The project employed a mixed method methodology approach and carried out quantitative analyses of existing data on social exclusion in later life in European countries and a qualitative survey based on biographical interviews with older adults in Romania. The qualitative survey included screening questionnaires, biographical interviews and life calendars and was carried out with 50 older adults (out of which 15 were Roma) living in rural and urban areas. Our nested quantitative-qualitative approach allowed us to generate new knowledge on patterns of social exclusion, vulnerable groups, consequences of social exclusion on health, the lived experience of social exclusion, and the general mechanisms that construct social exclusion and create health inequalities. In addition, the project undertook a policy analysis of health, pension and long-term care frameworks in Norway and Romania with the aim of better understanding national contexts and find the best policy practices that can be transferred from Norway to Romania to reduce social exclusion among vulnerable older groups. An overview of healthcare, pension and long-term care systems was carried out in the two countries with a focus on governance, financing and organizing, types of services available, accessibility and eligibility. Moreover, best practices in Norway in the field of social inclusion for older vulnerable groups were identified. Furthermore, an assessment of transferability to the Romanian context was performed based on a SWOT analysis and Policy Delphi methodology with two rounds that involved 20 experts in Romania from NGO’s as well as health and social services.

In adressing the multidimensional nature of social exclusion, our research employed a conceptual framework consisting of five dimensions: exclusion from social relations, exclusion from material resources, exclusion from neighborhood and community, from civic participation and exclusion from services. To reduce the inherent complexity in measuring this multidimensional concept, we developed a typology of social exclusion based on Latent Class Analysis of data in Balkan countries. In doing so, we observed that multidimensional exclusion affects almost one fourth of the older population in these countries (23%), exclusion from material resources has the same incidence (23%), whereas exclusion from material resources and social relations impacts 4% of the older adults. By linking the types of exclusion to potential risk factors, we revealed that there are generic and specific risk factors of the social exclusion types, and social exclusion types differ in severity of consequences for loneliness and mental health, which makes each social exclusion type qualitatively distinct (Aartsen et al. 2023). This methodology was also successfully applied in a study among Norwegian older adults. In contrast with the study in the Balkan states, this Norwegian study revealed one type of social exclusion among younger-old people (material and neighborhood exclusion) and two types of social exclusion among older-old people (material and digital exclusion, and digital exclusion). Multinomial regression further showed that low level of education, living alone and poor self-rated health increase the risks of any type of social exclusion. Our results highlight that even in countries with generous welfare regimes, people can be at risk of social exclusion (Enatsu-Møll et al. 2024).

That social exclusion differs by welfare states is further illustrated by another study of the AMASE project based on data from Europe. Our results highlighted the high discrepancy in old age social exclusion and mental wellbeing across welfare states and underscored the detrimental and differential impact of dimensions of social exclusion. Our results emphasise the importance of a set of policies that take into consideration the multi-dimensional problem of social exclusion by addressing the manifold components of old age needs (Precupetu et al. 2024).

Various risk groups were highlighted in our research by gender, urbanity, employment, education, marital status, health status, and ethnicity (Roma). Men and women, for example were found to be exposed differently to the various types of exclusion. Men have higher risks of suffering from material resources and social relations, while no gender differences were found for multidimensional exclusion and exclusion from material resources (Aartsen et al. 2023). The higher vulnerability of men to joint exclusion from material resources and social connections can probably be explained by the prevailing gender norms surrounding social roles in the countries included in analysis. With the male breadwinner norm mostly dominant, it is probable that those who cannot conform to societal expectations are more likely to withdraw from social relations and/or to be stigmatized.

Social exclusion has serious outcomes in terms of physical and mental health, loneliness and mortality. The higher the number of domains from which a person is excluded, the higher their loneliness and the lower their well-being. Exclusion from multiple domains is the most severe form of social exclusion. Specific domains of exclusion are associated with mental health. Our results showed that the association between three types of social isolation (i.e. living alone, frequency of contact with family living outside the household, frequency of contact with friends and neighbours) and mental wellbeing in people aged 65 and over living in the EU is mediated by loneliness. The absence of contact with family members influences mental wellbeing only if they activate the feeling of loneliness. Our results highlight the important role that different facets of social inclusion play in the mental wellbeing of older people, as neither one can substitute for the others. Although both family and friends can provide material and emotional support, their provision takes specific and complementary forms (Vasile et al. 2024).

