Vivere": An interdisciplinary survey addressing progress and inequalities of aging over the past 30 years in Switzerland.

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Protocol Paper

‘‘Vivre/Leben/Vivere’’: An interdisciplinary survey addressing progress and inequalities of aging over the past 30 years in Switzerland Catherine Ludwig a,*, Stefano Cavalli b,c, Michel Oris d,c a

School of Health – Geneva, University of Applied Sciences and Arts Western Switzerland (HES-SO), 47 Avenue de Champel, 1206 Geneva, Switzerland Centre of Competence on Aging, Department of Health Sciences, University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Via Violino, 6928 Manno, Switzerland c Swiss National Competence Center in Research LIVES – Overcoming Vulnerability: Life Course Perspectives, Universities of Lausanne and Geneva, Switzerland d Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Route des Acacias 54, 1227 Carouge, Switzerland b

A R T I C L E I N F O

A B S T R A C T

Article history: Received 2 October 2012 Received in revised form 12 April 2014 Accepted 24 April 2014 Available online xxx

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. ß 2014 Elsevier Ireland Ltd. All rights reserved.

Keywords: Aging Life conditions Inequalities Resources Cross-sectional study

1. 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

* Corresponding author at: School of Health – Geneva University of Applied Sciences and Arts Western Switzerland (HES-SO), 47 Avenue de Champel, 1206 Geneva, Switzerland. Tel.: +41 22 3885612; fax: +41 22 3885601. E-mail address: [email protected] (C. Ludwig).

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. 1.1. Progress and heterogeneity of life conditions in the aged population From the 1930s until the 1970s, the growing proportion of old individuals has been perceived as a social threat; aging was very

http://dx.doi.org/10.1016/j.archger.2014.04.004 0167-4943/ß 2014 Elsevier Ireland Ltd. All rights reserved.

Please cite this article in press as: Ludwig, C., et al., ‘‘Vivre/Leben/Vivere’’: An interdisciplinary survey addressing progress and inequalities of aging over the past 30 years in Switzerland. Arch. Gerontol. Geriatr. (2014), http://dx.doi.org/10.1016/ j.archger.2014.04.004

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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, Gans, Putney, & Silverstein, 2009; Binstock & George, 2011; Schaie & Willis, 2010; Settersten & Angel, 2011b; Wilmoth & 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 & Smith, 2003; Lalive d’Epinay & 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 & 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 & Hunt, 2000; Arber & Cooper, 1999), individuals with lower socio-economic status (Scho¨llgen, Huxhold, & Tesch-Ro¨mer, 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, Carnes, & De´sesquelles, 2001; Olshansky et al., 2005). 1.2. The value of adopting a developmental perspective From both the life course (Elder, 1998; Elder, Kirkpatrick Johnson, & Crosnoe, 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, 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 & Chicherio, 2009; Staudinger, Marsiske, & Baltes, 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 & Daub, 2009; Mayer, 2003; Oris, Ludwig, de Ribaupierre, Joye, & Spini, 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. 1.3. Current challenges in the research on aging 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 & Spini, 2008; Pilgram & Seifert, 2009; Wanner & 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.

2. ‘‘Vivre/Leben/Vivere’’ (VLV) 2.1. VLV: Brief overview ‘‘Vivre/Leben/Vivere’’ (VLV) — which corresponds to the translation of the verb ‘‘to live’’ in French, German, and Italian, respectively — is a large interdisciplinary survey that began in 2011. The objective of the survey is to evaluate the actual life and health conditions of individuals who are aged 65 and older and are living in Switzerland. VLV continues a long tradition of studies that are conducted at the Centre for the Interdisciplinary Study of Gerontology and Vulnerability at the University of Geneva, Switzerland (see Fig. 1).


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Fig. 1. Timetable of the surveys conducted at the University of Geneva.

