Gender and healthy ageing in Britain Emily Grundy, LSHTM, UK. GeNET Seminar October 2005.

Gender and healthy ageing in Gender and healthy ageing in BritainBritain

Emily Grundy, LSHTM, UK.Emily Grundy, LSHTM, UK.

GeNET Seminar October GeNET Seminar October 2005 2005

Topics coveredTopics covered

Mortality - changing trendsMortality - changing trends

Morbidity and disability, including causes of disabilityMorbidity and disability, including causes of disability

Gender, socio-demographic circumstances and healthGender, socio-demographic circumstances and health

Gender and living arrangementsGender and living arrangements

Gender and intergenerational supportGender and intergenerational support

Gender and IADL performance - changes over timeGender and IADL performance - changes over time

Sex Ratio (Males per 100 Females), England & Wales 2001, 2011 & 2021

0 20 40 60 80 100 120

65-69

70-74

75-79

80-84

85-89

90-94

95-99

100 & over

Ag

e g

rou

p

202120112001

Female life expectancy at birth and difference between female and male life expectancy at birth, selected European countries

1995-2000

-20

0

20

40

60

80

100

Fem

ale

e0 a

nd m

-f e

0

female e0male-female e0

Trends in further life expectancy at age Trends in further life expectancy at age 65, England & Wales, 1901 to 199565, England & Wales, 1901 to 1995

0

5

10

15

20

Male Female

Yea

rs

1900/1

1950/1

1970/1

1995

Female advantage in life expectancy at various ages, England and Wales 1960-2021

0

1

2

3

4

5

6

7

Year

Ye

ars

Age 0

Age 65

Age 80

Sex ratio of death rates from neoplasms by age group, England and Wales, 1911-15 to

1999

0

0.5

1

1.5

2

2.5

1911-15 1931-35 1951-55 1971-75 1987-91 1999

Rat

io M

/F d

eath

rat

es 55-59

60-64

65-69

70-74

75-79

80+

Survivorship (%) to age 80 by year of Survivorship (%) to age 80 by year of birth, England and Walesbirth, England and Wales

Year of birth Men Women

1861 10 16

1881 14 25

1901 17 34

1911 23 41

1921 29 47

Source: data from Government Actuary’s Dept.

Indicators of health by gender, Britain 2001/2002

Age group (years)

Gender

65-69 70-74 75-79 80-84 85+ 65+

M 19 23 31 33 31 25 Health in general in preceding year ‘not good’

F 17 24 28 32 36 25

M 8 10 12 18 35 12 Reported inability to manage one or more locomotion activities alone1 F 9 16 21 29 50 21

M 3 3 6 7 18 5 Reported inability to usually manage bathing/showering/ washing all over alone (%)

F 3 7 7 14 23 9

M 11 11 10 18 17 12 Psychological morbidity2 (England)

F 15 11 17 15 20 15

M 17 21 25 25 23 21 Taking three or more prescribed medications (England) F 18 20 23 31 30 22

Sources: 2001 General Household Survey; 2002 Health Survey for England

Rate per 1,000 of long standing illness or disability by condition group, England 1993, private household

population aged 65+

Condition group Men Women(ICD chapter, 9threvision)

Prevalence Rank Prevalence Rank

Musculoskeletal

system

264 2 388 1

Heart and circulatory

system

342 1 262 2

Respiratory system 135 3 92 4

Digestive system 86 4 94 3

Endocrine and

metabolic

75 5 79 5

Eye complaints 56 6 63 6

Source: Health Survey for England 1993.

Persons aged 70 and over reporting selected chronic conditions (%),

USA 1995

0

10

20

30

40

50

60

70

80

90

100

Arthritis Hypertension Heart disease Diabetes Respiratorydisease

Stroke Cancer

%

Men

Women

Persons aged 80+ needing daily help, Britain Persons aged 80+ needing daily help, Britain 1996/7 (private household population) 1996/7 (private household population)

% reporting need for daily help with:

Men Women

Practical care 22 27

Day-time personal care

13 18

Night-time personal care

6 10

Source: 1996/7 survey of disability, Grundy et al 1999.

