Older People's Health

120 Pages·2011·2.66 MB·English

by  The Scottish Government

The Scottish Health Survey
Topic
Older People’s Health Report
A National Statistics Publication for Scotland
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Topic
Report
Editors:
1 2
Catherine Bromley and Jennifer Mindell

Principal authors:
2 2 2 2
Damita Abayaratne, Maria Aresu, Wissam Gharib, Vasant Hirani, Henry
2 2 2 2 2
Jones, Jennifer Mindell, Marilyn Roth, Nicola Shelton, Faiza Tabassum.

1
Scottish Centre for Social Research, Edinburgh.
2
Department of Epidemiology and Public Health, UCL (University College
London).

© Crown copyright 2011

You may re-use this information (excluding logos and images) free of charge in any
format or medium, under the terms of the Open Government Licence. To view this
licence, visit http://www.nationalarchives.gov.uk/doc/open-government-licence/
or e-mail:
CONTENTS

Editors’ Acknowledgements 4
Introduction 5
Notes to Tables 11

Chapter 1: General and Mental Health 12
1.1 Introduction 13
1.1.1 The health of older people 13
1.1.2 Factors affecting general and mental health 13
1.1.3 Policy 14
1.2 Methods 14
1.2.1 General Health 14
1.2.2 Mental Health 14
1.3 Results 14
1.3.1 Self–assessed General Health 14
1.3.2 Long-term conditions 16
1.3.3 GHQ12 scores 17
1.3.4 WEMWBS mean score 18

Chapter 2: Lifestyle Behaviours 30
2.1 Introduction 31
2.1.1 Alcohol 31
2.1.2 Smoking 32
2.1.3 Diet 32
2.1.4 Physical activity 33
2.2 Results 34
2.2.1 Alcohol 34
2.2.2 Smoking 36
2.2.3 Diet 37
2.2.4 Physical activity 37

Chapter 3: Obesity 53
3.1 Introduction 53
3.2 Results 55
3.2.1 Response to anthropometric measurements by age and sex 55
3.2.2 Prevalence of overweight and obesity by age and sex 56
3.2.3 Prevalence of raised waist-hip ratio (WHR) and waist
circumference (WC) 57
3.2.4 Health risk category with overweight, obesity and waist
circumference 58

Chapter 4: Cardiovascular Disease, Diabetes and Hypertension 69
4.1 Introduction 69
4.2 Results 71
4.2.1 Cardiovascular disease 71
4.2.2 Diabetes 71
4.2.3 Hypertension 74
4.2.4 Factors associated with having cardiovascular disease 74

Chapter 5: Health and Social Care 83
5.1 Introduction 83
5.1.1 Care provision 83
5.1.2 Health-seeking behaviour 84
5.2 Results 84
5.2.1 Provision of care 84
5.2.2 Health-seeking behaviour 85

Chapter 6: Discussion 94
6.1 Introduction 94
6.2 Self-rated physical health 94
6.3 Mental health 95
6.4 Lifestyles and disease risk factors 96
6.5 Disease 97
6.6 Healthcare 98
6.6.1 Health-seeking behaviour 98
6.6.2 Detection and treatment of disease in older people 99
6.7 Provision of care 99
6.8 Ageing well 100

Appendix A: Glossary 104
EDITORS’ ACKNOWLEDGEMENTS

Our first thank you is to the 22,991 adults who gave up their time voluntarily to take
part in the 2008, 2009 and 2010 surveys and welcomed our interviewers and nurses
into their homes.

We would also like to thank those colleagues who contributed to the survey and this
report. In particular we would like to thank:

• All the interviewers and nurses who worked on the project. We owe a
huge debt of gratitude for the dedication and professionalism they
applied to their work.
• The authors of the chapters: Damita Abayaratne, Maria Aresu, Wissam
Gharib, Vasant Hirani, Henry Jones, Jennifer Mindell, Marilyn Roth,
Nicola Shelton and Faiza Tabassum.
• Joan Corbett, whose hard work and expertise has been crucial in
preparing the survey data.
• Other research colleagues, in particular: Lesley Birse, Shanna Dowling
and Helen Graham (ScotCen); and Barbara Carter-Szatynska (UCL).

Finally, special thanks are due to Julie Ramsay and her colleagues in the Scottish
Government Health Directorates, for support at all stages of the project.

Catherine Bromley and Jennifer Mindell
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INTRODUCTION
Jennifer Mindell
Worldwide, the number of older people is increasing both in absolute numbers
and as a proportion of the total population in both more and less developed
countries. As with worldwide demographic trends, the number of older people in
Scotland is rising rapidly. In the last hundred years Scotland’s life expectancy
has doubled; increasing from 40 years in 1900 to 74 in men and 79 in women in
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2004. By 2009, it had increased further, to 76.0 years in men and 80.6 years in
women (Figure 1), but this remains low compared with most countries in
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Western Europe.