More specifically, VLV constitutes the second replication of a broad cross-sectional survey on the aged population of Switzerland, which began in 1979. The survey has the aim of describing and understanding aging as a psychosomatic and sociocultural process. The initial survey was conducted in 1979; its main finding challenged the idea of an average aging process by showing that aging was best described by the diversity and multiplicity of life conditions and situations. Old age was not one condition, but of many conditions (Lalive d’Epinay et al., 1983). This survey was replicated 15 years later in 1994 (Lalive d’Epinay, Bickel, Maystre, & Vollenwyder, 2000). Both studies had similar designs and followed the same methodological and practical rules (Be´temps, Bickel, Brunner, & Hummel, 1997). They were based on random samples of adults who were aged 65 and older (60 in 1994), stratified by gender, age groups, and regions. The surveys were conducted in two areas of the French-speaking part of Switzerland in order to make possible comparisons of metropolitan (canton Geneva) and semi-rural (central area of canton Valais) areas. A comparative analysis of the collected data revealed a profound but quiet transformation of the life conditions related to aging. At equal age, older individuals demonstrated better health and better life conditions in 1994 than in 1979. Expressions of well-being drastically increased, and the density of the family and relational life increased as well. In 1994, participants of the survey were more active and willing to benefit from the modern world than their peers in 1979 (Lalive d’Epinay et al., 2000). Rooted in these findings, a complementary research program was launched in 1994 to more thoroughly investigate the life and health trajectories in very old age. The ‘‘Swiss Interdisciplinary Longitudinal Study on the Oldest Old’’ (SWILSOO, Guilley & Lalive d’Epinay, 2008; Lalive d’Epinay & Spini, 2008) followed two successive birth cohorts of octogenarians; one comprised individuals who were born between 1910 and 1914 and monitored over a period of 10 years (1994– 2004), and the other comprised individuals who were born between 1915 and 1920 and observed over a period of five years (1999–2004). The core assumption of SWILSOO was to

demonstrate that while very old individuals greatly vary in their life and health conditions, most of them shared the experience of frailty (Fried et al., 2001; Spini, Ghisletta, Guilley, & Lalive d’Epinay, 2007). This assumption was confirmed by the findings that revealed that frailty, defined in terms of diseases and/or dependency, was the dominant health status at very old age; the findings also showed that frailty could affect individuals to various degrees in a continuum between autonomy and dependency (Lalive d’Epinay & Spini, 2008). The findings from the surveys conducted at the University of Geneva supported the general report of an average enhancement of life and health conditions of the aged population, along with an increase in heterogeneity across individuals. The question of the sustainability of these trends was the main focus of the VLV study, which was a second survey replication that began in 2011. 2.2. The conceptual approach of VLV The conceptual approach in VLV relies on an overarching model, revolving around the notion of ‘‘resources’’ (see Fig. 2). As it is adopted by many disciplines — including geriatrics, psychiatric geriatrics, psychology, sociology, socioeconomics, social policy research, and demography — this notion provides a common interdisciplinary foundation and a common conceptual objective of study. From propositions made by the life course and the lifespan perspectives, it is assumed that the pool of resources, which is available to each individual at any time of its development, is rooted in a lifelong and dynamic interplay between individual and socio-structural factors. With this assumption, the approach used in VLV integrates past life trajectories and targets five major life dimensions, which are: family, occupation, residency, health, and if relevant, migration (see Fig. 2, box A). Both states (e.g. periods of depression, professional inactivity) and life events (e.g. loss of a partner, residential change) are meant to constitute a lifelong process of accumulation of (dis)advantage (Dannefer, 1987, 2003);


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Individual resources Trajectories Family Residency Employment Health Migration

A

Well-being

Practices

Health Personality Cognition Social capital Human capital Life conditions Employment Economy ….

C

Values and social policies Socio-structural resources

B

D

Fig. 2. Schematic representation of the conceptual approach used in VLV.

