Geen diatitel

1
The health of older women across Europe
Dorly J.H. Deeg, C. Bardage, T. Blumstein, M.
Jylhä, M. Noale, S.M.F. Pluijm, V.
Zunzunegui .for the CLESA working group
2
Well-known paradox

• Women live longer than men
• but
• Women have poorer health than men

3
Life expectancy at age 75 years by country and sex
Source Minicuci 2004
4
Disability-free life expectancy at age 75 years
by country and sex
Source Minicuci 2004
5
Life expectancy at age 65, disease groups

Source Longitudinal Aging Study Amsterdam
(Portrait 2000)
6
The oldest person in the world lives in the
Netherlands
Hendrikje Van Andel, 114 years
7
Why these gender differences?

• Biological differences genetic (X and Y),
  hormonal (estrogens)
• Risks during the life course (labour, smoking)
• Use of health care services
• Coping with disease (disease behaviour)
• Reporting behaviour

Source Verbrugge 1990
8
Any role for culture? Cross-national comparison
of health

• 1) Cross-national differences in levels
• ? Where can gains be obtained?
• 2) Cross-national differences in associations
  with potential determinants
• ? Achieve gains by improving levels of
• determinants

9
CLESAComparison of Longitudinal European Studies
on Aging (CLESA study)
n2021
n729
n596
n3475
n1199
n1277
Sample 50 men and women ages 65-89 yrs
10
Approach

• 1) Existing longitudinal studies of ageing, from
  ca. 1990
• 2) Post-harmonisation of measures and scores
• ? Optimal comparability across countries

11
Functional status physical and mental health
Disablement process
Global disability Usual daily activities

• IADL disability
• Instrumental activities of daily living

Depressed mood Cognitive ability
ADL disability Self-care activities of daily
living
Self-rated health
12
Measures of functional status

• Physical functioning
• 1) Global disability (1 item, 3 countries)
• 2) IADL-disability (3 items, all countries)
• 3) ADL disability (4 items, all countries)
• Mental functioning
• 4) Depressed mood (scale, all countries)
• 5) Cognitive ability (test, 5 countries)
• 6) Self-rated health (1 item, 5 countries)

13
Prevalence of global1 disability by country and
sex, ages 75-84 years


1 limited in usual activities for health reason
gender difference significant p lt 0.05
14
Prevalence of IADL1 disability by country and
sex, ages 75-84 years


1 cooking, housework, shopping gender
difference significant p lt 0.05
15
(No Transcript)
16
Prevalence of ADL1 disability by country and
sex, ages 75-84 years




1 bathing, dressing, transferring, toileting
gender difference significant p lt 0.05
17
Mean depressive symptom score1 by country and
sex, ages 75-84 years



1 range 0.0-1.0 gender difference significant
p lt 0.05
18
Mean cognitive ability score1 by country and
sex, ages 75-84 years



1 range 0.0-1.0 gender difference significant
p lt 0.05
19
Prevalence of fair/poor self-rated health by
country and sex, ages 75-84 years



gender difference significant p lt 0.05
20
Conclusions (1)

• Prevalence varies widely among countries
• part artifact, part genuine
• ? Room for improvement
• Women have more ADL disability, more depressed
  mood, and poorer self-rated health than men
• For IADL disability and cognitive ability, mixed
  gender differences

21
Women only explaining cross-country differences

• Socio-demographic characteristics
• Physical conditions
• Life-style factors
• Social factors

Cross-sectional associations
IADL-disability ADL disability Cognitive
ability Depressive symptoms Self-rated health
Sample Non-institutionalised Ages 65-89
22
Potential determinants

• 1) Socio-demographic characteristics
• age, sex, education, life-time occupation
• 2) Physical conditions
• number of chronic diseases, medication use
• 3) Life-style factors (5 / all countries)
• exercise / smoking, drinking
• 4) Social factors (4 countries)
• living arrangements, religious activity,
  proximity of children

23
(No Transcript)
24
Cross-national differences in IADL disability
(age-adjusted ORs)






Reference country (OR1.0) plt0.05
25
Cross-national differences in IADL disability
(adjusted ORs)
n.s.
n.s.

Reference country (OR1.0) n.s. plt0.05
26
Cross-national differences in ADL disability
(age-adjusted ORs)





Reference country (OR1.0) plt0.05
27
Cross-national differences in ADL disability
(adjusted ORs)
n.s.

Reference country (OR1.0) n.s. pgt0.05
28
Cross-national differences in depressed mood
(age-adjusted ORs)






Reference country (OR1.0) plt0.05
29
Cross-national differences in depressed mood
(adjusted ORs)

Reference country (OR1.0) all plt0.05
30
Cross-national differences in cognitive ability
(age-adjusted ORs)





Reference country (OR1.0) plt0.05
31
Cross-national differences in cognitive ability
(adjusted ORs)
n.s.
n.s.

Reference country (OR1.0) n.s. plt0.05
32
Cross-national differences in self-rated health
(age-adjusted ORs)





Reference country (OR1.0) plt0.05
33
Cross-national differences in self-rated health
(adjusted ORs)

Reference country (OR1.0) all plt0.05
34
Conclusions (2)

• IADL ADL Dep Cog SRH
• SES x x x x
• Ph H x x
• Li St x x x x
• Soc x
• x Partly explains functional status measure

35
Conclusions (3)

• Life style and social factors can be influenced,
  e.g. by preventative interventions
• The health and functional status of older women
  across Europe can be improved by country-specific
  interventions

36
(No Transcript)