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Heading

The Golden Generation?WELLBEING AND INEQUALITIES IN LATER LIFE

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Contents

Foreword from Anna Dixon, Centre for Ageing Better ........................................................... 4

Introduction from Professor James Nazroo, Co-Director, MICRA ........................................ 5

Executive summary .................................................................................................................... 6

Key findings ................................................................................................................................. 7

What happens to wellbeing as you get older?.......................................................................... 8

How is work changing for older people? .................................................................................. 10

Is retirement good for you? ....................................................................................................... 12

Why have an active social life? .................................................................................................. 14

Should you volunteer? ............................................................................................................... 16

Is the health of older people improving?.................................................................................. 18

Conclusions ................................................................................................................................. 20

About fRaill .................................................................................................................................. 21

Research papers.......................................................................................................................... 22

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Back in 1999 the Commission on Global Agingstated that nothing ‘is more likely to shapeeconomic, social, and political developmentsin the early 21st century than the simultaneousaging of Japan, Europe, and the United States…The human life cycle is undergoing unprecedentedchange. To preserve economic security, wemust adapt the social institutions built aroundit to these new realities’.

Against this backdrop, The University ofManchester has for many years been at theforefront of research to understand theimplications of ageing populations and theexperiences of people in later life, in order toinform policy developments at international,national and local levels. In particular our fRaill(Frailty, Resilience and Inequality in Later Life)programme of research has been specificallyconcerned with providing an integratedunderstanding of the processes that lead toboth positive and negative outcomes in laterlife, and how these are shaped by inequalities.

This five-year project has taken a holistic,interdisciplinary approach to examining thecausal processes relating to frailty andwellbeing at older ages. It has consideredfactors operating at particular points of thelife course – be they genetic, metabolic,psychological and social – and how these areframed by socioeconomic inequalities.

Within this report we present our key findingsfrom this programme of research. These have strong messages – and relevance – forpolicymakers, practitioners, activists, citizensand researchers alike.

Our central conclusion is that your experienceof older age is strongly determined by yoursocial and economic circumstances and thatthere are significant inequalities that continueinto later life.

These inequalities are present for almost allrelevant outcomes, and shape our life courseas we grow older. As we stress, the mostaffluent are likely to experience life afterretirement as a period of health andopportunity, precisely the kind of image of a‘golden generation’ that is widely portrayed inthe media when discussing baby boomers.

However the reality for the less well-off is that retirement means fewer years of lifeexpectancy, poorer health, fewer resourcesand greater constraint to social, cultural andcivic participation.

Professor James NazrooCo-Director, MICRA

Life expectancy gains in recent decades meanmore of us are living longer. This presentssignificant opportunities for individuals andsociety. However, unless the inequalities inlater life so starkly documented in this reportare addressed urgently, many people willcontinue to miss out on a fulfilling later life.Some die earlier than others, experiencefrailty and disability earlier, have poorer quality work, miss out on the benefits ofcontributing to their communities, and have fewer social connections.

The 15 year gap in life expectancy betweenthe richest and poorest neighbourhoods isnow widely recognised. Not only do poorerpeople not live as long but they experiencefrailty and disability at younger ages. Forexample, this report finds that the poorestthird of the population have levels of frailtyequivalent to those of people ten years olderin the richest third.

The Centre for Ageing Better works to bringabout changes in society so more people now and in future enjoy their later life. This research is an important contribution to our understanding of who is missing outand points to the sorts of changes that areneeded to tackle inequalities in later life.

We are determined to tackle these issues andare already working with others to addressworklessness among people over 50, toencourage employers to recruit and retainolder workers, to identify the barriers tovolunteering in socially deprivedneighbourhoods, and to promote physicalactivity to prevent frailty.

What is for sure is that it will require concertedaction from government and many otherorganisations to tackle the socioeconomicdeterminants of inequalities in later lifedescribed here.

Anna DixonChief Executive, Centre for Ageing Better

IntroductionForeword

“The University of Manchesterhas for many years been at the forefront of research tounderstand the implicationsof ageing populations...”

“The Centre for Ageing Betterworks to bring about changesin society so more people nowand in future enjoy their later life.”

7

The ageing of the baby boomer cohort (born between 1946 and 1964) alongsideincreasing life expectancy means that likeother countries the UK faces a rapidly growingpopulation of older people. Latest ONSestimates suggest that the UK populationaged 65 and over has risen by 21% over thelast ten years to 11.6 million people, while the population aged 85 or over has risen by30% to 1.4 million people, and aged 90 andover by 34% to more than half a million.

