Healthy Ageing. 12 years of results from the Australian Longitudinal Study on Women s Health (ALSWH) Professor Julie Byles

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1 Healthy Ageing 12 years of results from the Australian Longitudinal Study on Women s Health (ALSWH) Professor Julie Byles SCHOOL OF POPULATION HEALTH THE UNIVERSITY OF QUEENSLAND

2 Life in your years, not just years in your life This presentation will describe changes in women s physical health Decline in physical function and physical health-related quality of life is common in older age Some individuals appear resistant to decline in physical function; others are more vulnerable. More information on patterns and pace of age-associated changes in physical function, and factors associated with different patterns of change, is important for planning for an ageing population.

3 Measuring health-related quality of life MOS Short-form (SF-36) health profile 8 subscales score 0 to 100: physical function role limitations (physical health) pain general health social function mental health role limitations (emotional health) vitality A high score on the physical function subscale reflects ability to walk various distances, climb stairs, dress/bathe, carry groceries and engage in moderate and vigorous levels of activity

4 Changes in physical health (SF-36) N=5557 completed all 5 surveys

5 Variation in change in physical functioning scores Variation in change in physical health S5-S4

6 Patterns of change in physical function scores Class 1: Consistently high scores 50% Class 4: Increasing 3% Class 2: Declining 27% Class 3: Consistently low 20%

7 What the women said: # 1 Survey 1: 4 weeks ago I had a fall and fractured my arm. Normally I am a very healthy person for my age. Survey 2: I have a bladder problem Survey 3: My main problem is incontinence Survey 4: I have recently celebrated my 80 th birthday. My health has deteriorated slightly in the last 18 months but has not hampered me in my way of life. Survey 5: No comment

8 What the women said: # 2 Survey 1: My only health problem is arthritis I have had one successful hip replacement (1991) and have been told I need the other hip replaced Survey 2: I think I am quite healthy apart from osteoarthritis Survey 3: I have benefited greatly from my hip replacements Survey 4: I mostly feel very well, and able to live my normal life and do the things I enjoy doing. Survey 5: No comment

9 S1 factors associated with patterns of change in physical function (1) compared to women with continuously higher scores Declining scores (27%) Consistently low scores (20%) Increasing scores Odds ratio (95%CI) Age (continuous) 1.1( ) 1.1( ) 1.0( ) (3%) Marital Status# Married* Defacto 0.9( ) 0.2( ) 1.9( ) Never Married 1.1( ) 0.9( ) 0.3( ) Separated/Divorced 1.2( ) 1.2( ) 1.2( ) Widowed 1.1( ) 1.3( ) 1.2( ) Education# Higher school certificate or higher qualification* No formal qual/school (intermediate) certificate 1.3( ) 1.5( ) 1.2( ) * reference category # effects adjusted for age statistically significant effects in bold

10 S1 factors associated with patterns of change in physical function (2) compared to women with continuously higher scores Declining scores (27%) Consistently Low scores (20%) Increasing scores (3%) Odds ratio (95%CI) Smoking Never smoker* Ex-smoker 1.1( ) 1.2( ) 1.4( ) Current smoker 1.4( ) 1.6( ) 1.5( ) Body Mass Index Healthy* Underweight 1.0( ) 1.0( ) 0.8( ) Overweight 1.8( ) 2.7( ) 1.4( ) Obese 2.9( ) 10.3( ) 4.0( ) Physical Activity Low-high* Nil/very low 1.5( ) 4.1( ) 1.6( ) * reference category # effects adjusted for age statistically significant effects in bold

11 Body Mass Index and change in physical function Consistently high PF Consistently low PF Declining scores Healthy Underweight Overweight Obese Increasing scores

12 S1 factors associated with patterns of change in physical function (3) compared to women with continuously higher scores Declining scores (27%) Consistently Low scores (20%) Increasing scores (3%) Odds ratio (95%CI) Conditions Arthritis (S2) 1.7( ) 3.9( ) 2.8( ) Heart disease 1.7( ) 3.7( ) 3.1( ) Diabetes 1.6( ) 2.3( ) 3.2( ) Stroke 1.9( ) 3.5( ) 3.6( ) COPD/asthma 1.2( ) 2.0( ) 1.2( ) Cancer 1.3( ) 1.3( ) 1.6( ) Symptoms: Foot problems (S2) 1.6( ) 3.3( ) 1.5( ) Vision 1.2( ) 2.4( ) 1.9( ) Hearing 1.2( ) 1.6( ) 1.2( ) Incontinence 1.4( ) 2.5( ) 1.5( ) Back pain 1.4( ) 3.3( ) 2.5( ) reference category # effects adjusted for age statistically significant effects in bold

13 S1 factors associated with patterns of change in physical function (4) compared to women with continuously higher scores Events: Declining scores (27%) Consistently Low scores (20%) Odds ratio (95%CI) reference category # effects adjusted for age statistically significant effects in bold Increasing scores (3%) Fall (Survey 2) 1.4( ) 1.8( ) 1.5( ) Fall with injury 1.3( ) 2.1( ) 4.9( ) Other injury 1.3( ) 3.3( ) 4.7( ) Hip surgery 2.9( ) 8.8( ) 12.3( ) Eye surgery 1.2( ) 1.5( ) 1.3( ) Knee surgery or 1.5( ) 3.8( ) 4.0( ) arthroscopy Hospital past 12 months 1.3( ) 2.6( ) 2.8( ) Health care: Four or less* medications Five or more prescription 1.8( ) 4.6( ) 3.3( ) medications Four or less GP visits Five or more GP visits 1.5( ) 3.9( ) 3.2( )

14 Summary A large proportion of women in the study have lived long and well Over 70% of women aged in 1996 were still alive in 2009 Of the 45% still in the study, 50% had maintained high levels of physical functioning Many factors were associated with living well (maintaining PF), including: Non-smoker, healthy wt, physical activity, higher education Not having arthritis, heart disease, diabetes, stroke, COPD/asthma Some factors differentiated between other trajectories: More likely in poor health: widowed, obese, low PA, low education arthritis, heart disease, stroke, COPD/asthma, foot problems, incontinence, back pain, 4+ meds, 5+ GP visits, hospital admissions, hip and knee surgery More likely to have improved health: arthritis, hospital admissions, hip surgery, knee surgery

15 Conclusion Longevity and healthy ageing are subject to socio-economic disparities (such as education level) Healthy behaviours are important for survival and physical health related quality of life Low BMI increases risk of death, obesity increases the risk of disability Smoking affects both longevity and physical function Chronic disease has a high impact on physical function at older ages. Prevention is important Surgical and other health interventions may have an important role in helping women maintain or restore physical function However some women with these interventions were also likely to remain in poor health what factors differentiate these women? What is the role of co-morbidity in modifying these outcomes?