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Heal h and sel -pe cei ed ba ie s o in e ne use among olde mig an s : a popula ion-
based s udy
© The Au ho (s) 2022
Published e sion
Kou onen, Anne; Kemppainen, Teemu; Taipale, Saka i; Olaki i, An e o; W ede,
Si pa; Kemppainen, Lau a
Kou onen, A., Kemppainen, T., Taipale, S., Olaki i, A., W ede, S., & Kemppainen, L. (2022).
Heal h and sel -pe cei ed ba ie s o in e ne use among olde mig an s : a popula ion-based
s udy. BMC Public Heal h, 22, A icle 574. h ps://doi.o g/10.1186/s12889-022-12874-x
2022
Kou onene al. BMC Public Heal h (2022) 22:574
h ps://doi.o g/10.1186/s12889-022-12874-x
RESEARCH
Heal h andsel -pe cei ed ba ie s oin e ne
use amongolde mig an s: apopula ion-based
s udy
Anne Kou onen1,2*, Teemu Kemppainen3,4, Saka i Taipale5,6, An e o Olaki i1, Si pa W ede1,7 and
Lau a Kemppainen1
Abs ac
Backg ound: In olde adul s, including hose wi h a mig an backg ound, ill heal h is associa ed wi h less in e ne
use. Howe e , i is no known wha a e he speci ic sel -pe cei ed ba ie s o in e ne use among olde mig an s wi h
di e en heal h condi ions. The aim o his s udy was o in es iga e he associa ions be ween di e en heal h condi-
ions and sel -pe cei ed ba ie s o in e ne use among olde mig an s.
Me hods: We used he Ca e, Heal h and Ageing o Russian-speaking Mino i y in Finland (CHARM) s udy, which is
a na ionally ep esen a i e su ey o communi y-dwelling Russian-speaking adul s aged ≥50 yea s li ing in Finland
(N=1082, 57% men, mean age 63.2 yea s, s anda d de ia ion 8.4 yea s, esponse a e 36%). Pos al su ey da a we e
collec ed in 2019. Heal h indica o s we e sel - a ed heal h (SRH), dep essi e symp oms, cogni i e unc ioning, and
doc o -diagnosed condi ions. Linea eg ession analyses we e used o in es iga e he associa ions be ween heal h
indica o s and a summa y scale consis ing o he ollowing ba ie s o in e ne use: (1) in e ne use is oo complica ed
and ha d o lea n; (2) ha ing conce ns abou sa e y issues; (3) in e ne use is oo expensi e; (4) physical limi a ions
hinde he in e ne use; (5) memo y p oblems hinde he in e ne use. In addi ion, he wo mos commonly epo ed
ba ie s ( he i s wo) we e examined sepa a ely using logis ic eg ession analyses. The analyses we e adjus ed o age,
sex, educa ion, ma i al s a us, local language p o iciency, and income suppo , and he heal h condi ions, and we e
pe o med wi h weigh s accoun ing o he su ey design and non- esponse.
Resul s: A e adjus men s, spine/back p oblems (b=0.13; p=0.049), dep essi e symp oms (b=0.40; p=0.007), and
p oblems in lea ning new hings (b=0.60; p<0.0005) we e associa ed wi h highe le el o o e all ba ie s o in e ne
use. In addi ion, a numbe o heal h condi ions we e associa ed wi h indi idual ba ie s, albei some heal h condi ions
appea ed p o ec i e.
Conclusions: In gene al, olde mig an s wi h declining heal h expe ience mo e ba ie s o in e ne use han hei
coun e pa s wi h be e heal h. To p o ide be e access o heal hca e o olde adul s, including olde mig an s,
apidly changing de ices, so wa e and apps need o be modi ied and adap ed o hose wi h speci ic heal h- ela ed
needs.
Keywo ds: Digi al in o ma ion echnology, In e ne use, Olde adul s, Mig an s, Dep ession, Ba ie s o in e ne use,
Cogni i e unc ioning, Ch onic condi ions
© The Au ho (s) 2022. Open Access This a icle is licensed unde a C ea i e Commons A ibu ion 4.0 In e na ional License, which
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Open Access
*Co espondence: [email p o ec ed]
1 Facul y o Social Sciences, Uni e si y o Helsinki, PO Box 54,
00014 Helsinki, Finland
Full lis o au ho in o ma ion is a ailable a he end o he a icle
Page 2 o 12
Kou onene al. BMC Public Heal h (2022) 22:574
Backg ound
In No he n Eu ope, in e ne use has become a pa o
he e e yday li e o he as majo i y o olde adul s.