But what is quality of life like for older people,and are gains in life expectancy simplycomposed of increasing years spent withchronic health problems?

Precisely how quality of life relates to thecircumstances, experiences and opportunitiesof older people – and how this then relates tothe wider social and economic inequalitiesfound in our population – are among the keyquestions we have been studying.

We argue that policy interventions to ensureeveryone is able to live long, enjoyable andmeaningful lives need to pay direct attentionto inequalities in later life.

The main policy response and recentrecommendations have been to increase the pensionable age, alongside reforms to pensions that reduce benefits andindividualise risk1. However, we argue thatthese current policy choices simply increaseinequalities among older people and that the consensus on policy options needs to be rethought.

For instance, there needs to be a betterunderstanding of the barriers and incentivesto people remaining in work until they areolder, and of the impact of quality of work onhealth and wellbeing in later life. Similarly, weargue that pension reform needs to considerhow economic inequalities can be addressedin order to maximise the wellbeing andpotential of older people.

Our evidence has also shown that theprovision of public resources to encouragecultural and social participation can havesignificant positive health and wellbeingeffects. As such it is important to addressinequalities in access when developing policy.

In this context, the rapid digitisation of so many public services is another keydimension. Our work has shown markeddecreases in the use of technology as peoplegrow older, not just because they don’t wantto use technology, but because they areunable to because of poor health or pooreyesight or socioeconomic constraints onaccessing the relevant technology.

Another policy debate surrounds informalcaring roles which, given the strains on ourhealthcare system, are likely to become anincreasingly important complement to formalcare. As such, we argue that more support for caregivers should also be high on thepolicy agenda.

6

Executive summary

“There remain two verydifferent experiences ofold age in Britain. For themost affluent life afterretirement is likely to be one of less stress, and greater health andopportunity…. howeverfor the rest it comprisesrelatively fewer years,poorer health, fewerresources and greaterconstraint to social,cultural and civicparticipation.”

“Current policy choicessimply increase inequalitiesamong older people... theconsensus on policy optionsneeds to be rethought.”

Our research identifies a number of key findings:

There is clear evidence of large inequalities in healthand wellbeing in later life which relate to socioeconomicposition, ethnicity, gender, and where you live.

For the most affluent, life after retirement is likely to be one of less stress, and greater health andopportunity. But for the less well-off it meansrelatively fewer years of life expectancy, poorerhealth, fewer resources and greater constraint tosocial, cultural and civic participation.

There is no evidence that levels of health areimproving for newer cohorts of older people. This implies that continuing gains in life expectancyare likely to be composed of additional years spent in poor health, with the potential for greaterassociated healthcare costs.

For the poorest, levels of poor health are actuallyincreasing for newer cohorts of older people, suggestingan earlier onset of frailty as they grow older.

Wellbeing in later life is inversely related to levels of wealth. In addition, the decreases in wellbeing in later life are largely driven by the death of one'sspouse and deterioration in one's health. But these things occur more often in poorersocioeconomic positions.

Involvement in paid work and volunteering rolesamong older people has a positive impact on theirwellbeing, but only if these roles are of good quality,that is if the older person has control over their work routine and feels adequately rewarded for the effort they put in.

Providing informal care for someone else is likely tohave a negative impact on wellbeing, particularly if thecircumstances around providing that care are poor.Providing adequate resources and support for olderpeople providing informal care is, therefore, crucial.

The percentage of people using the internetfrequently (at least once a week) shows a strongdecrease with age, while use of the internet is lesscommon among the poorest, regardless of age.

Key findings

1: State Pension Age independent review: final report, John Cridland CBE, March 2017

What our research has also shown is thestrong influence that all of childhood, social mobility after childhood, and wealthaccumulation across the life course, have on wellbeing in later life.

A ‘life course’ approach, which analyses an individual’s experiences over their entire life, enables a more dynamic view on socioeconomic position. Childhoodconditions set in motion a complex cascade of direct and indirect influences on wellbeingand both physical and mental health inadulthood and later life.

However, these pathways are not inevitable.There are obvious opportunities to influencethe direction of these trajectories at variouspoints in the life course, particularly aroundretirement and other events in later life.

As such, it is vital that policymakers have astrong focus on what can be done to tackleeconomic, social and health inequalities inlater life. For example, if policies to encouragecontinued working are to succeed, inequalitiesand their effects in older age need to beconsidered in terms of this wider life course perspective.

