Health, Economic and Social Aspects of Ageing

Dr Virpi TimonenSchool of Social Work and Social Policy

Trinity College Dublin

Guest Lecture at the Royal College of Surgeons in Ireland19 December 2008

Key characteristics of ‘ageing’ as a research / study topic

� It is complex!

� Multi- / inter-disciplinary� Relatively new area of research, hence

much description, defining, conceptualising

� Tendency to problematise (aspects of) ageing, hence search for ‘solutions’ – and somewhat less for theories

Factors Influencing the Experience of Ageing

HappinessHappiness

HealthHealth WealthWealth

Quality of Life Quality of Life

Social networks (families), Social networks (families), leisure, care, housing, moraleleisure, care, housing, morale

ContributionsContributions mademadeby older peopleby older people

PhysicalPhysicalMental Mental

EnvironmentEnvironment

ExpectationsExpectations Experience,Experience,Life CourseLife Course

Work, PensionsGenesGenes

Key challenges

(1) How can one understand something as complex as ‘ageing’?

(2) Understanding ‘structure’ and ‘agency’: role of ‘actors’ vs. ‘the stage’

(3) Understanding ‘micro’ and ‘macro’ levels: how do individuals change & how do societies / policies change

Understanding ageing-related phenomena

The importance of the temporal aspect:

� Antecedents: Who? Why? � Processes: What? How?� Consequences: What? Why? How?

But: expense and demands of longitudinal studies

‘Tenets of gerontological imagination’(Ferraro 2006)� Ageing is not a cause of all age-related phenomena� Ageing involves biological, psychological and social

changes in individuals at varying rates� The imprint of genetics on development and ageing is

substantial� Age is positively associated with heterogeneity in a

population� Ageing is a life-long process and using a life-course

perspective helps advance the scientific study of ageing� Disadvantage accumulates over the life course� There is a propensity toward ageism in modern societies

The increasingly rectangular survival curve

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Global population will change markedly over the next 25 years

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Contents

Summary: findings and policy considerations

Selected demographic information

Burden of disease

Self-reported health

Health system

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Gait speed by wealth (ELSA)

% with severe pain in two or more of back, hip, knee or foot, by sex, age & wealth (ELSA)

Angina symptoms by age & wealth, men (ELSA)

% with personal computer, by age and wealth (ELSA)

Feel isolated from other people by age & wealth (ELSA)

Survival by marital status, males (ELSA)

Survival by alcohol consumption, females (ELSA)

Health by education, SHARE - Irl

Life satisfaction by education (SHARE- Irl)

Need for care by age and sex (SHARE – Irl)

Pattern of Multiple Deprivation by Age Group

Source: Whelan, C. and Maître, B. (2008) ESRI Life Cycle & Social Exclusion Seminar

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101214161820

children-aged 0-17

Young adults-18-29

younger to earlymiddle age

adults-30-49

Later middle ageadults-50-64

Older people-65+

%

Multiply Deprived on at least two dimensions including healthMultiply deprived on at least two dimensions including basic and consumptionMultiply Deprived on at least two dimensions including housing or neighbourhood environment

At Risk of Poverty by Life Cycle Stage & HRP Educational Qualifications

Source: Whelan, C. and Maître, B. (2008) ESRI Life Cycle & Social Exclusion Seminar

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10

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Children Living withothers WA

Living togetherwith partner WA

Lone parent withchildren

Living togetherwith partner with

children

Living alone WA Older people

%

Inter level Leaving toTertiary level No qualifications

Percentage of respondents who reported having 3 or more close people they could count on if they had serious personal problems, by age, gender and social class, SLAN III

Understanding the Pathways from ‘Social’ to Health (and vice versa)Social – health

Social Engagement

• Social network• Social integration• Social support•Relationship quality

Health Outcomes

Physical Disease:• Disability•Osteoarthritis•CVD•Respiratory Disease

Psychiatric Disease:•Cognitive decline: Dementia, Alzheimer's Disease•Depression

Mortality

Survival after adverse health events

Pathways

Psychological processes:

• Loneliness• Anxiety• Hostility• Perceived stress• Depression• Positive affect

Behavioral processes:

• Smoking• Alcohol• Exercise• Sleep• Nutrition

BiomarkersStress hormones: Cortisol,, Adrenaline

Inflammatory markers: IL-6, CRP, Fibrinogen

Cardiovascular: General: BMI, WHRBlood pressureHeart rate variabilityPulse wave velocityBiomarkers: HbA1c, LipoA, Fasting lipids, Homocysteine

Socio-demographicCharacteristics

What is ‘successful ageing’?

‘Minimization of losses that occur as a result of a reduction in physical, cognitive and social reserves and a maximization of gains that result through adaptation, mastery and the use of wisdom.’

Baltes & Baltes, 1990

Ageing as Adaptation (1)� Process of adaptation at both individual

and societal levels� But some face greater challenges than

others! Those same individuals less well equipped to deal with these challenges

� In most countries, adaptation expected to happen primarily at the level of individuals / families

Ageing as Adaptation (2)� Locus of adaptation in all systems has

been gradually shifting towards older people themselves

� The ‘problem’ becomes the ‘solution’ (at a high cost to some groups)

� Increasing focus on ‘opportunities’ & ‘freedoms’ → apparent / real decline in ageism; age resistance / denial

To conclude…Points for discussion…

� Plentiful evidence of links between health, economic & social aspects of life in older age

� But ‘pathways’ (the why & the how) poorlyunderstood!

� ‘Good old age’ in fact guaranteed for some, denied to others, at a much younger age?

� What, if anything, should be done?