Acco ding o he S a is ics Finland su ey conduc ed in
2020, 97% o he 55 o 64-yea -olds had used he in e -
ne in he las h ee mon hs. The co esponding igu es
o 65 o 74-yea -olds and 75 o 89-yea -olds we e 88%
and 51%, espec i ely [1]. In echnologically ad anced
coun ies wi h such high connec ion a es, in e ne use
has p ac ically become a necessi y o social inclusion
[2]. Public se ices and e e yday communica ion ha e
inc easingly gone online, which means ha hose who do
no use he in e ne can become excluded no only om
he essen ial heal h and o he public se ices, bu also
om social ne wo ks, and he socie y a la ge. Non-use s
inc easingly consis o he mos ulne able segmen s o
he popula ion: he oldes , he leas educa ed, hose wi h
ill heal h, and hose who a e socially mos isola ed [3]. In
addi ion, some s udies ha e shown ha e hnic mino i-
ies and mig an s use he in e ne less [4–13]. In con em-
po a y socie ies, digi al and social exclusion a e deeply
in e wined. Acco ding o he double jeopa dy hypo h-
esis, olde mig an s a e a a pa icula isk o social exclu-
sion because o hei age and mig a ion backg ound [14].
Olde mig an s wi h a low socio-economic s a us and
heal h p oblems may be especially ulne able: he in e -
sec ing domains o old age, ill heal h, low socio-economic
s a us, and a mig an backg ound ha e been shown o
inc ease he isk o social exclusion [15, 16]. A he same
ime, in ansna ional con ex , and ampli ied by he
COVID-19 pandemic, he abili y o emain connec ed
wi h he iends and amily has become e y s ongly
dependen on using digi al echnologies [17].
When popula ions a e ageing, heal h- ela ed ac o s
a e becoming inc easingly ele an in unde s anding
he “ he digi al di ide” [18], as de e io a ing heal h con-
di ions can hampe he use o digi al echnologies. In
olde adul s, a ious indica o s o ill heal h and disabil-
i y, such as subop imal sel - a ed heal h (SRH) [19–31],
men al ill heal h [23, 32], ch onic condi ions [33], ail y
[34], declining physical pe o mance [20], limi a ions in
physical capaci y [35], ision impai men [35], and cog-
ni i e decline, memo y limi a ions and demen ia [17, 20,
22, 35–40] ha e been associa ed wi h a lowe likelihood
o digi al echnology use. In esea ch, olde people a e
o en conside ed as a homogenous g oup, e en hough
his g oup and hei easons o no using he in e ne
a e inc easingly di e se [41]. Mo eo e , e en hough he
numbe s and p opo ions o mig an s, including olde
mig an s, a e apidly inc easing, in he heal h li e a u e
he mig a ion- ela ed aspec s o he digi al di ide a e
unde explo ed [8], and li le is known abou he posi-
ion o olde mig an s in ela ion o digi al di ide [42].
Mos o he s udies on heal h and in e ne use in olde
adul s ha e concen a ed on majo i y popula ions. I is
no known wha speci ic ba ie s o in e ne use olde
mig an s wi h di e en heal h condi ions expe ience.
I would be impo an o in es iga e, why hose who do
no use he in e ne , do no engage [43]. Fu he mo e,
di e en heal h condi ions may a ec in e ne use [20],
and ba ie s o use di e en ly. In a Taiwanese s udy pub-
lished in 2017, among hose aged 50 and o e , he mos
common easons o non-use we e di icul ies ela ed
o lea ning, which included ac o s such as eeling no
need, eeling unable o oo busy o lea n, no in e es ed,
and no able o use English [44]. In a Swedish s udy om
2020 he mos common easons o being a non-use o
he in e ne included no knowing how o use he in e -
ne and ha ing no need/in e es ; whe eas no possibili y
o b oadband, being oo busy, high cos s and secu i y
issues we e men ioned less o en [22]. In a Sco ish quali-
a i e s udy (2017), lack o ins uc ions and guidance,
lack o knowledge and con idence, heal h- ela ed ac o s
and cos s eme ged as ba ie s o in e ac ing wi h ab-
le compu e s [45]. In addi ion, among olde mig an s,
local language p o iciency has been ound o be he mos
impo an ba ie o he e ec i e u ilisa ion o he in e -
ne o seeking heal h in o ma ion [42].
As a No dic wel a e s a e, Finland has comp ehensi e
social igh s gua an eed by legisla ion, and an ex ensi e
ax- inanced public heal h and social wel a e sec o . O e
he las decade, he Finnish s a e has implemen ed as
digi alisa ion p ojec s in he public sec o . Howe e , li le
a en ion has been paid o he ba ie s ha digi alisa ion
o heal h and social wel a e se ices may c ea e o he ul-
ilmen o social igh s in gene al, and o people a isk o
social exclusion (e.g. olde mig an s), in pa icula .
The aim o his s udy was o in es iga e he asso-
cia ions be ween di e en dimensions o ill heal h and
sel -pe cei ed ba ie s o in e ne use among olde Rus-
sian-speaking mig an s li ing in Finland.