this accounts for individual differences in available resources at the time of the survey. Conceptually, such developmental dynamics can be related to a process of constitution of a ‘‘reserve’’ (Richards & Deary, 2005; Stern, 2007) or a ‘‘capital’’ (Bourdieu, 1980, 1985); this process can be called upon to manage constant developmental adaptation, including dealing with critical life events and conditions. For the model in VLV, resources, as trajectories, are multidimensional, as shown in Fig. 2, box B. The resources include physical health (e.g. degree of physical diseases, affections, comorbidities), psychological health (e.g. degree of mental health diseases, cognitive abilities, personality, coping strategies), social and human relations (e.g. family network, relations to kin, friends), life conditions (e.g. type of housing, household), occupation (e.g. labor, activity, retirement), and economy (e.g. income, assets, financial wealth). It is important to note that above and beyond the notion of resources, is the assumption that all resources interact and constitute a dynamic system, which defines individual situations or states at any given moment of life (Lalive d’Epinay et al., 1983). Fundamentally, the system of resources defines individual states of autonomy, frailty, or dependency (Spini et al., 2007). The proposed model also assumes that not only the pool of resources available accounts for differential development, but also the ability of each individual to use these resources, which is referred to as ‘‘practice’’, as represented in Fig. 2, box C. Practice is envisioned as the ability one has to be, to do, and to act (Sen, 1999). From this perspective, autonomy can be viewed as a practice that requires the capacity to judge (discernment), to decide (will), and to act (physical independency) upon society and upon one’s life (Lalive d’Epinay et al., 2000). In Western societies, both resources and practices are intimately connected to social policies and values (Kohli, 2007). Indeed, social policy arrangements structure individual resources and relevant actions; they do this both through mechanisms in the allocation of legal, material, and socio-cultural resources, as well as through cultural principles and meanings, conveyed by the institutionalized rules. In this perspective, VLV also addresses the issue of intergenerational relationships outside of the family, which is increasingly discussed in politics at the local level and is possibly becoming a new area of social intervention (Hummel & Hugentobler, 2007). Finally, life trajectories, individual resources, social policies and values, and practices are assumed to create developmental dynamics that determine individual differences in well-being; this is not only conceived as personal efficacy and growth (e.g., M. M. Baltes & Lang, 1997), but is also broadly viewed as the ability of

the individuals ‘‘to lead the kind of lives they value–and have reason to value’’ (Sen, 1999, p.18). 2.3. The main objectives of VLV Based on the above described conceptual model, VLV has two major objectives. The first is to study the composition of the elderly population, stratified by age and sex, according to the availability and diversity of the resources they own. Using the survey method, VLV intends to assess physical and psychological health, social relations and participation, and economical wealth, as well as individual values and opinions, of a representative sample of individuals who are aged 65 and older in Switzerland. Additionally, VLV aims at relating the pool of available resources to past trajectories by means of life history calendars, which allow reporting past life events and transitions. By these means, VLV intends to study the heterogeneity of life conditions in aging in order to identify conditions associated with a) more vulnerable and latent state of frailty; and b) conditions and resources that may prevent negative outcomes, in terms of subjective health and well-being. The second objective of VLV is to compare the data collected in 2011 with the data collected in the previous surveys from 1979 and 1994. This comparison will address the changes of the life conditions for the aged population over the last few decades, both in terms of progress and heterogeneity (or inequalities). Furthermore, the 30-year comparison makes it possible to address the effect of socio-historical contexts on the aging processes and opportunities. 3. Methods 3.1. Participants The survey is conducted in five Swiss cantons: Geneva (GE), Valais (VS, restricted in the Central Valais area), Bern (BE, restricted to the Mittelland, Oberland, and Seeland areas), Basel (including Basel-Stadt, BS and Basel-Land, BL) and Ticino (TI), as reported in Fig. 3. These regions were selected on the basis of the following: a) reproducibility of the 1979 and 1994 surveys; b) representativeness of the linguistic and urban/rural areas; and c) the regions’ potential to capture the effects of different social policy systems, regarding the elderly in the complex Swiss federal state. In each region, the relevant ethical committee approved the survey protocol. The target sample consists of 4200 respondents, comprising a main sample of 3600 individuals, a sample of 100 partners, and a


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Fig. 3. Map of Switzerland with the regions surveyed highlighted.

