Dr Shelton is the head of the Health and Social Surveys Research Group www.ucl.ac.uk/epidemiology/hssrg and the Director of CeLSIUS www.ucl.ac.uk/celsius the Research Support Unit for the ONS Longitudinal Study, in the Department of Epidemiology and Public Health, UCL. Her research is on health geography, health surveillance and the outcomes that can be measured through large and complex health data sets.
women are drinking too much alcohol6 - a couple sharing a bottle
of wine would be beyond twice the ‘safe’ session limits for women. Further study of the reasons behind increased drinking in older women is required without demonising their drinking.7
Physical activity
Physical activity reduces with age, and is also lower in women than in men at all ages. Chaudhury and Shelton found that participation in sports and exercise, walking, heavy housework and gardening were all lower in non-working than working older adults aged 60-69 in England in 2006, even after health status had been considered. Yet older adults aged 60-64 in England 2007 reported work and lack of time as barriers to physical activity.8 Twice as many women
as men additionally reported that not being ‘the sporty type’ was a barrier to physical activity or that they were too busy caring for older people or children. Around three quarters of adults aged 60-64 in England thought they were fairly physically active in 2007, yet less than a third of adults aged 55-64 in 2008 met the then recommendation for 5 days of a least 30 minutes moderate to vigorous activity in a week based on self reported data. In a subsample who had physical activity measured objectively using an accelerometer, only 5% of men aged 65 and over and less than 1% of women met the guidelines. The importance of replacing work related physical activity is a challenge post retirement. Yet the benefits of physical activity may still be accrued in later life. A 2009 study showed that adults who increased activity levels between 50 and 60 years of age lived as long as those who were already exercising regularly in middle age.9
Fractures
Fractures are a considerable public health burden. Donaldson et al have shown using data for England 2002-4 that fractures may be more common than previously estimated, with an overall annual fracture incidence of 3.6%, more than double previous estimates.10 Though the prevalence of ever having had a fracture
is higher in men than women in all age groups apart from age 75, the male to female ratio in fracture incidence in the last 12 months altered markedly between those aged under 55 years and those 55 years and above (with rates in women far higher than in men after age 55).This effect was most marked in fractures of the trunk (including vertebral fractures) and long bones(including hip
fractures) and continued to increase rapidly with age in women - it is likely to reflect postmenopausal bone density loss. There are associations between health behaviours of alcohol consumption and physical inactivity and osteoporosis.11
To conclude, the key to addressing health outcomes of older women such as fractures, but also cardiovascular disease and cancer, which are beyond the scope of this essay, may be through understanding health behaviours.
1 Knott C, Scholes S, Shelton NJ, Could More Than Three Million Older People Be At Risk Of Alcohol-Related Harm? A Cross-Sectional Analysis Of Age-Specific
Drinking Guidelines Journal of Epidemiology and Community Health 2012; 66:A58
2 Ng Fat L, Fuller E, Drinking Patterns Chapter 6 in The Health Survey for England 2011, Health, social care and lifestyles The Health and Social Care Information Centre Leeds, 2012
3 Department of Health. Sensible drinking: the report of an inter-departmental working group. Department of Health, London, 1995.
4 Ng Fat L, Fuller E, Drinking Patterns Chapter 6 in The Health Survey for England 2011, Health, social care and lifestyles The Health and Social Care Information Centre Leeds, 2012
5 Royal College of Psychiatrists Our invisible addicts First Report of the Older Persons’ Substance Misuse Working Group of the Royal College of Psychiatrists College Report CR165, 2011
6 Knott C, Scholes S, Shelton NJ, Could More Than Three Million Older People Be At Risk Of Alcohol-Related Harm? A Cross-Sectional Analysis Of Age-Specific
Drinking Guidelines Journal of Epidemiology and Community Health 2012;66:A58
7 The author is co-applicant with Holdsworth C (Keele) principal investigator and co-applicants Oliveira C and Pykhart H (UCL): on an ESRC funded project starting 1 March 2013: Alcohol consumption, life course transitions and health in later life (Understanding Individual Behaviour)
8 Chaudhury M, Shelton N Physical activity among 60–69 year olds in England: knowledge, perception, behaviour and risk factors Ageing and Society 2010, 30 (8) 1343-1355
9 Byberg L, Melhus H, Gedeborg R, Sundstrom J, Ahlbom A, Zethelius B, Berglund L, Wolk A. and Michaelsson, K. Total mortality after changes in leisure time physical activity in 50 year old men: 35 year follow-up of population based cohort. British Medical Journal, 338, 2009.
10 Donaldson L, Reckless I, Scholes S, Mindell J, Shelton N The epidemiology of
fractures Journal of Epidemiology and Community Health 2008 62 174-80
11 Kanis J, on behalf of the World Health Organization Scientific Group Assessment
Of Osteoporosis at the Primary Health Care Level World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, UK and the World Health Organization 2007
There is an expression that says that ‘men die quicker but women are sicker’. Although they tend to live longer, women are more likely to suffer from multiple conditions as they age.1 Health
care reforms in many countries have advanced the notion of an integrated, holistic approach for the care of older people, taking into account their physical, social and psychological needs. However, implementation lags behind recommendations and the configuration of our health systems and the training of our health care professionals are often not conducive to ensuring that such a holistic approach is applied in practice.
Medicines management for older women is a particularly problematic area. Prescribing in older people who have several conditions at once involves a delicate balance between limiting the number of drugs prescribed and offering drugs that may be of real benefit.2 I remember vividly my 90-year old grandmother
being prescribed one drug after the other by her physician over the phone, without regular reviews or any consideration for the combined effects of the drugs she was taking. Similarly, my mother-in-law, aged 79, suffered from repeated falls and confusion for months before a geriatrician examined her pillbox and told her that the combination of drugs she was taking was likely to be the cause of her symptoms.
A large number of studies around the world have shown that inappropriate prescribing is most common in older women.3
Women – particularly older women - are also more likely to suffer from adverse drug reactions than men.4 The most common type of