Me hods
Da a
The da a we e d awn om he Ca e, Heal h and Ageing
o Russian-Speaking Mino i y in Finland (CHARM) su -
ey ha was collec ed in 2019 [23]. The a ge popula ion
o he s udy was Russian-speaking communi y-dwell-
ing olde adul s (50 yea s o age o olde ) who pe ma-
nen ly eside in Finland. Russian-speake s a e he la ges
mig an g oup in Finland, making up abou 20% o he
coun y’s mig an popula ion. The s udy was designed
o collec da a on pa icipan s’ heal h and well-being,
public se ice expe iences, digi al inclusion, and access
o di e en ypes o ca e. A andom sample o 3000
people was d awn om he egis e o he Digi al and
Page 3 o 12
Kou onene al. BMC Public Heal h (2022) 22:574
Popula ion Da a Se ices Agency; hei egis e co e s
all pe sons egis e ed as pe manen ly li ing in Finland.
The sample was s a i ied by gende . Response a e was
36% (N=1082; 57% men; mean age 63.2 yea s, s anda d
de ia ion 8.4 yea s). The ques ionnai e was a ailable in
Russian and Finnish. Non- esponse bias was adjus ed o
by weigh ing he su ey esponses. Fo ha , he Finnish
Tax Adminis a ion egis e da a om 2017 we e used
o model he esponse p opensi y [46]. The ax admin-
is a ion da a included in o ma ion on ea nings, capi al
income, unemploymen bene i s, and pensions.
S udy pa icipa ion was olun a y, and he pa ici-
pan s we e in o med o hei igh o wi hd aw a any
ime wi hou any consequences. In o med consen was
ob ained om all pa icipan s. The E hical Re iew Boa d
in he Humani ies and Social and Beha iou al Sciences
a he Uni e si y o Helsinki app o ed he s udy p o ocol
(#6/2019).
Heal h indica o s
All s udy a iables we e sel - epo ed. The pa icipan s
we e asked i hey had e e been diagnosed wi h any o
he ollowing condi ions commonly expe ienced in his
age g oup (yes s no): high blood p essu e / hype en-
sion, spine de e io a ion, scia ica o o he back p oblem,
os eoa h i is o join de e io a ion, heuma oid a h i is
o o he heuma oid disease, dep ession o o he men al
heal h p oblem, as hma, diabe es, memo y diso de (Alz-
heime ’s o o he demen ia), cance , some o he ch onic
disease o heal h p oblem.
Dep essi e symp oms we e measu ed by he eigh -
i em Cen e o Epidemiologic S udies Dep ession Scale
(CES-D )[47], wi h a sco e o nine o mo e poin s indica -
ing dep essi e symp oms [48].
Sel - a ed heal h (SRH) was assessed wi h he ollow-
ing ques ion: “In gene al, would you say you heal h now
is…?” )[49]. Pa icipan s a ed hei heal h on a 5-poin
scale. A dicho omous a iable was c ea ed by ca ego is-
ing he answe s in o good (good o a he good) and sub-
op imal (a e age, ai ly poo and poo ) [50, 51].
Th ee aspec s o cogni i e unc ioning, ha is, sel -
a ed memo y, concen a ion, and lea ning abili y we e
measu ed by h ee i ems assessing he unc ioning o
1) memo y; 2) concen a ion; 3) capabili y o lea n new
in o ma ion and hings; using a i e-poin scale (1= e y
poo ly, 2=poo ly, 3=sa is ac o ily, 4=well, 5= e y well)
[52]. Cogni i e unc ioning a iables we e dicho omised
using 2 as a cu -o poin ( e y poo o poo unc ioning
s o he ).
Sel ‑ epo ed ba ie s oin e ne use
Sel - epo ed ba ie s o in e ne use we e measu ed
wi h he ollowing ques ion: “Some imes, he use o he
in e ne can eel di icul . A e he e some hings ha
hampe you in e ne use? (choose 1-3 mos ele an
op ions)”. Pa icipan s had o choose he ele an op ions
o he ollowing: 1) In e ne use is oo complica ed o
ha d o lea n; (2) I ha e conce ns abou in e ne sa e y
issues; (3) Someone else akes ca e o he ma e s ha
equi e in e ne use o me (“p oxy use”); (4) In e ne use
is oo expensi e; (5) In e ne use is di icul because o my
poo eyesigh o o he physical easons (e.g. s i ness o
inge s); (6) Memo y p oblems hinde my in e ne use; 7)
I am no in e es ed in he con en s o he in e ne ; 8) I
do no ha e ime o in e ne use; 9) I do no ha e hese
kinds o p oblems wi h he in e ne use.
Mul iple co espondence analysis (MCA) was applied
as a dimension educ ion me hod o c ea e a a iable
indica ing o e all ba ie s o in e ne use based on i ems
1, 2, 4, 5, 6 and 9. These six i ems we e selec ed o indica e
he p oblems o in e ne use ele an o he pe spec i e
o ou s udy. I ems 3 (“p oxy use”) and 7 (no in e es ed)
a e no ac ual ba ie s o in e ne use. MCA can be con-
side ed analogous o p incipal componen analysis wi h
he possibili y o using ca ego ical a iables. Simila ly o
o he dimensions educ ion echniques, i p o ides he
ad an age o inc eased eliabili y and con en alidi y in
he ope a ionalisa ion o complex concep s [53]. We pe -
o med MCA using Bu ’s app oach and ex ac ed s and-
a d no malized coo dina es [54–56]. In addi ion o MCA
app oach, he wo mos common ba ie s ( he i s wo)
we e examined sepa a ely as ou comes. Thus, we u ilise
ou ou come a iables in ou analysis.