The number of Scottish residents of pensionable age is projected to rise by
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around 26% between 2010 and 2035. The number of people aged 75 and over
is projected to rise by around 23% in the 2010-2020 period, followed by a more
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rapid rise up to 2035, resulting in an 82% increase between 2010 and 2035.
Three groups have been described: the ‘ young old’ (aged 65-74), the ‘ old’ (aged
75-84), and the ‘ oldest old’ (aged 85+ ). Previous analyses of projected life
expectancy identified the 85+ age group as the group that is proportionately the
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fastest growing.

Figure 1 Lif e ex pectancy ( LE) and healthy lif e ex pectancy ( HLE) at
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b irth, Scotland, 1 9 8 0 - 2 0 0 9

Figure 1 shows that not only life expectancy but also healthy life expectancy
has been rising in Scotland. Although women spend more years in poor health,
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in 2009, healthy life expectancy was 60.0 years for men and 62.2 years for
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women. The method used for calculating healthy life expectancy was changed
recently, following the development of a joint World Health Organisation and
European Union recommendation on the measurement of self-assessed health
to provide consistency across European countries. However, this change in
method prevents comparisons with the previous trend. These new figures are
over 8 years lower than previous estimates, both of which are shown in Figure
1. The new method has also been used to estimate HLE in some previous
years, showing that HLE estimated by the new method has been increasing
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with a similar trend to the previous HLE measure.

Figure 2 Healthy Life Expectancy at Birth in Scottish Index of Multiple
Deprivation 15% most deprived areas and the whole of
Scotland, 1999-2000 to 2007-2008

Figure 2 illustrates the substantial socially-patterned inequalities in health in
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Scotland. Older people have lower incomes: 56% of participants aged 65 and
over in the Scottish Health surveys 2008, 2009 and 2010 combined had
household incomes in the bottom two quintiles, compared with 32% of adults
aged 16-64 years. However, the proportion of older people living in the 15%
most deprived areas of Scotland was lower than for younger adults (Table A).
This is almost certainly because of the lower life expectancy among the more
deprived groups.

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Table A Socio-economic status of participants in the Scottish Health
Surveys, 2008, 2009 and 2010 combined, by age

Age-group Proportion living in the 15% Proportion in the lowest two
(years) most deprived areas (%) quintiles of income (%)
16-44 16 33
45-64 14 30
65-74 13 53
75+ 11 60

For those who have reached 65 years of age, life expectancy in 2008-10 was a
further 16.6 years in men and 19.2 years in women, i.e. the average age at
death for people who have reached 65 years would be 81 years for men and 84
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years for women.

The dependency ratio (the ratio of the population younger and older than
working age to the working age population) is changing less, but there is
concern about the financial implications of the growing numbers of older people.
If age-specific disease rates remain unchanged, the numbers of people
requiring health and social care will rise exponentially. Age-specific mortality
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rates have been falling. The increase in healthy life years suggests that age-
specific disease rates are falling, with many more older people living healthy
lives into their 80s and beyond. For example, non-smokers not only have higher
life expectancy than smokers but also spend less time in ill-health –
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‘compression of morbidity’, a concept first described in 1980. This
compression of morbidity has also been described as compression of
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disability.

The Scottish Government is working to enable older people to live healthy,
active and independent lives. It works with the UK Government to tackle
pensioner poverty and providing security and dignity for older people is central
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to its social justice agenda. A long-term strategy, setting out the Scottish
Government’s vision for older people, was published in 2007, addressing the
issues of an ageing population and outlining the opportunities for and choices
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available to older people. In April 2011, a consultation was launched about
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reshaping care for older people.

Allied to the long-term strategy for older people, there is a strong focus on
improving health within the Scottish Government’s National Performance
Framework (2007). It aims to “Help people…sustain and improve their health,
especially in disadvantaged communities, ensuring better, local and faster
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access to health care”. This aim is assessed against national outcomes
including whether the population are living “longer, healthier lives” and whether
the “significant inequalities in Scottish society” have been tackled.

This report examines the current health status of people aged 65 and over in
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Scotland. It uses data from the Scottish Health Surveys (SHeS) of 2008,
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2009 and 2010 combined to enable analysis by smaller age-groups than the
main annual reports. The SHeS design now enables this kind of report to be
produced, so that the health and circumstances of older people in Scotland can
be explored in detail, rather than always treating the over 65s or over 75s as a
homogenous group.

It considers self-assessed health, mental health and well-being, cardiovascular
disease, the main lifestyle risk factors for cardiovascular disease and cancers,
and health-seeking behaviour. Comparisons are made between different age-
groups among older people as well as between older people and those aged
16-64 years.

Given the acknowledged importance of the social determinants of health in
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Scotland and elsewhere, key aspects of health are also examined in relation
to household income, area deprivation, and other measures of socio-economic
position (these measures are described in the Glossary). This report does not
examine trends over time, as earlier surveys have not included sufficient
numbers of older people to do so.

The Scottish Health Surveys are a series of health examination surveys of a
nationally representative sample of the household population of all ages living in
private homes in Scotland. This report therefore excludes people living in
communal establishments. For details of the survey methods, including sample
selection and data collection, and results for the general population, readers
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should consult the three most recent annual reports. In this report,
descriptions of the results refer to the figures for men and women separately
where these differ, and to all adults where they do not.

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