The perceived deficit of social relations (often referred to as loneliness) as well as an actual deficit of social relations (often referred to as social isolation) increase mortality. In our study on 15-year mortality it was observed that loneliness was related to mortality risk even after controlling for social isolation, but the effect of loneliness became insignificant for women after adjusting for objective social exclusion for women, but not for men. Objective aspects of exclusion from social relations, and for men also the subjective evaluation of being excluded, are associated with increased mortality (Aartsen et al. 2024).

Life-course drivers and mechanisms can explain patterns of social exclusion in later life. Our qualitative analysis highlighted four types of mechanisms through which disadvantage acumulated over the life cicle of our participants: Low socioeconomic status + negative life events; A trigger life event that proved a turning point; 3. Early transitions that keep people out of formal institutions and contribute to life trajectories at the margins of society; 4. A long time process of problems acumulation with immediate and long term effects. In case of older Romanian Roma, the intersection between ethnicity, gender, education, work, income, and residence/segregation can explain how disadvantage unfolds across the life course, contributing to pathways within social exclusion (Precupetu et al. 2024).

That conditions very early in life can have a profound impact on social exclusion in later life as suggested by the qualitative research mentioned above is confirmed in a quantitative research based on Finnish older people, in which one of the project members was involved (Tiilikainen et al., 2024). Early-life circumstances were found to be associated with loneliness trajectories in later life. Adversities experienced in childhood and youth increased the chances of loneliness in older adults. Support for individuals at risk of long-term and severe loneliness is highly needed for decreasing and/or preventing the negative effects of loneliness on health in old age.

Further emphasizing the relevance of our research findings for policy and practice is our study, which explores how life course transitions and living arrangements can either drive social exclusion or serve as preventative measures. Transition into parenthood is such a transition as it can have effect for social connectedness across the life cycle and into old age. Our study found a negative impact of childlessness on exclusion from social relations which is robust, lingers in time and has a similar bearing on the genders. Given the current upward trends in delayed childbearing and the falling birth-rates in Western countries, interventions aiming to reduce social exclusion should take the effect of childlessness into account (Sauter et al. 2024, in R&R). Single motherhood was found to be associated with later life depressive symptoms in many European countries. Exclusion from sufficient financial resources and not having a partner were the mechanisms linking adverse mental health symptoms to single motherhood (Wörn et al. 2024, submitted).

The scientific output of the project is beyond what was promised in the project proposal: 14 articles finalized (6 articles published; 8 articles submitted or in R&R) (in comparison to 6 planned); 2 book chapters published (extra); 1 descriptive report published online (extra); 25 presentations in conferences (in comparison to 6 planned); 4 policy briefs published on the website; 5 joint applications submitted (in comparison to one planned), one funded application; PhD Thesis defended and title awarded with the highest qualification in March 2024. Scientific dissemination further included: organization of an international conference, two sessions and one colloquium in international conferences, four in-person consortium meetings, one international workshop on advanced statistical methods for early career researchers, one international workshop on social exclusion.

Our results pertain in addition to the scientific community, to national and European stakeholders, among which older age people, policy makers, NGOs, Roma, the general public, local authorities, civil society organisations, and service providers. The project contributed to reduced social and/or economic disparities through new scientific knowledge on social exclusion in later life, a socially corrosive phenomenon that can generate further social and health inequalities in societies. Our research provided a better understanding of the patterns of social exclusion in later life in European countries; vulnerability in specific social groups; the consequences of social exclusion for health; the role of state provisions in preventing and reducing social exclusion; the lived experience of social exclusion; the general mechanisms that construct social exclusion and create health inequalities. Insights into these patterns and mechanisms are valuable not only for Romania but also for Norway and other European countries where substantial social and health inequalities continue to exist.

The AMASE A multidimensional approach to social exclusion in later life – health consequences for ageing populations project has received funding from Norway Grants 2014 –2021