Understanding the Challenges of Aging in a Nordic Welfare State: Micro-Level Investigations from a Life Course Perspective

Across the more developed countries, societies are facing aging populations. This dissertation focuses on the challenges that this demographic development poses to modern welfare states. The dissertation consists of six self-contained research articles. Through a life course perspective on aging, with empirical investigations at the micro-level, each article contributes to furthering our understanding of the challenges of aging in the context of the Nordic welfare state model. Utilizing the richness of linked survey and register data from Denmark, the dissertation combines novel panel data techniques, allowing for both descriptive and causal longitudinal analyses. With departure in the life course perspective, each article sheds light on important transitions and events, from mid-life to old age, which shape the individual aging process. In combination, the six articles advance our understanding of the aging process at the micro-level, as well as the role of the Danish welfare state in shaping the opportunities and outcomes of its citizens in later life. The following section provides an overview of the main results.

Article I asks how and why the Scandinavian countries have increased their female labor market participation at older ages. My findings point to major qualitative developments in older women’s employment patterns across cohorts. I explain this development, which is largely attributable to improvements in women’s educational attainment and cumulative work experience across cohorts. My results from a Scandinavian dual-worker economy demonstrate the massive societal potential associated with women’s employment throughout the life course.

Article II asks whether older citizens are worse off under choice-based models of public service provision. My findings from the hospital sector in Denmark reveal a negative age gradient, according to which citizens of advanced age and declining health possess lower levels of user capacity. I explain this age gradient, which is largely attributable to cohort differences in educational attainment. My results from the Danish health sector, influenced by choice-based policies, show that while the current generation of older service users may constitute a vulnerable group, this challenge is likely to diminish in the future.

Article III asks whether and under what conditions older adults without children are at risk of facing insufficient support in later life. Our results reveal that in the context of a comprehensive welfare state, childlessness in itself is no disadvantage for tangible support. However, we show that particularly widowed, divorced, and never-married older men without children enjoy lower levels of support. Detailed analyses of the conditions under which childlessness may become a disadvantage point to the importance of adult children as a source of support when advanced health needs arise. Our findings shed light on the societal consequences that may follow from the current demographic developments projecting an increase in the number of childless older adults in the future.

Article IV asks when and why older adults rely on different sources of care. Our results highlight four qualitatively distinct patterns of care utilization that differ with regards to the utilization and combination of formal services and informal care. Together, pre-disposing factors, needs factors, and enabling factors determine individual patterns of care utilization in later life. Our results direct attention to subgroups who may become affected in the future when the reforms of Nordic care policies are likely to shift the balance between state, market, and family.

Article V asks whether spousal bereavement affects loneliness in both the short and longer run. Based on a causal design, my results reveal a substantial increase in loneliness immediately following the loss, and a lasting effect even into the fifth year following bereavement. The short-term response is gendered, with widowers experiencing a substantially larger increase in loneliness than widows. My results point to the death of a partner as an adverse life event that puts older individuals at considerable risk of loneliness both in the short and longer run, and I show that men are particularly vulnerable after this life event.

Article VI introduces the main data source of the dissertation by describing five waves of the Danish Longitudinal Study of Aging (DLSA) and making clear to the reader the study’s advantages and limitations. One aim is to make the DLSA data set accessible to international researchers, thereby facilitating possibilities for comparative research in the future. Contributing to the design of the DLSA’s fifth wave questionnaire – for which data were collected in 2017 by the Danish Center for Social Science Research (VIVE) – and working with the dissemination of the results constitute key contributions of this PhD project.

Together, the empirical micro-level studies included in this dissertation make three broad contributions. First, my findings provide evidence on the role of the state and the family in providing care and support for older individuals. Second, they enhance our understanding of the circumstances which shape the needs and behaviors of a growing user group in society consisting of older citizens with health needs. Third, this dissertation both builds on and adds to the evolving body of aging research that uses longitudinal data to study the aging process from a life course perspective. In conclusion, the findings of this dissertation enhance our understanding of how the challenges of aging unfold in the context of a Nordic welfare state.