Correlates of subjective health across the aging lifespan: understanding self-rated health in the oldest old

OBJECTIVES: To examine the determinants of self-rated health (SRH) in different age groups of older adults, including the oldest-old. METHODS: Variables assessing physical health, difficulty with self-care, depressive symptoms and cognitive impairment were pooled and harmonised from three Australian longitudinal studies of ageing (n=5,222). The association of these with SRH was examined in older adults aged 60-64 years, 65-74 years, 75-84 years and 85 years and older. RESULTS: SRH was not associated with cognitive impairment or difficulty with self-care in the oldest-old, and its association with physical health was diminished compared with younger groups. Depression showed a significant relationship in all age groups, conferring an approximately fourfold increase in the likelihood of poorer SRH. DISCUSSION: As old age progresses, self-reports of poor health become most closely related to psychological symptoms. This explains some of the paradoxes of past literature and offers important insights for health professionals working with the oldest-old.National Health and Medical Research Council (NHMRC); Australian Research Council Centre of Excellence in Population Ageing Research (CEPAR

Cross-national gender differences in the socioeconomic factors associated with smoking in Australia, the United States of America and South Korea

Objectives: We compared rates of smoking among those aged 45 years and older in Australia, the United States of America and South Korea, and examined cross-national gender differences in key socioeconomic differentials in smoking. Methods: We conducted weighted analyses on cross-sectional data from nationally representative surveys conducted in 2006. Results: Current smoking was more prevalent for males than females in all countries; the gender difference was largest in Korea. Being unpartnered increased the likelihood of smoking in all countries, while greater wealth reduced it. In Korea these effects interacted with gender; both indicators showed larger differentials among women than men. Lower educational attainment increased the likelihood of smoking for all groups except Korean women, among whom high school educated women were less likely to smoke than the tertiary educated. Conclusions: Our findings support a cultural interpretation of gender differences in smoking: in countries with low gender empowerment, gender differences in smoking are greater. With increasing divorce and female tertiary education rates in nations like Korea, we highlight the need for health promotion messages targeted towards older and more educated women

Alcohol use and depression from middle age to the oldest old: Gender is more important than age

Background: Alcohol use disorders are associated with other mental health disorders in young adults, but there are few data on alcohol use and mental health outcomes in older adults, particularly the oldest old. This study examines the relationship between alcohol consumption and depressive symptoms. Methods: Data were collected from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project, which has pooled nine Australian longitudinal studies. Alcohol consumption was classified using standard drinks (10 g alcohol)/day as: abstinent, low risk (2–≤4) and short-term risk (>4). Probable depression was classified from harmonized scores on various standard instruments (e.g. Centre for Epidemiological Studies Depression scale). Results: Overall, 39,104 (86%) participants contributed data. Alcohol classification at baseline showed 7,526 abstinent, 28,112 low risk, 2,271 long-term risk, and 1,195 short-term risk participants. Age ranged from 45 to 103 year (median 60). Using generalized estimating equations (GEE), there were significant gender by alcohol and gender by age interactions, so the analysis was split by gender. Among males, the abstinent and short-term risk groups had increased likelihood of depression: in females the abstinent, long- and short-term risk groups had increased odds of depression. Increased odds of depression was also associated with former and current smoking, younger age-group, not being partnered, leaving school before age 15 and increasing levels of health-impaired walking, dressing, or bathing. Conclusion: The impact of alcohol use differs by gender, nevertheless those using higher levels of alcohol or who smoke should be screened for depression and may benefit from interventions

Cross-national insights into the relationship between wealth and wellbeing: a comparison between Australia, the United States of America and South Korea

The positive relationship between wealth and wellbeing has received considerable attention over the last three decades. However, little is known about how the significance of wealth for the health and wellbeing of older adults may vary across societies. Furthermore, researchers tend to focus mainly on income rather than other aspects of financial resources even though older adults often rely on fixed income, particularly after retirement. Using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey (N=1,431), the Health and Retirement Study (HRS, N=4,687), and the Korean Longitudinal Study of Ageing (KLoSA, N=5,447), this exploratory cross-national study examined the relationship between wealth satisfaction and objective wealth and wellbeing (measured as self-rated health and life satisfaction) among older Australians, Americans and Koreans (50+ years). Regression analyses showed that wealth satisfaction was associated with wellbeing over and above monetary wealth in all three countries. The relationship between monetary wealth and self-rated health was larger for the United States of America (USA) than Australian and Korean samples, while the additional contribution of wealth satisfaction to life satisfaction was larger for the Korean than the Australian and USA samples. These findings are discussed in terms of the cultural and economic differences between these countries, particularly as they affect older persons.This research was funded through a grant. - Sarang Kim was supported by ARC/NHMRC Research Network in Ageing Well, Davina French by NHMRC Project Grant No. 410215 and Kaarin Anstey by NHMRC Research Fellowship No. 366756