Co a ia es
Co a ia es included he ollowing socio-demog aphic
cha ac e is ics: sex, age (squa ed), ma i al s a us (ma -
ied o cohabi ing s o he ), educa ional le el in he
coun y o o igin, p o iciency in local languages, and
eceip o means- es ed income suppo bene i (yes s
no) du ing he las 12 mon hs as a measu e o po e y
[57]. The highes educa ional le el in he coun y o o i-
gin was ca ego ised based on he old So ie educa ional
sys em as ha ing no o only basic educa ion; oca ional
aining; highe educa ion. Sel - epo ed local language
p o iciency was assessed on a ou -poin scale, which o
he analysis was dicho omised in o good (“I use Finnish
o Swedish language in a ious ways in di e en si ua-
ions” and “I can pa icipa e on e e yday con e sa ions in
Finnish o Swedish”), and poo (“I can cope wi h simple
e e yday si ua ions in Finnish o Swedish” and “I do no
speak ei he language a all”).
S a is ical analysis
Two nes ed models we e speci ied o explo e he
socio-demog aphic and heal h- ela ed p edic o s o
Page 4 o 12
Kou onene al. BMC Public Heal h (2022) 22:574
sel - epo ed ba ie s o in e ne use. Model 1 included
all socio-demog aphic a iables, while Model 2 u he
adjus ed o all heal h indica o s. The models o MCA-
based ou come a iable we e es ima ed as linea eg es-
sion models, whe eas hose o single-i em ou comes we e
speci ied as logis ic eg ession models. Possible cu ilin-
ea i y ega ding he age a iable was es ed o all ou -
comes adding age squa ed o he models. All models we e
es ima ed accoun ing o esponse-p opensi y adjus ed
sampling weigh s. Mo eo e , clus e - obus a iance es i-
ma ion was used wi h adminis a i e egions as clus e s.
To de ec possible mul icollinea i y, a iance in la ion
ac o s we e examined: he maximum was 1.53, which is
well below 10, he o -used limi o conce n. S a a e sion
15.1 was used o all analyses.
Resul s
Table1 p esen s he cha ac e is ics o he sample and
shows ha he majo i y o he pa icipan s (75%) we e
ma ied o cohabi ing, 50% had acqui ed a highe edu-
ca ion deg ee in hei coun y o o igin, and 38% a ed
hei local language (Finnish o Swedish) skills as good.
As many as 42% o he pa icipan s had ecei ed means-
es ed income suppo o e he las 12 mon hs; his indi-
ca es widesp ead po e y in his g oup as in 2020 he
co esponding igu e o he whole popula ion o Finland
was 7.5%, and o people o e 65 yea s o age i was only
1.8% [58]. Dep essi e symp oms we e commonly expe-
ienced (18%). Rega ding sel - a ed heal h, 60% o he
pa icipan s a ed hei heal h as poo o ai ly poo . Sel -
a ed p oblems wi h memo y, concen a ion o lea ning
we e a e. The p e alence o diagnosed diseases anged
om commonly epo ed high blood p essu e / hype -
ension (48%) o a ely epo ed memo y diso de s (2%).
Abou hal o he pa icipan s epo ed ha hey did no
ha e p oblems wi h he in e ne use. Ele en pe cen
ound in e ne oo complica ed o ha d o lea n, and
almos one qua e we e wo ied abou in e ne sa e y
issues. Cos , poo eyesigh o o he physical p oblems o
memo y p oblems we e only a ely pe cei ed as ba ie s
o in e ne use.
Table1 u he shows bi a ia e associa ions be ween
he p edic o s and ou come a iables. Va ious socio-
demog aphic ac o s we e associa ed wi h he h ee
ou come measu es. Fo example, age was posi i ely
co ela ed wi h he MCA measu e o ba ie s ( =0.30;
p<0.0005) and was associa ed wi h a highe likelihood
o he expe ience ha in e ne is oo complica ed (odds
a io, OR=1.10; p<0.0005). Conce ning heal h indica-
o s, he e we e se e al s a is ically signi ican bi a ia e
associa ions wi h he MCA ou come, and he di icul y
ou come, bu less wi h he hi d, he sa e y ou come. Fo
ins ance, hose who epo ed ha hey ha e a diagnosed
memo y diso de had a 0.78 uni s highe mean in he
MCA ou come (p=0.012) han hose wi hou his diag-
nosis, which equals o 78% o he ou come measu e’s
s anda d de ia ion (SD).
