Living well into old age

Jean Collins, Andrew Holman, Simone Aspis, Yve Amor

1 July 1997

This study of 1,500 people aged 65 and over found that the majority were happy with the overall quality of life; contrary to popular images of very old people as lonely or isolated, most respondents were well-supported by their families and friends.

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Summary

Three samples of over 1,500 people aged 65 and over were followed up between 1986/7 and 1992/3. The study aimed to explore what is 'successful' ageing in terms of what sustains well-being and quality of life. The study, by Ann Bowling, Emily Grundy and Morag Farquhar of St Bartholomew's Hospital Medical College and King's College London, found that:

  • Between 68 and 73 per cent of the members of the three samples were happy with their overall quality of life. There was little change over time in these proportions.
  • Poor and worsening levels of satisfaction were most closely associated with some worsening ability to perform everyday tasks and with declining health status.
  • Anxiety and depression were consistently associated with poor or deteriorating levels of ability to perform routine tasks. Improvements in these abilities and in physical health led to improvements in mental health.
  • In the sample of people aged 85 and over, half of the men and 40 per cent of the women had at least five 'good' quality of life scores (out of 8 or 9 indicators) at first interview. The higher the number of 'good' scores, the more likely interviewees were to survive until the follow-up interviews.
  • Contrary to popular images of very old people as lonely or isolated, most respondents were found to be well-supported by their families and friends.
  • In the sample of people aged 85 and over, after allowing for differences in health, men with few social contacts had a higher risk of death than others, while women who belonged to social clubs had a better chance of living longer.
  • The earlier detection of treatable health problems (eyesight, hearing, feet, arthritis, anxiety and depression) might lead to reductions in depression and anxiety and an increase in life satisfaction for very elderly people.
  • Between 27 and 43 per cent of the members of the three samples said there was something that could be provided to make it easier for them to maintain their independence at home. Most of them mentioned aids and adaptations.

The researchers interviewed all people aged 85 and over in Hackney in 1987 and two random samples of people aged 65-84 in Braintree and Hackney in 1989. The survivors from all three groups were interviewed two and a half to three years later.

 

Satisfaction with life

 

Poor and worsening satisfaction with their lives was most clearly associated with some worsening ability to perform everyday tasks and with declining health, particularly among those aged 85 and over. Around two-thirds of interviewees expressed good levels of satisfaction with their lives at the first interview, and the proportions hardly changed over time.

Among respondents aged 85 and over those with poor life satisfaction in both interview years were those most likely to have the fewest relatives, friends and confidantes at the first interview, and in most instances also at follow-up. The most notable factors associated with improvements in life satisfaction among the 85+ group were not obvious but losses in the number of friends was associated with worsening life satisfaction.

 

Ability to perform everyday tasks

 

At the first interview a third of the 85+ sample had difficulty carrying out everyday tasks due to physical problems. This compared with 9 per cent of the 65-84 Hackney sample and 4 per cent of the Braintree sample. At the follow-up the proportion of respondents reporting a poor level of functioning had increased markedly among the 85+ sample to 54 per cent, in comparison with 10-11 per cent in the younger samples. Figure 1 shows that some individuals improved even among the sample of those aged 85 and over.

The single physical health symptom which was consistently associated with chronic difficulties in daily living was foot problems. Those who showed an improvement over time in their general function were also less likely to have problems with their feet.

In the 85+ group, ability to perform daily tasks was associated with changes in living arrangements. Nearly one-third of women living alone at the first interview who had severe problems with several aspects of daily living were in institutions by the time of the follow-up interview.

 

Anxiety and depression

 

Anxiety and depression were consistently associated with chronic poor functioning and with deterioration. Symptoms of anxiety and depression increased with age. At the first interview 26 per cent of the 85+ sample had these symptoms, as did 10-11 per cent of the sample of people aged 65-74 and 18-21 per cent of those aged 75-84.