A simple measure with complex determinants: investigation of the correlates of self-rated health in older men and women from three continents

Self-rated health is commonly employed in research studies that seek to assess the health status of older individuals. Perceptions of health are, however, influenced by individual and societal level factors that may differ within and between countries. This study investigates levels of self-rated health (SRH) and correlates of SRH among older adults in Australia, United States of America (USA), Japan and South Korea. We conclude that when examining correlates of SRH, the similarities are greater than the differences between countries. There are however differences in levels of SRH which are not fully accounted for by the health correlates. Broad generalizations about styles of responding are not helpful for understanding these differences, which appear to be country- and possibly cohort-specific. When using SRH to characterize the health status of older people, it is important to consider earlier life experiences of cohorts as well as national and individual factors in later life. Further research is required to understand the complex societal influences on perceptions of health.The Australian data on which this research is based were drawn from several Australian longitudinal studies including: the Australian Longitudinal Study of Ageing (ALSA), the Australian Longitudinal Study of Women’s Health (ALSWH) and the Personality And Total Health Through Life Study (PATH). These studies were pooled and harmonized for the Dynamic Analyses to Optimize Ageing (DYNOPTA) project. DYNOPTA was funded by a National Health and Medical Research Council (NHMRC) grant (# 410215)

Gender differences in alcohol consumption among middle-aged and older adults in Australia, the United States and Korea

OBJECTIVES: To compare gender differences in alcohol use and the socioeconomic correlates of at-risk drinking among middle-aged and older adults in Australia, the United States (US) and South Korea. METHOD: Data were drawn from large nationally representative surveys of people aged 45 years and older, collected in 2006. RESULTS: Rates of any drinking and at-risk drinking (>14 US standard drinks/week) were higher for males than females in all countries and these gender differences were largest in Korea. Socioeconomic differentials for at-risk drinking varied by country and gender. In the US, at-risk drinking was associated with lower educational levels among men, but higher educational levels among women; in Korea, it was associated with being unpartnered, particularly for women; and in Australia, at-risk drinking was associated with higher income. CONCLUSIONS: Gender-role expectations differ between countries and may influence both the levels at which older adults consume alcohol and the ways in which at-risk drinking is associated with socioeconomic factors. IMPLICATIONS: Heavy alcohol use in middle-aged and older adults is a cause for concern. Health promotion strategies should target older age groups and consider the ways in which gender, marital status and education influence norms and opportunities for risky alcohol use.This paper uses unit record data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. The HILDA Project was initiated and is funded by the Australian Government Department of Family, Housing, Community Services and Indigenous Affairs (FaHCSIA) and is managed by the Melbourne Institute of Applied Economic and Social Research (MIAESR). HRS is sponsored by the National Institute of Aging (Grant No. NIA U01AG009740) and conducted by the University of Michigan. KLoSA is conducted by the Korean Labor Institute and funded by the Korean Ministry of Labor through the Employment Insurance Fund

Alcohol, hospital admissions, and falls in older adults: a longitudinal evaluation

Background: There are limited data on the impacts of alcohol use in older adults. We aimed to evaluate self-reported hospital admissions and falls against current Australian alcohol consumption guidelines. Methods: We conducted a longitudinal analysis of data from five Australian cohort studies. The study comprised 16,785 people aged 65 years or older at baseline. Alcohol consumption was categorized using Australian guidelines in standard (10 g) drinks per day as “abstinent,” “low-risk” (>0 ≤2), “long-term risk” (>2 ≤4), or “short-term risk” (>4). Separate generalized estimating equations for men and women, controlling for key demographic, and health variables (depression, diabetes, circulatory and musculoskeletal conditions) were used to examine the relationship of alcohol consumption with hospitalization and falls against a reference category of low-risk consumption. Results: Most participants were in the low (10,369, 62%) or abstinent (5,488, 33%) categories. Among women, all alcohol groups had greater odds of admission than low-risk users; among men, only the abstinent group had increased odds. For both genders, depression, diabetes, circulatory and musculoskeletal conditions all increased the odds of admission. For both genders, the unadjusted model showed that abstainers had increased odds of falling, with depression, diabetes, and for women, musculoskeletal conditions also associated with falls in the adjusted model. Conclusion: These outcomes suggest that older women in particular could benefit from targeted alcohol consumption messages or interventions. In relation to falls, other health conditions appear better targets for intervention than alcohol use