To de e mine whe he heal h condi ions we e associ-
a ed wi h sel - epo ed o e all ba ie s o in e ne use
a e accoun ing o po en ial con ounde s, we eg essed
sel - epo ed ba ie s (MCA ou come) on co a ia es and
he p esence o di e en heal h condi ions. As Table2
shows, ba ie s o in e ne use seemed o inc ease wi h
age (Model 2.1: b=0.04; p<0.0005; Model 2.2: b=0.03;
p<0.0005); he squa ed e m was no s a is ically sig-
ni ican and was hus omi ed o e ain a pa simoni-
ous model. Highe educa ion was associa ed wi h ewe
ba ie s: Model 2.1 shows a s a is ically signi ican
g adien whe e oca ional educa ion adds 0.19 uni s
(p=0.007, while he lowes educa ional le el adds 0.36
uni s (p=0.025) o he MCA ou come (SD=1.00). Wi h
he inclusion o heal h indica o s, hese esul s los some
powe , bu he pa e n was simila . Rega ding heal h
indica o s (Model 2.2), spine/back p oblems (b=0.13;
p=0.049), dep essi e symp oms (b=0.40; p=0.007), and
di icul ies in lea ning new hings (b=0.60; p<0.0005)
we e s a is ically signi ican . In e ms o he s anda d
de ia ion (SD) o he ou come a iable, he e ec sizes
anged om 13% (spine/back) o 60% (di icul ies in
lea ning new hings).
Tables 3 and 4 display he associa ions be ween he
co a ia es, heal h condi ions and he wo mos common
ba ie s o in e ne use. In Models 3.1 and 3.2 (Table3),
age, p o iciency o Finnish/Swedish, and educa ion
appea ed as consis en and s a is ically signi ican p edic-
o s o eeling ha in e ne is oo complica ed and ha d
o lea n. Again, wi h inc easing age, his ba ie became
mo e common (Model 3.2: odds a io, OR=1.10; 95%
con idence in e al (CI): 1.09-1.11); and like abo e, he
squa e e m was no s a is ically signi ican . Mas e ing
well he local languages seemed o lessen he isk o expe-
iencing his ba ie (Model 3.2: OR=0.62; 95% CI: 0.40-
0.95). Finally, he e was a clea educa ional g adien wi h
ORs inc easing om 1.73 ( oca ional educa ion; 95% CI:
1.22-2.46) o 5.36 (lowes le el; 95% CI: 1.91-15.05).
Rega ding heal h indica o s, ha ing os eoa h i is
(OR=1.53; 95% CI: 1.05-2.22 and expe ienced di icul-
ies in lea ning new hings (OR=4.53; 95% CI: 2.22-9.24)
we e associa ed wi h a highe likelihood o epo ing
ha in e ne use is oo complica ed and ha d o lea n.
In con as , i a pa icipan had as hma (OR=0.33; 95%
CI: 0.12-0.87), diabe es (OR=0.63; 95% CI: 0.40-0.99) o
p oblems wi h concen a ion (OR=0.31; 95% CI: 0.10-
0.99), hey we e less likely o epo his pa icula ba ie
o in e ne use.

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Table 1 Cha ac e is ics o he sample and he bi a ia e associa ions be ween p edic o s and ou come a iables
Ba ie s o in e ne use
(MCA) In e ne oo complica ed In e ne sa e y
conce ns
Va iable Coun % Mean p%p%p
Gende 0.786 0.544 0.941
Female 466 43.1 -0.01 11.59 23.82
Male 616 56.9 0.01 10.71 23.86
Age 1082 63.2 (8.4) 0.30 <0.0005 1.10 <0.0005 0.98 0.365
Ma i al s a us 0.013 <0.0005 0.387
Ma ied o cohabi ing 796 74.6 ‑0.05 9.67 25.38
O he 271 25.4 0.14 15.50 20.66
Command o Finnish o Swedish <0.0005 <0.0005 0.023
Poo 634 62.2 0.08 14.04 21.92
Good 385 37.8 ‑0.17 5.45 26.75
Highes educa ion in he coun y o o igin <0.0005 <0.0005 0.502
Highe educa ion 541 50.0 ‑0.12 7.02 23.66
Voca ional educa ion 459 42.4 0.09 13.94 24.62
Gene al/No educa ion/Missing 82 7.6 0.25 21.95 20.73
Income suppo <0.0005 <0.0005 0.020
No 592 58.4 ‑0.12 7.26 27.03
Yes 421 41.6 0.11 15.44 19.95
In e ne p oblems
Use is oo complica ed and i is oo ha d o lea n 120 11.1 . . . . . .
I am conce ned abou in e ne sa e y issues 258 23.8 . . . . . .
Someone else han mysel akes ca e o he ma e s ha equi e
in e ne use
160 14.8 . . . . . .
Use o in e ne is oo expensi e 38 3.5 . . . . . .
Use o in e ne is complica ed by he limi ed eyesigh , hea ing
o o he physical easons
56 5.2 . . . . . .
Memo y p oblems hinde he in e ne use 20 1.9 . . . . . .
I ha e no aced any o such p oblems 563 52.0 . . . . . .