Determinants of health in later lifeDeterminants of health in later life

Life course influences recognized to be Life course influences recognized to be important, but most attention paid to socio-important, but most attention paid to socio-economic (and early life) factorseconomic (and early life) factorsLargely separate literature has shown Largely separate literature has shown differences by socio-demographic factors differences by socio-demographic factors such as marital and household status and such as marital and household status and social supportsocial supportNeed to consider both socio-economic and Need to consider both socio-economic and socio-demographic influences and historysocio-demographic influences and history

Social influences on health & well-being in later lifeSocial influences on health & well-being in later life

Personal capital & resilienceInfluenced by education & life history

Family status & social support Socio-economic resources & status

GenderEnvironmentPolicy

583 619

240

392

2,462

3,160

189

627

2,300

2,072

312 310

1,940

2,661

266

840

0

500

1,000

1,500

2,000

2,500

3,000

3,500

Widowed2001

Never married2001

Married2001

Divorced2001

(00

0s

)

Males

Females

Marital Status of Population aged 65 & over, England and Wales, 2001 &

2021

Men and women aged 85+ by family/household

type, England & Wales, 2001.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Men Women

Pe

rce

nt

Institution

Lives with non relative

Lives with other relative

Lives with a child

Couple+others

Couple only

Solitary

Health Survey for England

• Nationally representative sample of individuals in private households

• Stratified multi-stage random probability design using Postcode Address File as sampling frame.

• Data Collected through

– Interviewer administered questionnaire

– Nurse administered measurements

– Laboratory analysis of blood samples

– Co-operation from 77-81% of eligible households

ONS Retirement SurveyBaseline 1988/9Interviews with a nationally representative sample of

3,543 adults aged 55-69.

Questions on numbers and ages of children, help given to children and help received from children

Follow- up 19942,247 re-interviewed (70% of survivors)

Re-weighting undertaken to adjust for differential loss to follow up.

In this analysis the childless and remarried men excluded (16%).

Socio-demographic characteristics of men and women aged 65-84, England 1993-5

65-74 75-84

Men Women Men Women

% Married 77 55 68 29

% no lack ofsocialsupport

52 62 54 62

% owneroccupiers

72 68 65 58

% Noeducationalquals.

58 71 61 78

% receiveincomesupport

8 13 13 23

N 2694 3271 1213 1951

Prevalence of psychiatric morbidity among elderly people by whether living with a

spouse, others, or alone, Britain 1993-95

0

5

10

15

20

25

30

35

40

45

65-69 70-74 75-79 80-84 85+ 65+

%

lives with spouse lives with others lives alone

Source: Analysis of HSfE data in Grundy 2001

05

1015202530354045

65-69 70-74 75-79 80-84 85+ 65+

Men Women

Health inequalities & differentials

Odds of perceived severe lack of social support by marital Odds of perceived severe lack of social support by marital status and by living arrangement, England 1993-5status and by living arrangement, England 1993-5

MenMen WomenWomen65-7965-79 80+80+ 65-7965-79 80+80+

Never-marriedNever-married 2.8***2.8*** 4.3***4.3*** 2.0***2.0*** 1.61.6

MarriedMarried 1.01.0 1.01.0 1.01.0 1.01.0

Wid/divWid/div 1.5**1.5** 1.01.0 1.01.0 0.90.9

NN 32883288 628628 42184218 12551255

Lives aloneLives alone 1.91.9 1.31.3 1.11.1 1.01.0

Lives with spouseLives with spouse 1.01.0 1.01.0 1.01.0 1.01.0

Lives with othersLives with others 1.51.5 1.41.4 1.11.1 0.70.7

NN 32873287 628628 42054205 12481248

Source: Analysis of HSfE data

Associations between living arrangements and health among people aged 65 and over in private households, England 1993-5

Psychiatric Morbidity (GHQ 4+)

Poor self rated health

Household Type Model 1 Odds Ratio

Model 2 Odds Ratio

Model 1 Odds Ratio

Model 2 Odds Ratio

Men

Lives alone 1.68*** 1.60*** 1.18* 1.07 Lives with spouse

1.00 1.00 1.00 1.00

Lives with others

1.67** 1.47* 1.55** 1.32

N 4124 4108 4199 4103 Women

Lives alone 1.05 1.01 0.99 0.89 Lives with spouse

1.00 1.00 1.00 1.00

Lives with others

1.37** 1.28* 1.19 1.09

N 5744 5724 5728 5709 ***P<.001; **P<.01; *P<.05 Model 1: Controlling for age Model 2: Controlling for age, smoking habit, social class, number of somatic health conditions and year of survey

Associations between receipt of income support (for those on very low incomes) and health, men and women, England 1993-5