sample of 500 immigrants from Italy, Spain, Portugal, and ExYugoslavia. The sample of partner is added to allow an exploratory investigation of the principle of ‘‘linked-lives’’, formulated by Elder (1974); this principle assumes that each individual life trajectory is tight to and modulated by the trajectories of other individuals who are socially related, as is the partner. The sample of immigrants is added to investigate the specificities of migrant trajectories and their impacts on life and health conditions. The main sample is randomly selected in the cantonal and national population records. Moreover, the main sample is stratified by age (65–69, 70–74, 75–79, 80–84, 85–89, 90 and above) and sex, for a total of 720 respondents in each canton. The respondents are either community-dwelling or living in nursing homes. The sample of 500 immigrants is also randomly selected in the cantonal records with the additional criterion of nationality and with a restricted age range from 65 to 79. Italian, Spanish, and Portuguese communities are surveyed in canton Geneva; the communities from Italy and Ex-Yugoslavia are surveyed in Basel. Like the other migrants, older migrants are located in urban areas, such as Geneva and Basel. These two areas have different histories of immigration and consequently, different national communities. It is worth noting that the migrant sample will allow for a comparison with previous surveys, conducted in Geneva and Basel in 1994, among older Italians and Spaniards (Bolzman, Fibbi, & Vial, 1999) as well as in 2002, among older Italians, Spaniards and former Yugoslavians (Bolzman, Poncioni-Derigo, Vial, & Fibbi, 2004). All respondents need to give written informed consent for participation. 3.2. Material The data are collected by using a self-assessed life history calendar, a self-assessed questionnaire, and a questionnaire that was administered during an interview conducted by a trained interviewer, who used the Computer Assisted Personal Interview (CAPI) method. Together, these instruments contain more than 500 questions; some questions served as filters for thematic sections (e.g. immigration, widowhood), which are addressed only to concerned respondents. The life history calendar (Belli, 1998; Freedman, Thornton, Camburn, Young-DeMarco, & Alwin, 1988; Glasner & van der Vaart, 2009) is a retrospective method that is used to gather reasonably valid information on past trajectories and events. The tool is a yearbased report (from birth to the time of the survey) of important transitions and events in five dimensions of the individual’s life, which are: family, residency, health, activities and, if relevant, migration. The calendar is presented on a large sheet of paper, with

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age and years in lines, and life dimensions in contiguous columns. Each person in our sample receives an individualized calendar that starts from his/her year of birth. Age and years are cues for remembering specific events, and the contiguity of dimensions serves as cues for recalling contingencies and associations in multiple spheres of life. The calendar is self-administered, subsequently checked by the interviewer and, if necessary, completed at the beginning of the interview. Accordingly, the respondent is asked to report periods of happiness and vulnerability. The questionnaires assess a large array of resources available to the individuals (see Table 1). Questions target physical, cognitive, and psychological health, social relations and participation, family configurations, activities and employment, material and financial conditions, as well as opinions and values. The questions were created to respond to the conceptual framework adopted for the project (Fig. 2), following the aim to consider various resources and spheres of life as interacting forces (see Fig. 4). About one-third of the content of the questionnaire entails questions that were already used in the 1979 and 1994 surveys (Tholomier, 2011) for comparison purposes. The additional content has been constituted to study new dimensions and/or to assess existing ones in a finer manner (e.g. bereavement and widowhood, immigration, chronic diseases and pain). A substantial part of the questionnaire entails existing scales and measures, gathered from various disciplines. Hence, functional heath is assessed using the Activity of Daily Living and Instrumental Activities of Daily Living scales (ADL and IADL, Katz, Downs, Cash, & Grotz, 1970; Lawton & Brody, 1969) and the health-related Quality of Life scale (EuroQol, EuroQoL Group, 1990). Physical health is assessed with the Brief Pain Inventory (BPI, Cleeland, 1989) and the DELPHI DOLBaPP (Dionne et al., 2008), which provide subjective measures of pain. Physical health is also assessed with the Geriatric Index of Comorbidity (GIC, Rozzini et al., 2002), which assesses concomitant medical affections. Psychological health and resources are estimated by using the Self-Assessing Depression Scale (SASD, Wang, Treul, & Alverno, 1975) and the Anxiety and Depression subscales of the General Health Questionnaire (GHQ, Goldberg et al., 1997), which measure anxiety and depressive symptoms; Big-Five Inventory-10 Items (BFI-10, Rammstedt & John, 2007), which assesses personality types; and the Satisfaction With Life Scale (SWLS, Diener, Emmons, Larsen, & Griffin, 1985), which provides a subjective and global estimation of satisfaction with life. Measures of cognitive resources have also been introduced and consist of the Mini Mental Status Evaluation (MMSE, Folstein, Folstein, & McHugh, 1975), a short version of the Mill Hill vocabulary scale (Deltour, 1993), and the Trail-Making Test, which measures executive functions (TMT-A and TMT-B, Reitan, 1958). Finally, social relations are estimated by means of the Family Network Method (FNM, Widmer, Chevalier, & Dumas, 2005), which allows for a fine assessment of the social and family relations. It is important to acknowledge that the development of a multidimensional assessment tool constitutes an important challenge in itself (Tholomier, 2011). The operationalization of interdisciplinarity is intended to not only to establish common grounds and languages and to define shared concepts and models, but also to deal with different disciplinary traditions and requirements, in terms of measurement tools, scales, and methodologies. The questionnaires used in VLV, while addressing a variety of resources, are also the results of deals, bargains, and compromises inherent to interdisciplinarity. The preservation of disciplinary constraints, in terms of measurement validity and reliability, is of central concern. Indeed, for some scholars, a major concern is that standardized scales are administered, while maintaining instructions, item numbers, and orders, as well as


