Women’s health: insights from the past illuminating the future
This week I attended a presentation by Professor Julie Byles at an event organised by the International Longevity Centre, UK and kindly hosted by Mercer, a world leader in the health and benefits marketplace. Amongst her many titles Professor Byles is the Global Innovation Chair in Responsive Transitions in Health and Ageing and a Director of the Australian Longitudinal Study on Women’s Health School of Medicine and Public Health, The University of Newcastle, Australia.
As a clinical epidemiologist, Professor Byles’ interests are in risk determination, health assessment, health care use, measurement of health outcomes, and other health care evaluation. But to put it more simply, when it comes to ageing and Australian women, she is the global expert. Hence the title of her presentation: Women’s health over the life-course and across the generations – Lessons from Australia
Healthy ageing, as pointed out by Professor Byles, depends on many factors, starting in early life and continuing to the last breath. Accordingly, the impact of ageing on society depends not only on the health of people who are older now, but also on the health and lifestyle choices of younger generations. Understanding the future of ageing therefore requires knowledge of life-course factors that contribute to health in older age, and of the cohort changes that will shape health and health care needs of older people in the future.
The Australian Longitudinal Study on Women’s Health (ALSWH) provides an opportunity to examine these life-course and cohort effects.
- Since 1996, the study has followed three cohorts of women born 1921-26, 1946-51, 1973-78
- This has provided valuable information on changes in these women’s health as they age through their 20’s and 30’s, 40’s and 50’s, 70’s and 80’s and now into their 90’s
- Some 10% of the women from the oldest cohort (now aged in their late 90’s) still complete six-monthly surveys on their wellbeing, and with ongoing linkage to data on health and aged care service use.
In 2013, the study added a new cohort of over 17000 women born 1989-95, providing insights into the health of a whole new generation. Comparisons across cohorts provide some extraordinary insights, showing hope for greater workforce participation into later life, balancing work and caregiving, and healthy ageing. However, the study also identifies large sub-groups with poor health behaviours, high levels of illness and disability, and growing needs for health care. These findings underscore the need to increase efforts to promote health across the life-course, and to prevent chronic disease and its consequences.
Insights from the most senior cohort
Professor Byles’ focus was on the most senior cohorts and some of the lessons learned, but first she expanded on the best a way of evaluating ageing, explaining the difference between the concepts of successful ageing versus healthy ageing.
- Successful ageing sets the bar high – no disabilities, no disease, engagement with life and no cognitive problems. Yet the reality of the survey – and the reality of ageing – seemed to confirm that a better evaluation was a concept determined by WHO – Healthy ageing.
- Healthy ageing may be summed up as the ‘functional ability to do the things you choose to do and the ability to do so.’ Because the reality of ageing is that it is a fight against the ageing process, and as Professor Byles confirmed, one of the most important lessons learned from the women’s reports was not to surrender too easily any ability; use it, fight to keep it – or lose it.
Big takeaways from the presentation
- Ageing is all about multiple morbidity: in the case of the oldest cohort survivors, 17% have diabetes, 70% arthritis, 17% asthma, 40% heart disease, 70% hypertension and 12% stroke. 29% suffer from dementia.
- The healthier you are as you age, specifically the higher your level of physical function, the slower your rate of decline. The top cohort in the study declined at a rate of only 42% in comparison to the second cohort.
- The importance of exercise – the highest cohort was 96% less likely to have poor physical function
- The dangers of poor weight management – being overweight made it 5 times more likely to have poor physical function. Being obese made it a shocking 26 times more likely.
- For those of ‘normal weight’ (using the BMI scale) average total life expectancy was 15.75 years, with a healthy life expectancy of 10.63 years
- For those ‘underweight’ (using the BMI scale) average total life expectancy was 12.37 years, with a healthy life expectancy of 8.17 years
- For those ‘overweight’ (using the BMI scale) average total life expectancy was 15.94 years, with a healthy life expectancy of 9.84 years
- For those ‘obese’ (using the BMI scale) average total life expectancy was 14.66 years, with the lowest healthy life expectancy of 8.08 years – and the longest period of ill-health.
- Those enjoying good health were more positive and remained more active, enjoying pastimes such as dancing, gardening and volunteer work, with high life satisfaction, belief in themselves and pride in their achievements.
- Those in poor health tended to be more pessimistic and were more passive in their activities, with reading featuring highly; while not discontented they did display feelings of being pathetic.
- One group clearly could be described as ‘can-do’, remaining optimistic and social, while the other glass half empty group tended to be more negative and showed more signs of retreating from life, even wishing for death.
As to what the future holds…
This was the most disturbing part of the presentation. As the babies of over twenty years ago have grown into young women and form the new cohort in the study, some clear comparisons can be made and predictions about the future. This generation, while smoking less are heavier and suffer more chronic disease. This in turn points to more diabetes, more heart disease, more arthritis, more asthma, more health care in twenty years’ time. The sooner we all start to regularly take a quality of life fitness checklist the better, while the need for preventative wellness programmes is more urgent than ever!
It seems to me a healthy lifestyle = smarter ageing – and it’s never too early, or too late to begin.
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