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The promotion of ageing well in later life hasbecome a key strategy for both public healthand social policy. In the UK this has beenreflected by a shift from the measurementand definition of successful ageing as theabsence of physical and mental healthconditions, towards the assessment of wellbeing.

In other words how happy people are, howsatisfied they are with their lives, and towardsan assessment of their quality of life in termsof their positive experiences, rather thansimply the absence of negative experiences.

Our research

Our research has shown that across the rangeof dimensions people tend to witness anongoing improvement in their wellbeing for anumber of years as they move through their50s and 60s, before then experiencing a sharp decline.

So what explains this sharp fall? It seems that it is largely a consequence of factors such as the occurrence of poor health andwidow(er)hood. We also found that whenwellbeing is measured over time, people arealso more likely to experience a faster declineat the oldest ages, which might be related to events and circumstances that theyexperience in their final years of life, such asthe death and illness of friends.

Differences in socioeconomic position,measured as wealth, are not related to thisdecline in wellbeing in later life. However it isstrongly related to the level of wellbeingacross all ages in later life from 50s to theoldest, with the level of wellbeing stronglygraded by wealth and the level of deprivationin the area in which you live. The risks of illhealth and the death of a spouse, both ofwhich explain the decline in wellbeing in laterlife, are much higher for those in poorersocioeconomic positions.

In order to understand how wellbeing developsin later life it is important to consider howrisks and advantages accumulate across the life course.

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What happens to wellbeingas you get older?

“If early retirement is linked with poorer workingconditions, which may belinked with lower social statusand wealth, we are observingeffects of social inequalitieswhich may have persistedacross the life course, rather than of only work or retirement.”

Poorest Richest

Age50 55 60 65 70 75 80 85 90

Depressed mood is strongly influenced by wealth, with the poorest fifth of the population having much higher rates

of depressed mood than the richest fifth, across all ages in life.

Age, depressed mood and wealth

“Frequent use of the internet is less commonamong those in lower wealth quintiles regardlessof age group. For example in the 75 to 79 agegroup less than a fifth of people in the poorestfifth frequently access the internet, comparedwith over half of people in the wealthiest fifth.”

Our research has shown that the percentageof people using the internet is strongly relatedto socioeconomic circumstances, gender andage cohort, and decreases as people get older.

Similarly, there is a strong relationshipbetween internet use and indicators of areadeprivation for older people. Those who areless likely to use the internet are also morelikely to have difficulties in accessing servicessuch as banks, cashpoints, supermarkets ortheir GP.

Given the increasing dependence on digitaltechnologies for everyday life, this is animportant source of inequality and leads to an inequality in access to citizenship rights.

An important point here is that these issuesdon’t simply arise because older people don’twant to use technology. Often it is simplybecause they are unable to because of theirpoor health, such as because of pooreyesight, or because of a lack of necessaryeconomic resources.

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The rapidly changing structure, dynamics andnature of employment is having a huge impactacross our working lives and beyond intoretirement. As such, it is important to placepresent evidence within the context of theseimportant demographic changes.

The sharp rise in self-employment and part-time working, plus the rise of the ‘gig’economy – a labour market characterised byshort-term contracts and freelance work –means the concept of retiring at a set age isbecoming increasingly redundant as peopleeither embrace, or are forced into, moreflexible and uncertain working lifestyles.

This is in part driven by huge technologicalchange. But it is also a consequence ofemployers increasingly choosing to operatewith more flexible workforces.

Our research

The extent of later life involvement in paidwork, informal care provision and volunteeringare set to change dramatically, particularly as labour markets become ever more flexibleand public sector pension contributions arefurther reduced and replaced by the private sector.

The consequences of these labour marketchanges are extensive for both individuals andsociety. Our research has shown that this newnation of flexible, older workers – and theprecise nature and character of their workinglives – is cause for concern.

What we have found is that one consequenceis people find themselves working well intoretirement because of mortgage debt andother financial constraints, often feeling theyhave no choice but to continue working, withdetrimental effects on their health. The samecan also be said for volunteering roles if theindividual is not carrying out this role out of choice.

Technological exclusion is a particularconcern. For instance more frequent internetuse is associated with wellbeing and higherlevels of social and civic engagement, butolder people who don’t have access to theinternet and social media can find themselvesexcluded from many new jobs and workingpractices - as well as from a broader range ofsocial activities, goods and services.

This can also apply to those who have retiredearly from their previous career job, possiblybecause of poorer working conditions, andlack the skills, knowledge and resources toembrace new technologies. Such individualscan find it hard adapt to this new world ofwork, which brings us back to the fact we areoften observing the effects of socialinequalities that have persisted acrosssomeone’s whole life.

