The Scottish Health Survey Topic Older People’s Health Report A National Statistics Publication for Scotland 0MEFS1FoQMFhs)FBMUI 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 4 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 1 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 2 Western Europe. The number of Scottish residents of pensionable age is projected to rise by 3 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 3 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 4 fastest growing. Figure 1 Lif e ex pectancy ( LE) and healthy lif e ex pectancy ( HLE) at 5 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, 5 in 2009, healthy life expectancy was 60.0 years for men and 62.2 years for 5 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 6 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 2 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. 6 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 7 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 8 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 – 9 10 ‘compression of morbidity’, a concept first described in 1980. This compression of morbidity has also been described as compression of 11 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 12 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 1 available to older people. In April 2011, a consultation was launched about 13 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 14 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 15 Scotland. It uses data from the Scottish Health Surveys (SHeS) of 2008, 7 16 17 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 18,19 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 15,16,17 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. 8