The deterioration in mental health was greatest in the 85+ sample. Of the 125 people in this group with good mental health at the first interview almost a fifth had poor mental health at follow-up, in comparison with between 9 and 13 per cent of the youngest sample members. Of those who were anxious or depressed at first interview, between 49 and 54 per cent of each sample remained in this state at follow-up. There was remission for 6-12 per cent in all three samples. Just under a fifth of all respondents were taking psychotropic medication for mental health conditions.

 

Table 1 shows the percentages of respondents with various health limitations at first interview.

 

Social networks

 

Contrary to popular images of very old people as lonely or isolated, most respondents were found to be well-supported by their families and friends. Loss of relatives, friends and confidants was greatest, as one might expect, in the 85+ group. Most people had at least one person in their network, although 14 per cent of the very elderly Hackney sample had no one in their network by the second interview. Most respondents at both the first and follow-up interviews reported having relatives in their network, although, at follow-up, the proportions with none ranged from 5 per cent in Braintree to 22% among the very elderly Hackney sample. Far more respondents reported having no friends (24-40 per cent) and no living children (13-29 per cent), with the very elderly sample again being most likely to report this.

Among men in the 85+ sample, those with few social ties had a higher risk of death in the first 30 months of follow-up while among women of this age those active in clubs seemed to have a lower risk of death.

 

Use of services

 

About four-fifths of the members of all three samples had seen their GPs in the last 12 months at each of the interviews. Few respondents did not use health or social services at all in both years. Both the Hackney samples made more use of all services than the Braintree sample. For example, among the Hackney respondents aged 85+, 87 per cent used services at both baseline and follow-up, in comparison with 70-76 per cent of the younger sample members.

Table 2 gives the percentage of the 85+ sample at the time of the second interview who needed help with specified tasks and the source from which help was received.

Use of services such as district nursing and home help (home care) was clearly associated with frailty - those who were most frail were in receipt of most services. However, the services being used tended to be 'maintenance' rather than preventive or rehabilitative.

 

Unmet need

 

Few of the Braintree respondents with difficulties in coping with the tasks of daily living reported wanting more help (up to 15 per cent wanted help with a named task at the time of the second interview). More respondents in both the Hackney samples said they would like more help. At follow-up, up to 23 per cent of the respondents aged 85+ and up to 25 per cent of respondents aged 65-84 who had difficulties wanted more help with: cutting toenails; washing/bathing; housework; and jobs around the house.

In reply to a question about whether anything else could be provided that would make it easier for them to maintain their independence at home, 39 per cent of the Hackney respondents and 27 per cent of the Braintree respondents at follow-up said yes. Most of them mentioned aids and adaptations in the home, such as grab rails, higher chairs, trolleys and various home improvements.

 

Survival and quality of life

 

Seventy-two per cent of the women and 60 per cent of the men included in the 85+ study were still alive 30 months later. The ability to perform everyday tasks at the first interview was associated with differences in survival as those who were least able were less likely to survive. Among women, age and social class also had a slight influence on survival chances, with those who had not been married and those at the younger end of the age range having higher survival prospects. Survival was also associated with social support.

The proportion of elderly people who had multiple problems, or by contrast, enjoyed good health in the fullest sense was analysed. The number of 'good' or 'poor' scores on eight or nine measures was examined. Few people had no 'good' scores; half of the men and 40 per cent of the women had at least five 'good' scores at the first interview. The number of 'good' scores was associated with survival. There were light shifts from 'good' to 'poor' scores between the first and second interviews.

 

About the study

 

The study was based on two random samples of people aged 65-84 living at home in Braintree, Essex (276 people) and in Hackney (464 people) and a census of all people aged 85+ in Hackney (630 people). There were contrasting areas, with Hackney having much higher levels of social deprivation. The samples were drawn from the lists of patients registered with NHS general practitioners, held at the Family Health Services Authorities. Respondents were interviewed in their own homes in 1987 (the 85+ group) and 1989 (65-84 samples) and survivors were re-interviewed two and a half to three years later, in 1990 and 1991. Death registrations were traced through the NHS Central Register and other sources were used to track service use.

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