Social determinants of health of older adults determinants of health of older adults ... •...
Transcript of Social determinants of health of older adults determinants of health of older adults ... •...
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Social determinants of healthof older adults
Andrew SteptoeDepartment of Epidemiology and Public Health
University College London
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Social determinants of healthy ageing
• Initiated by WHO European Regional Office for their Solid Facts series
• AimTo identify the key social determinants of healthy and active ageing, with supporting evidence and policy recommendations
• Edited by Andrew Steptoe, Michael Marmot and AgisTsouros
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Contributors
• Hugh Barton (UWE)• Lisa Berkman (Harvard)• Peter Goldblatt (London)• Sally Greengross (House
of Lords)• Susan Handy (UC Davis)• Diana Kuh (UCL)• Piroska Östlin (Karolinska)• Javier Gómez-Pavón
(Madrid)
• Brenda Penninx (VU Amsterdam)
• Teresa Seeman (UCLA)• Gita Sen (Bangalore)• Johannes Siegrist
(Düsseldorf)• Nicholas Steel (UEA)• Richard Wilkinson
(Nottingham)
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Social determinants of healthy ageing
• Determinants that are active earlier in life, and persist into later life
• Determinants that are active earlier in life, but become accentuated in later life
• Emerging social factors at older ages• Which determinants most amenable to policy
initiatives:Within health systemsAt the societal level
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Social determinants of healthy ageing
• Macrosocial factors
• Individual / microsocial factors
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Social determinants of healthy ageing
• Macrosocial factorsEconomic factors / poverty
Socioeconomic disparities persist into old ageMany older people face economic hardship
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SES, age, and all cause mortality
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40 - 64 65-69 70-89
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0 pe
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yea
rs Admin Prof Clerical Other
Marmot & Shipley, 1996
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Social determinants of healthy ageing
• Macrosocial factorsEconomic factors / poverty
Socioeconomic disparities persist into old ageMany older people face economic hardshipEnsuring adequate financial resourcesManaging retirement more effectivelyEnsuring appropriate facilities for care and support
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Social determinants of healthy ageing
• Macrosocial factorsEconomic factors / povertyEmpowerment and political engagement
Involving older people in planning for their older agePromoting opportunities for participationReducing age discriminationReducing misconceptions and stereotypes
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Social determinants of healthy ageing
• Macrosocial factorsEconomic factors / povertyEmpowerment and political engagementGender issues
Health differentials result from a combination of biological differences and social differentialsCumulative effects of women’s lower social position throughout life impact in old age
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UNICEF, 2006
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Social determinants of healthy ageing
• Macrosocial factorsEconomic factors / povertyEmpowerment and political engagementGender issues
Health differentials result from a combination of biological differences and social differentialsCumulative effects of women’s lower social position throughout life impact in old ageGender related to other social determinants: widowhood (loneliness), lower income (poverty), less social support, less developed muscle mass (work patterns), poorer nutrition
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Social determinants of healthy ageing
• Macrosocial factorsEconomic factors / povertyEmpowerment and political engagementGender issuesDistribution of health resources
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Social determinants of healthy ageing
• Macrosocial factorsEconomic factors / povertyEmpowerment and political engagementGender issuesDistribution of health resources
Maximise healthy ageing by compressing morbidityGood quality health care for older peopleAccess to affordable preventive careBetter evidence base for effective treatment for older peopleWell designed clinical information systems
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Social determinants of healthy ageing
• Macrosocial factorsEconomic factors / povertyEmpowerment and political engagementGender issuesDistribution of health resourcesDesign of living environments
Built environment tied to health concerns: risk of injury, exposure to toxins, crime, exercise, social contact, access to services‘Ageing in place’ desirableStrategic planning for health equity and well-being requiredUrban design for age-friendly environments
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Social determinants of healthy ageing
• Macrosocial factorsEconomic factors / povertyEmpowerment and political engagementGender issuesDistribution of health resourcesDesign of living environmentsWorking life
Work has direct and indirect health effectsDirect: physical demands, stress, exposure to hazardsIndirect: Socioeconomic position achieved through workNeed to improve quality of work for older people
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Quality of work and intended retirement
Siegrist and Wahrendorf2009, Lancet
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Social determinants of healthy ageing
• Macrosocial factorsEconomic factors / povertyEmpowerment and political engagementGender issuesDistribution of health resourcesDesign of living environmentsWorking life
• Microsocial factors
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Social determinants of healthy ageing
• Microsocial factorsSocial relationships and social participationExposure to life stress / resilience and coping
Later life stressors: retirement, bereavement, caregivingAccumulative effects of biological ‘wear and tear’Greater understanding of determinants of resilience in old age
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Social determinants of healthy ageing
• Microsocial factorsSocial relationships and social participationExposure to life stress / resilience and copingMental well-being
Poor mental well-being detrimental to physical health
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Depressive symptoms and survival following MI
Lespérance et al, Circulation, 2002
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Social determinants of healthy ageing
• Microsocial factorsSocial relationships and social participationExposure to life stress / resilience and copingMental well-being
Poor mental well-being detrimental to physical healthDirect biological correlates and impact on unhealthy lifestylesPositive well-being appears to be protective
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Prospective association of positive affect and mortality
Chida and Steptoe2008, Psychosom Med
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Social determinants of healthy ageing
• Microsocial factorsSocial relationships and social participationExposure to life stress / resilience and copingMental well-beingHealth habits and health behaviours
Habitual behaviours: smoking, alcohol, physical activity, food choicePreventive actions: cancer screening, vaccinations, dental careIndividual motivation/choice and physical and social enviromentaldeterminants
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Health Benefits of Regular Physical Activity for Older Adults
How physical activity can
improve physical functioning
How physical activity can
improve mental functioning
How physical activity can be
beneficial at older ages in general
• Improved cardiorespiratory
fitness • Improved glucose metabolism
and insulin sensitivity • Reduced blood pressure • Improved lipid profiles • Reduced levels of inflammatory
markers • Induction of growth factors • Improved balance • Improved strength, flexibility and
joint mobility (range of motion) • Reduced decline in bone density • Helps maintain a healthy weight
• Enhanced emotional well-being • Provides relaxation and helps
lower stress levels • Helps maintain cognitive
function and alertness • Helps reduce depression • Enhanced perceptions of coping
ability • Improved sleep
• Helps maintain independence • Improved quality of life • Increased energy • Helps maintain social
connectedness
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SHARE/ELSA - physical activity in Europe
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Complete 65 or older
Proportion of adults (50+) reporting moderate or vigorousactivity at least once a week
Share wave 2ELSA wave 2
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Diabetes and physical inactivity (HRS/SHARE/ELSA)
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Physical inactivity %
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Steptoe and WikmanNAS report, in press
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Social determinants of healthy ageing
• Macrosocial factorsEconomic factors / povertyEmpowerment and political engagementGender issuesDistribution of health resourcesDesign of living environmentsWorking life
• Microsocial factorsSocial relationships and social participationExposure to life stress / resilience and copingMental well-beingHealth habits and health behaviours
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Diabetes and physical inactivity (HRS/SHARE/ELSA)
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5
10
15
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0 5 10 15 20 25
Physical inactivity %
diab
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pre
vale
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%
Steptoe and WikmanNAS report, in press
USA
CH
ItalyBel