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

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

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

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

Indicators of health by gender, Britain 2001/2002 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+

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

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

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

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

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

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

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 Survey Baseline 1988/9 Interviews with a nationally representative sample of 3,543 adults aged Questions on numbers and ages of children, help given to children and help received from children Follow- up ,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

Prevalence of psychiatric morbidity among elderly people by whether living with a spouse, others, or alone, Britain Source: Analysis of HSfE data in Grundy 2001 MenWomen Health inequalities & differentials

Odds of perceived severe lack of social support by marital status and by living arrangement, England MenWomen Never-married2.8***4.3***2.0***1.6 Married Wid/div1.5** N Lives alone Lives with spouse Lives with others N Source: Analysis of HSfE data

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

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

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

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

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

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).

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 Mens social disability in some IADLs reducing; womens mortality from mens diseases increasing, but extent of convergence varies between countries and social groups. Implications for future cohorts?