Health indicator

Men Women

Does not receive IS

Receives IS Does not receive IS

Receives IS

Reports health as bad or very bad

1.0 2.78** 2.06-3.76

1.0 2.24** 1.76-2.84

Longstanding illness

1.0 1.34* 1.04-1.73

1.0 1.58** 1.32-1.90

2 or more physical complaints

1.0 1.37* 1.06-1.75

1.0 1.40** 1.18-1.66

Psychiatric morbidity (GHQ score)

1.0 1.80** 1.31-2.47

1.0 1.28* 1.04-1.59

Controlling for age, marital status, smoking, education, tenure, height and social support. Source: analysis of HsfE data

Social status and health

• Problems of measurement in older ages, especially for older women: few still in employment; many be educationally relatively homogenous.

• Different sources of status in later life and for women and men?

• Different life course of women and men may mean alternative/additional indicators needed, of demographic as well as work history

Odds ratios (95% confidence intervals) of fair or Odds ratios (95% confidence intervals) of fair or not good health by each of the socio-economic not good health by each of the socio-economic status variables, women 1988/9 (aged 55-69)status variables, women 1988/9 (aged 55-69)

0

1

2

3

4

5

6

7

IIIn

m

IV &

V

o le

vel

no

ne

2n

d

low

est 1

3 o

r m

ore 1

3 o

r m

ore

pri

vate

Od

ds

Ra

tio

Social Class

Educational Attainment

Income QuartileConsumer Durables

Townsend Poverty Indicators

Housing Tenure

Car Access

Analysis of RS data in Grundy & Holt 2001Ref. categories: most advantaged

Odds ratios (95% confidence intervals) of fair or not good health by various socio-economic status variables, men 1988/9

(aged 55-69) (Source Grundy and Holt 2001)

0

2

4

6

8

10

12

14

16

IIIn

m

IIIm

IV &

V

o le

vel

trad

e

none

2nd

3rd

low

est 1 2

3 or

mor

e 1 2

3 or

mor

e

priv

ate

LA

/HA

no a

cces

s

Od

ds R

ati

o

Social Class

Educational Attainment

Income Quartile

Household resources lacked

Townsend Deprivation Indicators

Housing Tenure

Car Access

Proportions with living child(ren) and frequent contact by age and social class, Women,

Britain,1999

Kin availability & family support

Proportions with living child(ren) and frequent contact by age and social

class, Men, Britain,1999

Kin availability & family support

% of non co-resident children with at least weekly face-to-face contact with a parent, by gender of child and parent,

Britain 1999

0

10

20

30

40

50

60

70

80

90

100

22-29 30-39 40-54Age group of child

%

D-M

D-F

S-M

S-F

0

10

20

30

40

50

60

Non Manual Manual Non Manual Manual

Social Class

Pe

rce

nt 1

2

3

4+

MothersFathers

% of parents receiving regular help from a child by Social Class and number of children, Britain 1994

3rd Age adults regularly providing help to/receiving help

from adult children, 1988 & 1994.

Help tochildren

Help fromchildren

Men 1988 1994 1988 1994Married 65 68 30 31Unmarried 34 40 41 47All 62 63 32 33WomenMarried 65 61 30 34Unmarried 55 49 55 62All 57 56 37 44

Demographic factors associated with frequent face to face contact between adult children and their mothers/fathers, Britain

1999

(among children with a living mother/father; controlling for education, proximity, region and housing tenure).

Co-variate Contact withmother

Contact withfather

Daughter (v.son) +++ +++Age (adult child’s) -- NSNo. sibs --- --Has dependent child -- NSCo-parent dead NS (OR=1.2) -- (OR=0.6)

% of elderly people unable to cook a meal on their own, by gender, Britain 1980-94

0

5

10

15

20

25

30

35

40

65-9 70-4 75-9 80-4 85-9

Age group

%

Men 1980

Men 1895

Men 1994

Women 1980

Women 1985

Women 1994

Women v Men: advantages and disadvantages of being a woman when old

• Advantages• Longer life expectancy

• More contact with/support from children

• Stronger social networks

• Better relevant life skills?

• Disadvantages• More disability - higher

prevalence and higher proportion of life

• Less likely to have spouse, more likely to live alone

• Greater risk institutional residence

• Poorer

Conclusions

• Women have fewer material resources in later life, but more social ones. However also greater needs for assistance

• Men’s ‘social disability’ in some IADLs reducing; women’s mortality from ‘men’s diseases’ increasing, but extent of convergence varies between countries and social groups.

• Implications for future cohorts?