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Table 1 Summary of the questions, by domain of investigation and instrument. Domain of investigation (and scales, if relevant) Socio-demographic variables Date of birth, gender, marital status, confession, place of birth, place of residency, nationality, languages Educational level, occupational status, first and last occupation, assets and income, insurance coverage and social benefits Past life trajectories Residential and familial situation during childhood Residential trajectory Familial trajectory Health trajectory Occupational and retirement trajectory Migration trajectory Main turning points Periods of vulnerability and happiness Living circumstances Area of residence Last move: timing and reasons Place of residence: private or nursing home Household size, pets Household equipment Use of transportation: car, public transports, bike, etc. Health and physical resources Activities of daily living (ADL and IADL, Katz, Downs, Cash, & Grotz, 1970; Lawton & Brody, 1969) Sensory functioning/visual and auditory problems Illnesses and health-related incidents: e.g., falls, hip-fracture, hospitalization Affections and diseases over the 4 last weeks Comorbidities (GIC, Rozzini et al., 2002) Pain (BPI, Cleeland, 1989; DELPHI, Dionne et al., 2008) Self-rated health, per se and by comparison Health-related quality of life (EuroQoL, EuroQoL Group, 1990) Habits involving risk, tobacco alcohol (CAGE, Mayfield, McLeod, & Hall, 1974) Consumption of medication Body mass index Psychological resources Global cognition (MMSE, Folstein et al., 1975) Fluid cognition (TMT-A and TMT-B, Reitan, 1958) Crystallized cognition (Mill Hill, Deltour, 1993) Self rated memory problems Anxiety (GHQ, Goldberg et al., 1997) Depression (GHQ, Goldberg et al., 1997; SADS, Wang et al., 1975) Satisfaction with life (SWLS, Diener et al., 1985) Stress and daily hassles Personality (BFI-10, Rammstedt & John, 2007) Religious faith (DUREL, Koenig & Bu¨ssing, 2010) Attributions Beliefs (BJW, Dalbert, Montada, & Schmitt, 1987) Values and opinions: Social behaviors, intergenerational relationships Social resources – Family relations Mother and father: year of birth/death, nationality, place of residency Siblings: number (including number in life) Children: gender, year of birth/death, nationality, marital status, place of residency, occupation Grand-children and grand-grand-children: number and area of residency Exchanges: type and frequency Support provided and received: frequency and nature Family network evaluation (FNM, Widmer et al., 2005) Social resources – Partnership

Instrument QA/QF

QA/QF

QA LHC LHC LHC LHC LHC QA LHC

QA QF QA QA QA QA

QA + QF

QA QA QA QF QF QA QF QA QF QA

QF QF QF QF QA QA QA QA QA QA QA QA QA/QF

QA QA QA QA QA QA QF

Table 1 (Continued ) Domain of investigation (and scales, if relevant) Current partner: gender, year of birth, nationality, occupational status, respondent-rated health, year of couple beginning, satisfaction. Precedent partner: gender, year of birth/death, nationality, occupational status, year of couple beginning, reasons and year of separation, satisfaction. ‘‘Great Love’’ (if different from previously): gender, year of birth/death, nationality, occupational status, year of couple beginning, reasons and year of separation, satisfaction. Bereavement: circumstances of the death and coping Social resources – Friendships Having a close friend Exchanges: type and frequency Support provided and received: frequency and nature Social resources – Activities and social participation Use made of the medias Leisure activities Religious activities Political activities, voting behavior Club and associations: membership, responsibilities and active participation, currently and at age 45 Knowledge of and participation to association for seniors