Diagnosed diseases
High blood p essu e, hype ension 515 47.6 0.13 <0.0005 13.79 <0.0005 24.47 0.703
Spine de e io a ion, scia ica o o he back p oblem 344 31.8 0.07 0.095 11.52 0.410 26.45 0.102
Os eoa h i is, join de e io a ion 304 28.1 0.14 0.012 15.46 <0.0005 23.03 0.740
Rheuma oid a h i is o o he heuma oid disease 121 11.2 0.23 0.027 15.70 0.203 25.62 0.151
Dep ession o o he men al heal h p oblems 106 9.8 0.16 0.155 16.04 0.008 19.81 0.301
As hma 72 6.7 0.14 0.144 9.72 0.942 25.00 0.687
Diabe es 144 13.3 0.14 0.226 11.81 0.971 26.39 0.587
Memo y diso de s (Alzheime ’s o demen ia) 19 1.8 0.78 0.012 31.58 0.007 21.05 0.294
Cance 76 7.0 0.12 0.258 10.53 0.999 18.42 0.857
O he ch onic disease o heal h p oblem 374 34.6 0.10 0.081 13.64 0.020 21.39 0.062
Dep essi e symp oms (CES‑D) <0.0005 0.024 0.009
No 772 71.4 ‑0.13 9.46 22.41
Yes 194 17.9 0.39 18.56 30.41
Missing 116 10.7 0.21 9.48 22.41
Sel ‑ a ed heal h <0.0005 <0.0005 0.055
Good o ai ly good 431 40.2 ‑0.29 5.34 21.35
A e age o poo 640 59.8 0.18 14.69 25.47
Memo y: poo o e y poo 64 6.0 0.55 0.006 28.13 0.002 17.19 0.410
Concen a ion: poo o e y poo 27 2.6 0.79 <0.0005 33.33 <0.0005 11.11 0.261
New in o ma ion and lea ning: poo o e y poo 79 7.6 0.82 <0.0005 35.44 <0.0005 24.05 0.976
Foo no e:
S a is ical es s pe o med wi h clus e - obus a iance es ima ion & su ey weigh s
Resul s wi h a p- alue ≤ 0.05 in bold
Cell con en s o age: coun , mean (SD); co ela ion, p; odds a io, OR, p; OR, p
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In e ms o expe iencing in e ne ela ed sa e y con-
ce ns, age had a cu ilinea pa e n wi h he ou come
(Fig.1; Table4): as Fig.1 shows, he p obabili y o such
conce ns inc eases o almos hi y pe cen a 65 yea s,
a e which i s a s o ma kedly dec ease.
In con as o he esul s in Table3, good command o
Finnish/Swedish was associa ed wi h a highe likelihood
ha he pa icipan was conce ned abou he in e ne
sa e y (Model 4.2: OR=1.35; 95% CI: 1.01-1.80). Receip
o income suppo was ela ed o a lowe likelihood o
such conce n (Model 4.2: OR=0.64; 95% CI: 0.47-0.86).
Model 4.2 u he shows ha back p oblems (OR=1.45;
95% CI: 1.03-2.04), dep essi e symp oms (OR=2.13; 95%
CI: 1.11-4.11p=0.024), and p oblems wi h lea ning new
hings (OR=1.86; 95% CI: 1.02-3.40) we e associa ed
wi h a highe likelihood o ha ing conce ns abou in e -
ne sa e y issues, whe eas hose in he e y he e ogenous
ca ego y o “o he diseases” we e less likely o epo his
issue (OR=0.67; 95% CI: 0.48-0.92).
We conduc ed wo obus ness checks: (1) a model
whe e he dep essi e symp oms a iable did no include
a sepa a e ca ego y o missing cases; and (2) an es ima-
ion wi hou su ey weigh s. Conce ning he MCA ou -
come, he esul s o he ollowing a iables we e ound
o be ully obus : age, dep ession symp oms, and lea n-
ing p oblems. Rega ding he expe ience o in e ne being
Table 2 The associa ions o co a ia es and heal h condi ions wi h o e all ba ie s o in e ne use
Foo no es:
Clus e - obus a iance es ima ion. Su ey weigh s accoun ed o
Resul s wi h a p- alue ≤ 0.05 in bold
CI con idence in e al
Model 2.1 Model 2.2
b p 95% CI b p 95% CI
Female -0.03 0.561 -0.13 0.07 -0.09 0.164 -0.21 0.04
Age 0.04 <0.0005 0.02 0.05 0.03 <0.0005 0.02 0.04
Ma ied o cohabi ing -0.10 0.122 -0.23 0.03 -0.08 0.255 -0.21 0.06
Good command o Finnish/Swedish -0.05 0.448 -0.17 0.08 -0.02 0.743 -0.13 0.09
Highes educa ion in he coun y o o igin
Voca ional educa ion 0.19 0.007 0.06 0.32 0.14 0.040 0.01 0.27
Gene al/No educa ion/Missing 0.36 0.025 0.05 0.66 0.32 0.077 -0.04 0.67
Receip o income suppo 0.02 0.710 -0.11 0.16 -0.07 0.360 -0.21 0.08
Diagnosed diseases
High blood p essu e, hype ension . . . . 0.10 0.086 -0.01 0.21
