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Gender Matters: Differences and change in disability and health among our oldest women and men
Stockholm University, Faculty of Social Sciences, Department of Social Work. (Socialgerontologiska forskningsgruppen, Aging Research Center)
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis investigates gender differences in health and how they have changed between 1992 and 2002 among very old people. It explores gender differences in the association between disability and health, and gender differences in care utilization among our oldest old people. The studies are based on nationally representative data of the population in Sweden aged 77 and older (SWEOLD).

 Results from Study I showed that women generally had more health problems than men. Analyses of change between 1992 and 2002 showed increased prevalence rates for both sexes, especially women. However, women’s reporting of poor global self-rated health did not increase. There were no gender differences and there was no change over time in activities of daily living (ADL). Several health indicators seem to be developing differently for women and men.

 Study II showed that associations between ADL disability and other health indicators changed between 1992 and 2002, with several health problems and functional limitations becoming less disabling over time. This trend was especially true for women, while for men, the findings were mixed.

 Study III found no gender differences in physician visits and dental visits, despite women’s worse health and dental status. Marriage was associated with more physician visits for men and dentist visits for women. Results imply that women and unmarried older adults may have unmet health-care needs.

 Study IV examined whether the increase in life expectancy at age 65 observed between 1992 and 2002 consisted of years with or without musculoskeletal pain. Results showed that total years without pain decreased for both women and men, but more so for women. Women also had more years with pain added to life.

 The results of this thesis suggest an increase of health problems, but not disability, in the oldest Swedish population. However, gender variations in the findings highlight the importance of analyzing health trends separately for women and men.

Place, publisher, year, edition, pages
Stockholm: Department of Social Work, Stockholm University , 2011. , 90 p.
Series
Stockholm studies in social work, ISSN 0281-2851 ; 29
Keyword [en]
oldest old, gender differences, health trends, disability, care utilization, healthy life expectancy, Sweden
National Category
Social Work
Research subject
Social Work
Identifiers
URN: urn:nbn:se:su:diva-55282ISBN: 978-91-7447-253-0OAI: oai:DiVA.org:su-55282DiVA: diva2:402241
Public defence
2011-04-08, Aula Svea, Socialhögskolan, Sveaplan, Stockholm, 09:00 (Swedish)
Opponent
Supervisors
Note
At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 2: In press. Paper 3: Manuscript. Paper 4: Submitted.Available from: 2011-03-17 Created: 2011-03-07 Last updated: 2011-03-17Bibliographically approved
List of papers
1. Sex differences in health in 1992 and 2002 among very old Swedes
Open this publication in new window or tab >>Sex differences in health in 1992 and 2002 among very old Swedes
2008 (English)In: Journal of Population Ageing, ISSN 0167-5923, Vol. 1, no 1, 107-123 p.Article in journal (Refereed) Published
Abstract [en]

Background. Despite their longer life spans, women show higher morbidity rates compared to men at all ages. The gender gap in mortality has decreased over the past twenty years, but few studies have examined sex differences in morbidity over time. This study examines sex differences in health and changes in sex differences between 1992 and 2002.

Methods. SWEOLD is a nationally representative interview survey of persons aged 77+. Outcomes include self-reported and objective health indicators.

Results. Women had significantly higher prevalence rates for most health problems. Analyses of change over time showed that women had greater increases in, e.g., hypertension and poor lung function, and men had greater increases in poor self-rated health (SRH) and myocardial infarction (MI). The sex difference decreased significantly for SRH due to men’s increased reporting of poor health and increased for MI due to increased prevalence among men.

Conclusions. Several health indicators seem to be developing differently for men and women. The gender gap has narrowed for poor SRH and widened for MI.

Place, publisher, year, edition, pages
Oxford: Springer, 2008
Keyword
gender differences, elderly population, health trends, morbidity, functioning
National Category
Social Work
Research subject
Social Work
Identifiers
urn:nbn:se:su:diva-55278 (URN)10.1007/s12062-009-9009-1 (DOI)
Available from: 2011-03-07 Created: 2011-03-07 Last updated: 2011-03-16Bibliographically approved
2. Gender differences in associations between ADL and other health indicators in 1992 and 2002
Open this publication in new window or tab >>Gender differences in associations between ADL and other health indicators in 1992 and 2002
2011 (English)In: Aging Clinical and Experimental Research, ISSN 1594-0667, Vol. 23, no 2, 91-98 p.Article in journal (Refereed) Published
Abstract [en]

Background and aims: Research has shown increased prevalence rates over time in several health indicators in the older population. These increases have not been accompanied by corresponding increases in ADL and IADL disability. Given that disability and other health indicators follow different trends, the associations between them may change. Since both health and disability appear to follow different trends for men and women, we can also expect gender differences in the associations. We examined gender differences in how objective tests of function as well as self-reported health and function indicators were associated with ADL/IADL in 1992 and 2002.