Instrument QA/QF

QF

QF

QF

QA QA QA

QA QF QF QF QA

QF

Social resources – Home care Health care: type and frequency Social care: type and frequency Day hospital: frequency

QA QA QA

Retirement Current work: type and reasons to continue to work Age of retirement Early/delayed retirement: age and reasons

QA QA QA

Immigration Type of residence permit Reasons for immigration Family situation at time of immigration and family gathering Relations with Swiss administrations Relations with country of origins Future plans (e.g., eventuality of going back, place to be buried)

QF QF QF QF QF QF

Note. QA: Questionnaire Auto-administered; QF: Questionnaire Face-to-face; LHC: Life History Calendar.

response modalities. For others, this constraint may appear to be of less importance than preserving the consistency and coherence of the survey questionnaire as a whole. Another concern is to adapt scales that were originally intended to be used in clinical practice with specific groups of patients (e.g. MMSE, Folstein, Folstein, & McHugh, 1975; GIC, Rozzini et al., 2002) to large-scale general population applications. As a result, great effort is needed in order to build the survey questionnaire and arrange the scales and items so that all of these constraints are preserved. To accomplish this goal, scales are organized within the whole questionnaire, first, according to appropriateness of face to face vs. self-administered format, which is kept identical for the questions used in previous studies. Second, items and scales are organized according to thematic content, and an effort is made to group sets of questions with similar response modalities (e.g. 4-points or 5-points Likert scales). In cases in which scales report on specific time frames (e.g. past 4 weeks), they are grouped together by similar time frames. Finally, care is placed on the length of the questionnaire, which is balanced across the face-to-face and the self-administered versions. Finally and when relevant, available short versions or subscales were used, rather than complete or exhaustive


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Fig. 4. Structural organization of VLV.

instruments; this was done to keep the length of the questionnaire appraisable. All of the choices implied interdisciplinary decisional processes. 3.3. Procedure The survey is conducted in-house without entrusting the task to a private institute. The survey is conducted at the Center for the Interdisciplinary Study of Gerontology and Vulnerability at the University of Geneva. However, local offices are established in each canton and run by bilingual on-site research coordinators. Field work and interviews are conducted by local interviewers, who receive week-long extensive training. Respondents are assigned to interviewers by the local coordinators, and interviewers are in charge of contacting and interviewing them. Respondents are first individually sent a regular mail, which includes a flyer and a short letter that presents the survey and announces an upcoming phone call by the interviewer. Letters are sent by the interviewer who is in charge of the subsequent interview. The contact mail is followed by a phone contact. Upon acceptance of participation, a paper questionnaire and an individually adapted paper life history calendar are sent. Finally, the CAPI is conducted by the interviewer, usually at the home of the respondent. The contact methodology is complemented by particular procedures. These procedures are aimed at increasing the response rates and the amount of data collected for two types of often under-represented populations: individuals from foreign communities and individuals with major cognitive disabilities. With respect to immigrants, the original French questionnaires are translated in Spanish, Portuguese, Serbo-Croatian, and Albanian, in addition to Italian and German (i.e. the translations done for the field in the main Swiss linguistic areas). Bilingual interviewers are recruited in order to offer immigrants the opportunity to participate and respond to the survey in their mother tongue. For individuals who are identified as cognitively unable to respond suitably to the interview (e.g., demonstrating important memory deficits, or known to suffer from mild or severe dementia), a proxy procedure is used (Kapp, 1995). This procedure consists of