Spine de e io a ion, scia ica o o he back p oblem . . . . 0.13 0.049 0.00 0.26
Os eoa h i is, join de e io a ion . . . . -0.04 0.401 -0.14 0.06
Rheuma oid a h i is o o he heuma oid disease . . . . 0.03 0.754 -0.19 0.26
Dep ession o o he men al heal h p oblems . . . . 0.08 0.603 -0.23 0.39
As hma . . . . -0.17 0.252 -0.47 0.13
Diabe es . . . . -0.03 0.718 -0.22 0.15
Memo y diso de s (Alzheime ’s o demen ia) . . . . 0.40 0.259 -0.32 1.13
Cance . . . . 0.01 0.930 -0.31 0.34
O he ch onic disease o heal h p oblem . . . . -0.09 0.320 -0.26 0.09
Dep essi e symp oms (CES‑D)
Yes .. ..0.40 0.007 0.13 0.67
Missing . . . . 0.28 0.014 0.06 0.49
Sel ‑ a ed heal h: a e age o poo . . . . 0.10 0.175 -0.05 0.25
Memo y: poo o e y poo . . . . -0.16 0.223 -0.44 0.11
Concen a ion: poo o e y poo . . . . -0.10 0.774 -0.80 0.61
New in o ma ion and lea ning: poo o e y poo . . . . 0.60 <0.0005 0.35 0.84
Cons an -2.23 <0.0005 -2.82 -1.64 -2.01 <0.0005 -2.48 -1.54
n 942 908
R squa ed 0.106 0.167
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oo complica ed, he ollowing esul s we e ully obus :
age, educa ion, as hma, and lea ning p oblems. Co e-
spondingly o he las ou come, ully obus esul s we e
ound o age, income suppo and dep essi e symp oms.
(Resul s a e a ailable by eques .)
Discussion
Based on a ep esen a i e su ey among olde Russian-
speaking mig an s in Finland, his s udy in es iga ed he
associa ions be ween di e en heal h condi ions and sel -
epo ed ba ie s o in e ne use.
Ou s udy con i ms ea lie indings ha people do
no ha e jus one simple ba ie o in e ne use [43].
The mos commonly men ioned ba ie s we e ha he
in e ne is oo complica ed o ha d o lea n, and sa e y
conce ns. Howe e , sligh ly o e hal o he pa icipan s
epo ed ha hey did no ha e any p oblems wi h he
in e ne use.
In he p esen s udy, dep essi e symp oms we e consis -
en ly associa ed wi h sel - epo ed ba ie s o in e ne use.
Ea lie s udies ha e shown an associa ion be ween in e -
ne use and dep ession in olde adul s [23, 33, 59–61].
The indings om a sys ema ic e iew indica ed a posi i e
associa ion be ween in e ne use and good men al heal h
and wellbeing among olde adul s [32]. The psychoso-
cial links connec ing in e ne use and men al heal h can
Table 3 The associa ions o co a ia es and heal h condi ions wi h he expe ience ha in e ne is oo complica ed and ha d o lea n
Foo no es:
Clus e - obus a iance es ima ion. Su ey weigh s accoun ed o
Resul s wi h a p- alue ≤ 0.05 in bold
OR odds a io; CI con idence in e al
Model 3.1 Model 3.2
OR p95% CI OR p95% CI
Female 1.27 0.250 0.84 1.92 0.99 0.975 0.60 1.64
Age 1.11 <0.0005 1.10 1.12 1.10 <0.0005 1.09 1.11
Ma ied o cohabi ing 0.85 0.329 0.62 1.17 0.78 0.196 0.54 1.13
Good command o Finnish/Swedish 0.58 0.001 0.42 0.80 0.62 0.027 0.40 0.95
Highes educa ion in he coun y o o igin . . . . . . . .
Voca ional educa ion 1.81 <0.0005 1.44 2.26 1.73 0.002 1.22 2.46
Gene al/No educa ion/Missing 4.04 0.010 1.39 11.75 5.36 0.001 1.91 15.05
Receip o income suppo 1.87 0.069 0.95 3.69 1.58 0.243 0.73 3.38
Diagnosed diseases ... . . . . .
High blood p essu e, hype ension . .. . 1.44 0.158 0.87 2.41
Spine de e io a ion, scia ica o o he back p oblem . .. . 0.66 0.105 0.40 1.09
Os eoa h i is, join de e io a ion . .. . 1.53 0.027 1.05 2.22
Rheuma oid a h i is o o he heuma oid disease . .. . 1.07 0.907 0.34 3.33
Dep ession o o he men al heal h p oblems . .. . 2.03 0.132 0.81 5.13
As hma . .. . 0.33 0.025 0.12 0.87
Diabe es . .. . 0.63 0.047 0.40 0.99
Memo y diso de s (Alzheime ’s o demen ia) . .. . 8.86 0.060 0.91 85.99
Cance . .. . 0.81 0.663 0.31 2.09
O he ch onic disease o heal h p oblem . .. . 1.27 0.472 0.67 2.41
Dep essi e symp oms (CES‑D) ... . . . . .
