title: Gender-related differences in the multi-pathway effect of social determinants on quality of life in older age-the COURAGE in Europe project.
abstract: Gender-related differences in life expectancy, prevalence of chronic conditions and level of disability in the process of ageing have been broadly described. Less is known about social determinants, which may have different impacts on quality of life in men and women. The investigation aims to reveal gender-related differences in social determinants on quality of life assessed by a multi-pathway model including health, social, demographic and living place characteristics.
  
  
  
  The study group consisted of 5099 participants aged 50+ representing general populations of three different European regions (Finland, Poland, Spain) who participated in COURAGE in EUROPE Project. Standardized tools were used to measure quality of life (WHOQOL-AGE) and social determinants (COURAGE Social Network Index, OSLO-3 Social Support Scale, UCLA Loneliness Scale, participation scale and trust). A multipath model considering exogenous predictors (demographic, economic), mediators (social) and endogenous outcome (QOL) was created to reveal the role of determinants. Gender-related differences were investigated across three age categories: 50-64; 65-79 and 80+.
  
  
  
  The model (RMSEA = 0.058; CFI = 0.939) showed the effects of all of the investigated determinants. Gender-related differences in the association between social constructs and QOL were observed for social networks in the group of 80+, for social support in the group of 50-64 and 65-79 years, and for social participation in the group of 65-79 years. Males benefited more (in QOL) from social networks and social support, and women from social participation.
  
  
  
  The research provides valuable knowledge about the role of social determinants in QOL considering complex relations between different social constructs. Additionally, the results showed gender-related differences in the associations between social networks, social support, social participation and QOL, suggesting that men might benefit more from the interventions in the first two. Although our research did not investigate the effects of interventions, the results show directions for future investigations, how to shape social interventions at the population level to improve quality of life of older adults, and thus help achieve successful ageing.
authors.affiliation: Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kopernika 7a, 31-034, Krakow, Poland. mytobias@cyf-kr.edu.pl.
authors.forename: Beata
authors.initials: B
authors.lastname: Tobiasz-Adamczyk
authors.affiliation: Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, 7, Kopernika St, 31-034, Krakow, Poland.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Galas
authors.affiliation: Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kopernika 7a, 31-034, Krakow, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Zawisza
authors.affiliation: Department of Health Statistics and Information Systems, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland.
authors.forename: Somnath
authors.initials: S
authors.lastname: Chatterji
authors.affiliation: Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental, CIBERSAM, Madrid, Spain.|Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Dr. Antoni Pujadas, 42, 08830 Sant Boi de Llobregat, Barcelona, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Haro
authors.affiliation: Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental, CIBERSAM, Madrid, Spain.|Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain.|Department of Psychiatry, Universidad Autónoma de Madrid, Arzobispo Morcillo, 4, 28029, Madrid, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Ayuso-Mateos
authors.affiliation: National Institute for Health and Welfare, Mannerheimintie, 166, 00300, Helsinki, Finland.
authors.forename: Seppo
authors.initials: S
authors.lastname: Koskinen
authors.affiliation: Fondazione IRCCS, Neurological Institute Carlo Besta, Via Celoria, 11, 20133, Milano, Italy.
authors.forename: Matilde
authors.initials: M
authors.lastname: Leonardi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D005060:Europe; D005260:Female; D005783:Gender Identity; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012944:Social Support
keywords: Gender-related differences; Loneliness; Quality of life; Social networks; Social participation; Social support; Trust