collecting information by means of a short interview of a socalled ‘‘proxy’’ (i.e. a parent, partner, caregiver); this entails the advantage of gathering information about these particularly vulnerable populations, which are often under-studied in gerontological research precisely because cognitive deficits prevent individuals from properly responding (Settersten & Angel, 2011a). All of these procedures are aimed at increasing both the response rates and the representativeness of the interviewed sample. 3.4. Planned analyses To fulfill the aims of the survey, three types of analyses are planned: (1) Detailed analyses of the current situation of the aged population of Switzerland for the data collected in 2011; (2) An analysis of the life trajectories of individuals, using retrospective data collected in 2011, by means of the life history calendars and ad hoc items that were included in the questionnaires; (3) A comparative analysis that compares the data from 2011 with the data collected in 1979 and 1994. The aim of the first set of analyses is to provide the prevalence of each measure interest (i.e. outcome measures), as a function of age group, gender, and region, which are the first-level independent variables in this study. Additional predictors that are assumed to account for differences in resources (e.g. level of education, marital status, nationality, comorbidities) will be considered for a second step. The second set of analyses aims at identifying accurate information about the past life trajectories, whether they are objective (e.g., residential and familial situation during childhood) or subjective (e.g., perception of the main life turning points). This will be done by using the TraMineR software and procedures for temporal series analysis (Gabadinho, Ritschard, Mu¨ller, & Studer, 2011). These analyses will provide an up-to-date picture of the health and life conditions in the Swiss elderly population. Finally, the third set of analyses aims at clarifying the trends over the past 30 years by comparing the data collected in the 1979, 1994, and 2011 surveys. These analyses provide a means to investigate issues such as: the evolution in the socio-economic structure of the elderly population, the changes in life conditions, health and well-being, and the modifications of the socioeconomic inequalities.


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4. Conclusion The VLV survey intends to provide an updated picture of the life conditions of individuals who are aged 65 and older in Switzerland. The general approach in VLV revolves around the interdisciplinary concept of resources, which is integrated into a developmental perspective. The design considers how resources are built through individual lives, embedded in family trajectories and socioeconomic, cultural, and political contexts. The survey intends to estimate how health, family, residency, occupation and, if relevant, emigrational lifelong trajectories have created the pool of resources available to aged individuals. VLV also aims at assessing the current state of these resources, their diversity, and the way they are managed by individuals in order to best maintain an active life, high levels of well-being, and autonomy. Furthermore, VLV proposes to address the way that individual and socio-structural resources interact. For this objective, the comparison of five regions from three linguistics areas (Geneva, Valais, Bern, Basel and Ticino) is indeed of particular interest. In the same vein, the comparison with the data collected in the 1979 and 1994 surveys, in Geneva and Valais, constitute a great and unique opportunity to assess the effect of the socio-historical context and the evolution of the aged population over the past 30 years (Schaie & Elder, 2005). Finally, the resource-based approach and the design in VLV use powerful tools to identify the most relevant predictors of wellbeing, in the past and the present, as well as the ways that individual actions and social policies could be implemented to anticipate losses and/or promote ‘‘successful’’ aging processes. Therefore, VLV will undoubtedly provide valuable responses to the actual challenges in the research of aging.

Conflict of interest statement None. Acknowledgments This publication results from research work conducted within the framework of the National Competence Center in Research LIVES and the Sinergia Grant n8 CRSII1_129922, both financed by the Swiss National Science Foundation. The survey presented here has also received financial support from Pro Senectute Schweiz, and logistic support from the following cantonal authorities and institutions: De´partement de la solidarite´ et de l’emploi du Canton de Gene`ve; De´partement des affaires re´gionales, de l’ećonomie et de la sante´ du Canton de Gene`ve; De´partement de la sećurite´, des affaires sociales et de l’inte´gration de l’Etat du Valais; De´partement des finances, des institutions et de la sante´ de l’Etat du Valais; Dipartimento della sanita` e della socialita` del Canton Ticino; University of Applied Sciences and Arts of Southern Switzerland (SUPSI). The authors wish to address particular acknowledgments the co-applicants of the research project: Prof. Pasqualina PerrigChiello (University of Bern), Prof. Jean-François Bickel (University of Applied Sciences and Arts Western Switzerland), Prof. Claudio Bolzman (University of Applied Sciences and Arts Western Switzerland), Dr. Alessandra Canuto (Geneva University Hospitals & University of Geneva), Prof. Dominique Joye (University of Lausanne), Dr. Christophe Luthy (Geneva University Hospitals & University of Geneva), Prof. Dario Spini (University of Lausanne), Prof. Eric Widmer (University of Geneva). The study has been approved by the following ethical committees: Commission centrale d’e´thique de la recherche du Canton de Gene`ve; commission d’e´thique facultaire de la Faculte´ de psychologie et des sciences de l’e´ducation de l’Universite´ de

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