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How is work changingfor older people?

Poorest RichestAge50

0%

40%

60%

80%

100%

20%

60 70 80 90

The overall downward sweep of lines show a decrease in internet use for each older

cohort. An upward gradient on individual lines shows

an increase in internet use over time. But importantly, regardless of any increase,

poorer people are consistently much less likely to use the

internet, for all age cohorts.

Each line represents the poorest or richest fifth of the population and a particular age cohort.

Impact of wealth and age on internet use

Voluntary retirement Involuntary retirement

Life satisfaction Quality of lifeDecrease in

depression symptoms

People who take voluntary retirement have an improvement in their wellbeing,while those who take involuntary retirement have a decrease in wellbeing,

compared to those who take the standard route to retirement.

For example, while health deteriorates withage, we found evidence that this deteriorationslows after retirement for those in the leastfavourable socioeconomic circumstancesprior to retirement and for those in physicallydemanding occupations.

Our research also found that rates of ill-healthwere higher for older workers involved inunsatisfying jobs or where work demandsexceed returns from work. It seems thatthose facing such forms of disadvantage inemployment conditions experience a slowerincrease in rates of illness when the demandsof work are removed.

Also, underlying policies around extendingworking lives is the notion that retirement is avoluntary choice that needs to be discourageduntil an appropriate age is reached. While thismay be the case for the richest in our society,where early retirement is often chosen andfinanced largely through occupational pensionschemes or accumulated wealth andinvestments, the poorest in society tend tomove out of the labour market into retirementthrough poor health and redundancy.

Therefore, the outcomes of our researchshow that retirement is good for you, but onlyif you retire from a good job.

This suggests a need to consider howemployment conditions might be reshaped tonot only improve quality of work, but also tomitigate the risks of redundancy and inabilityto re-enter paid work and to enable those inpoorer health to remain in work.

Our research also showed that involuntaryretirement has a large negative effect on allaspects of wellbeing in later life comparedwith those who stay in work. By contrastthose who retire voluntarily (for example, to spend time with family or fulfil otherambitions) have an improvement in theirwellbeing in comparison with those whoremain in work.

As such, if increases to the State Pension Ageare to be successful, there needs to be anunderstanding of the barriers to remaining inwork, of who the older workforce comprises,and of the factors which might encourageolder people to remain in employment.

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Retirement age has emerged as a key issuewithin policy discussions and developmentslinked to the benefits and challenges ofpopulation ageing. However policy reformsaround retirement have so far failed toaddress socioeconomic and healthinequalities in later life.

Many Western countries have implementedpolicies to increase the State Pension Age. For instance in the UK it will increase to 67 by2028 for both men and women, with plannedfuture increases. The justification for doing sois based upon the principle expressed by theformer Chancellor George Osborne that weshould spend around a third of our adult livesin retirement. A principle that implies thatState Pension Age would rise to 69 by thelate 2040s.

There is some evidence to suggest that suchpolicies, together with broader changes in theemployment context (such as the rise in part-time work) has increased the number of olderpeople in work. For example over the period2002/3 to 2014/5 the proportion of men aged60-64 in paid work rose from 47.5 per cent to58.8 per cent. While for women aged 55-59 itrose from 61.1 per cent to 66.7 per cent2.

Our research

The rationale underlying such policies is thatengaging in paid work is a positive outcomefor individuals as well as for society and the economy.

However, our research has shown thatincreasing the State Pension Age may haveunintended negative consequences. This isparticularly evident given the relationshipbetween poor quality work and the starkinequalities in life and healthy life expectancyaccording to socioeconomic position.

And where poor quality work, as well as lowincomes, are a driver of such inequalities,increasing the State Pension Age may onlyserve to exacerbate the extent of healthinequalities between social groups andgeographical areas in later life.

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Is retirement good for you?

“Proposals to increaseretirement age without alsotackling inequalities incircumstances in the finalyears of employment arelikely to increase inequalitiesin self-reported health.”

2: Elsa Wave 7 Report, Banks et al (2016)

Wellbeing and type of retirement transition

On average we found that retirement orwidowhood did not lead to a greater risk ofsocial and cultural detachment. Instead, lifecourse experiences leading up to theseevents have a larger impact.

Not unexpected was our finding that olderpeople living in rural areas are at higher risk ofbeing socially detached, perhaps reflectingthe fact that opportunities to engage sociallyor culturally are fewer and further away in ruralareas, making access to such facilities muchharder for older people.

