Gender and healthy ageing in Britain

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

2. Topics covered • Mortality - changing trends • Morbidity and disability, including causes of disability • Gender, socio-demographic circumstances and health • Gender and living arrangements • Gender and intergenerational support • Gender and IADL performance - changes over time

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

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

9. Indicators of health by gender, Britain 2001/2002 Sources: 2001 General Household Survey; 2002 Health Survey for England

10. Rate per 1,000 of long standing illness or disability by condition group, England 1993, private household population aged 65+

11. Persons aged 70 and over reporting selected chronic conditions (%), USA 1995

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

13. Determinants of health in later life • Life course influences recognized to be important, but most attention paid to socio-economic (and early life) factors • Largely separate literature has shown differences by socio-demographic factors such as marital and household status and social support • Need to consider both socio-economic and socio-demographic influences and history

14. Social influences on health & well-being in later life Gender Environment Policy

15. Marital Status of Population aged 65 & over, England and Wales, 2001 & 2021

16. Men and women aged 85+ by family/household type, England & Wales, 2001.

17. 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

18. ONS Retirement Survey Baseline 1988/9 Interviews 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 1994 2,247 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%).

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

20. Health inequalities & differentials Prevalence of psychiatric morbidity among elderly people by whether living with a spouse, others, or alone, Britain 1993-95 Men Women Source: Analysis of HSfE data in Grundy 2001

21. Odds of perceived severe lack of social support by marital status and by living arrangement, England 1993-5 Source: Analysis of HSfE data

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

24. 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

25. Odds ratios (95% confidence intervals) of fair or not good health by each of the socio-economic status variables, women 1988/9 (aged 55-69) Ref. categories: most advantaged Analysis of RS data in Grundy & Holt 2001

27. Kin availability & family support Proportions with living child(ren) and frequent contact by age and social class, Women, Britain,1999

28. Kin availability & family support Proportions with living child(ren) and frequent contact by age and social class, Men, Britain,1999

29. % of non co-resident children with at least weekly face-to-face contact with a parent, by gender of child and parent, Britain 1999

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

31. 3rd Age adults regularly providing help to/receiving help from adult children, 1988 & 1994.

32. 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).

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

35. 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?