Methods: Data were from the Swedish Panel Study of Living Conditions among the Oldest Old (SWEOLD), a nationally representative interview survey of persons aged 77+.

Results: Compared to men, women had significantly higher prevalence rates for most health indicators both survey years, but there were no significant gender differences in ADL/IADL limitations. Prevalence rates increased significantly between 1992 and 2002 for all health indicators, but not for ADL/IADL. Most of the associations between ADL/IADL and other health indicators were stronger for men than for women. The overall pattern was that associations have become weaker for women over time; for men, the picture was mixed.

Conclusions: The changing associations between ADL/IADL and other health indicators may reflect a complex interplay between changes in a range of social and environmental factors, some of which may be modifiable. ADL/IADL appear to reflect different dimensions of health and different kinds of needs for men and women.

Keyword
gender differences, elderly population, disability, health, ADL, IADL
National Category
Social Work
Research subject
Social Work
Identifiers
urn:nbn:se:su:diva-55279 (URN)000292805800003 ()21743288 (PubMedID)
Available from: 2011-03-07 Created: 2011-03-07 Last updated: 2013-10-01Bibliographically approved
3. Gender differences in physician and dental visits among very old persons
Open this publication in new window or tab >>Gender differences in physician and dental visits among very old persons
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objectives. To analyze gender differences in care utilization and correlates to utilization among very old people for visits to physicians and dentists.

Methods. Based on non-institutionalized respondents in SWEOLD, a nationally represen­tative interview survey of persons aged 77+ (n=529).

Results: There were no gender differences in physician visits but men were more likely to have visited the dentist than women. Marriage was positively associated with visits to the physician and the dentist for men. Higher education was positively associated with physician visits for men and with dentist visits for women. Men with impaired mobility were less likely to report physician visits than men without mobility problems.

Discussion: Unmarried men may be at a disadvantage for both dental and physician care. Given women’s poorer physical and dental health status, they may be disadvantaged both regarding visits to physician and dentist.

Keyword
gender differences, health care, dental care, elderly population
National Category
Social Work
Research subject
Social Work
Identifiers
urn:nbn:se:su:diva-55280 (URN)
Available from: 2011-03-07 Created: 2011-03-07 Last updated: 2011-03-16Bibliographically approved
4. The pains of a longer life: Gender differences in life expectancy free from musculoskeletal pain at age 65 in Sweden
Open this publication in new window or tab >>The pains of a longer life: Gender differences in life expectancy free from musculoskeletal pain at age 65 in Sweden
Show others...
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background. Life expectancy (LE) has increased. Health expectancy studies divide LE into life spent in different health conditions.

Objective. To describe the number of years spent with musculoskeletal pain in relation to total LE at age 65 in 1991/1992 and 2000/2002 and to examine the change in the proportion of LE spent free from musculoskeletal pain (pain-free life expectancy, PFLE) among men and women. Do the years added to life consist of years with or without musculoskeletal pain?

Methods. PFLE was calculated using Sullivan’s method by combining prevalence rates of musculoskeletal pain from two nationally representative population-based studies in Sweden (LNU and SWEOLD) from 1991/1992 and 2000/2002 and life tables from Statistics Sweden.

Results. In 1991/1992, both men and women aged 65 could expect to live 12 years free from musculoskeletal pain. However, the proportion of PFLE among men (75%) and women (60%) differed significantly (p = 0.000). Ten years later, both men and women could expect significantly more years with pain. PFLE among women had decreased to 51% (p = 0.059; 10.6 pain-free years, 10.0 years with pain); among men it had decreased to 68% (p = 0.152; 11.7 pain-free years, 5.5 years with pain). 

Conclusions. The estimated proportion of pain-free LE at age 65 decreased between 1991/1992 and 2000/2002. For men, the number of pain-free years remained unchanged, but years with pain increased. For women, there was both a decrease in pain-free years and an increase in years with pain.  Results suggest an expansion of morbidity in the older population.

Keyword
gender, pain, healthy life expectancy, older people
National Category
Social Work
Research subject
Social Work
Identifiers
urn:nbn:se:su:diva-55281 (URN)
Available from: 2011-03-07 Created: 2011-03-07 Last updated: 2011-03-16Bibliographically approved

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