Yes ... . 1.93 0.074 0.94 3.98
Missing . .. . 0.50 0.070 0.24 1.06
Sel ‑ a ed heal h: a e age o poo . .. . 1.02 0.913 0.70 1.49
Memo y: poo o e y poo . .. . 0.50 0.103 0.21 1.15
Concen a ion: poo o e y poo . .. . 0.31 0.048 0.10 0.99
New in o ma ion and lea ning: poo o e y poo . .. . 4.53 <0.0005 2.22 9.24
Cons an 0.00 <0.0005 0.00 0.00 0.00 <0.0005 0.00 0.00
n 942 908
Pseudo R squa ed 0.187 0.240
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include enhanced in e pe sonal in e ac ions, inc eased
access o esou ces and se ices as well as empowe ed
social inclusion [32]. In e ne use can dec ease loneli-
ness and social isola ion [59], which a e associa ed wi h
dep ession [62]. In pa icula , in e ne use o social pu -
poses has been shown o indi ec ly impac wellbeing ia
educed loneliness and inc eased social engagemen ,
whe eas in e ne use o in o ma ional and ins umen al
(i.e., managing pe sonal adminis a ion and daily ac i i-
ies) pu poses has been shown o impac well-being
h ough engagemen in a wide ange o ac i i ies [63].
In ou s udy, e en hough dep essi e symp oms we e
associa ed wi h mo e ba ie s, diagnosed men al dis-
o de s we e no . I is possible ha in a highly digi al-
ised se ice sys em, some le el o digi al inclusion is
equi ed o be e en able o ob ain a diagnosis. On he
o he hand, since he diagnosis may da e se e al yea s
o e en decades back in ime, cu en sel - epo ed
dep essi e symp oms may be e indica e he cu en
men al heal h s a us o he pa icipan .
In ou s udy, hose who epo ed p oblems in hei
cogni i e unc ioning, mo e speci ically in hei abili y o
Table 4 The associa ions o co a ia es and heal h condi ions wi h ha ing conce ns abou in e ne sa e y
Foo no es:
Clus e - obus a iance es ima ion. Su ey weigh s accoun ed o
Resul s wi h a p- alue ≤ 0.05 in bold
OR odds a io; CI con idence in e al
Model 4.1 Model 4.2
OR p95% CI OR p 95% CI
Female 0.95 0.715 0.75 1.22 0.90 0.441 0.68 1.18
Age 1.54 0.003 1.16 2.05 1.68 0.007 1.15 2.46
Age squa ed 1.00 0.002 0.99 1.00 1.00 0.005 0.99 1.00
Ma ied o cohabi ing 1.08 0.570 0.83 1.39 1.07 0.649 0.80 1.42
Good command o Finnish/Swedish 1.30 0.055 0.99 1.70 1.35 0.045 1.01 1.80
Highes educa ion in he coun y o o igin
Voca ional educa ion 1.13 0.553 0.75 1.71 1.02 0.931 0.63 1.65
Gene al/No educa ion/Missing 1.14 0.643 0.66 1.97 0.98 0.942 0.54 1.76
Receip o income suppo 0.69 0.009 0.52 0.91 0.64 0.004 0.47 0.86
Diagnosed diseases
High blood p essu e, hype ension . .. . 1.02 0.893 0.75 1.40
Spine de e io a ion, scia ica o o he back p oblem . ...1.45 0.032 1.03 2.04
Os eoa h i is, join de e io a ion . .. . 0.81 0.133 0.61 1.07
Rheuma oid a h i is o o he heuma oid disease . .. . 0.98 0.936 0.66 1.46
Dep ession o o he men al heal h p oblems . .. . 0.65 0.273 0.30 1.41
As hma . .. . 0.92 0.809 0.46 1.82
Diabe es . .. . 1.05 0.871 0.56 1.99
Memo y diso de s (Alzheime ’s o demen ia) . .. . 2.37 0.486 0.21 26.78
Cance . .. . 0.82 0.669 0.33 2.04
O he ch onic disease o heal h p oblem . ...0.67 0.015 0.48 0.92
Dep essi e symp oms (CES‑D)
Yes ....2.13 0.024 1.11 4.11
Missing . ...2.33 0.003 1.33 4.06
Sel ‑ a ed heal h: a e age o poo . .. . 1.31 0.147 0.91 1.89
Memo y: poo o e y poo . .. . 0.84 0.556 0.46 1.51
Concen a ion: poo o e y poo . .. . 0.30 0.220 0.04 2.07
New in o ma ion and lea ning: poo o e y poo . ...1.86 0.043 1.02 3.40
Cons an 0.00 <0.0005 0.00 0.00 0.00 0.006 0.00 0.01
n 942 908
Pseudo R squa ed 0.021 0.056