may represent obstacles to longer working lives, while high education is a consistent factor in avoiding early exit from the labour market. Originality/value This study provides insights on the link between labour market attachment in different stages of the career and the exit from the labour market as well as work-related benefits dependency in the year of exit.

Background: Despite its relevance for healthcare expenditures and public health, few studies have examined how secondary healthcare use changes during the retirement transition. We therefore use Swedish register data to examine whether retirement is associated with intensified secondary healthcare use overall and for specific subgroups based on gender and education.

Methods: The sample was all individuals registered in Sweden who retired from paid work in 2010. We used Generalised Estimating Equations models to analyse changes in two indicators of secondary healthcare use, namely specialist visits and hospitalisation, from 3 years prior to 5 years after retirement.

Results: Retirement is not associated with changes in specialist visits or hospitalisation per se. Three years before retirement, women were more likely to visit a specialist but less likely to be hospitalised than men; these gender differences disappeared approximately 1 year before retirement. Women with high education were more likely to visit a specialist than women with low education across the entire retirement transition, particularly post-retirement. Significant differences with regard to specialist visits between male educational groups only emerged 12 months after retirement. There were no educational differences with regard to hospitalisation.

Conclusions: We conclude that secondary healthcare use in Sweden does not generally change with retirement. However, over the course of retirement gender differences in secondary healthcare use tend to decrease and within-gender educational differences tend to increase. We interpret the results as reflecting the role of labour market institutions in contributing to gender differences but repressing educational differences in secondary healthcare use.

Aim: We aimed to understand the interplay between retirement pathways and healthcare use in the postponed and structurally changing context of retirement.

Methods: Based on Swedish register data on income and healthcare use, we applied combined sequence and cluster analysis to identify typical pathways into retirement and analysed their relation to healthcare use developments.

Results: We detected five distinct pathways into retirement. Level of healthcare use was significantly higher for the pathway via disability pensions. We saw an overall increase in healthcare use across the retirement process that was related to age rather than to the different pathways.

Conclusions: Level of healthcare use at the beginning of the retirement process may be related to selection into different pathways of retirement. We did not find clear evidence across several healthcare measures that different pathways lead to different developments in healthcare use.

The involvement of older people in research on digital technologies is uneven. Some groups of older people, e.g. the older ones, are less likely to participate in research which evaluates new digital technologies, compared to their counterparts. This may bias research results and produce wrong research conclusions. In this work, we aim at understanding whether and how the uneven involvement of older people in research on digital technologies has an impact on the research results. Our example is an intervention study which evaluated a web-based system for monitoring the postoperative progress of individuals after day surgery, i.e. ‘Mobile Phone in Recovery after Ambulatory Surgery’ (MIRAS). We considered a sample of 717 individuals of age 50 years and older (mean age: 65) who underwent a day surgery at one of the MIRAS recruitment sites during the recruitment timeframe. This group included both MIRAS participants and those who were not recruited byMIRAS. Based on information on age, gender, recruitment status, and intervention results, we implemented a weighting procedure to adjust the intervention results for the over-representation and the under-representation of groups of older people in the MIRAS sample by age and gender. We found that weighted and unweighted intervention results differed one another. The unweighted intervention results were over-positive with regards to the efficacy of the intervention due to the under-representation of groups of older people who were older and men. Biased results generate inaccurate conclusions which, in turn, can inform inappropriate digitalisation strategies and policies.