A criticism of the policy agenda is that thefocus is now almost entirely on encouragingpeople to work longer, without giving thesame priority to interventions aimed at socialengagement that benefit both individuals and wider society.

While there have been programmes orientedtowards enabling participation in socialactivities, such as Active at 60, these havebeen one-off and afforded limited funding andpolitical support.

Our findings suggest that these programmesare best targeted at those older adults whohave experienced sustained disadvantageover the life course and recent declines inhealth, rather than those who haveexperienced short-term changes inemployment or marital status.

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There is an ever increasing literature aroundthe benefits of social activity in later life onhealth and wellbeing. The consensus is thatactive ageing produces individual, as well associal, benefits and that if older people are notworking they should be engaged in social orcivic activities, including volunteering.

Also conversely it has become widelyaccepted by policymakers that a lack of social and cultural activity, so called socialdetachment, has a detrimental effect onphysical and mental health in later life. Olderpeople who are withdrawn from social, leisureand cultural activities are shown to be atgreater risk of mortality, disability, depressionand cognitive decline.

It is therefore important to ask why certainpeople are disengaged from social and culturalactivities. The answers to these questionshave important implications for public policiesthat aim to ensure positive, fair and equitableoutcomes among older people.

Our research

The suggestion is that wellbeing is fostered byan active lifestyle and our studies, adding tothe work of others, shows that wellbeing isindeed significantly higher in older adults whoare socially active.

Long-standing socioeconomic and healthinequalities in older adults lead to withdrawalfrom social and cultural activities, as well asdrive persistent detachment from theseactivities over time. Put another way,disadvantaged older adults find it difficult toengage in – and stay engaged in – social andcultural activities and this then impactsnegatively on their wellbeing.

These disadvantages may stem from nothaving the financial or physical capability toattend activities, as well as a lack of confidenceor skills to engage with others in social andcultural settings – characteristics which mayreflect socioeconomic disadvantageoperating across their life course.

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Why have an active social life?

“The benefits of engagementwith social activities on healthand wellbeing are widelyreported. Less is known,however, about what driveswithdrawal from and re-engagement with socialactivities in later life.”

Wealth has a huge impact on a person’s social detachment. Overall, 1 in 3 men and women in the poorest group are detached from 3 or more social domains, compared with 1 in 20 of the wealthiest.

Poorest 4 3 2 Richest

50%

40%

30%

20%

10%

0%

Social detachment and wealth

The risk of becoming socially detached for the richest group is just one fifth

of the risk for the poorest.

Risk of social detachment

Surprisingly, rates of volunteering also don’tbegin to decrease until people get to their late 70s.

Socioeconomic position is also a strongpredictor of volunteering. As their levels ofwealth increase, the proportion of olderpeople volunteering increases, with aparticularly high rate of volunteering in therichest fifth of the population. Notsurprisingly, health is also strongly related to volunteering, with those in good healthmuch more likely to volunteer.

Meanwhile there is also an increasing blurringof the boundary between volunteering andinformal caring roles. Such roles are likely tobecome an increasingly importantcomplement to formal care, but – as withvolunteering – they can have a negativeimpact on wellbeing if the caring role is of low quality.

In this context a number of policy measurescould be considered such as: allowing carersaccess to unpaid leave; paid short-term leavefor emergencies; entitlement to regular paiddays off work; and flexible hours toaccommodate hospital visits.

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Existing research has suggested thatvolunteering improves a range of wellbeingoutcomes. This is particularly relevant giventhat recent UK data has revealed significantinvolvement in both volunteering (more thana fifth of 50 to 69-year-olds volunteered atleast once a month) and in the provision ofinformal care.

However, long-standing socioeconomic andhealth inequalities can lead to lower levels ofparticipation in civic activities such asvolunteering. All of this contributes to lowerlevels of wellbeing for those in poorersocioeconomic circumstances.

Our research

Our research clearly demonstrates thatvolunteering does indeed improve wellbeing.Those people who volunteer in later life havebetter wellbeing than those who do not (aftertaking account of other differences in theircharacteristics). Those who start volunteeringin later life have an improvement in theirwellbeing, while those who stop experience adeterioration. We also show that the morefrequently people in later life volunteer, andthe more volunteering activities that they do,the better their wellbeing.

But there is a caveat. This positive correlationbetween volunteering and wellbeing existsonly if these roles are of good quality, whereasvolunteering involvement can have no impacton wellbeing if the roles are of low quality.

Another key finding is that the take up ofvolunteering activities varies greatly acrossgroups of older people.

For instance, we found that the freeing up oftime around retirement increases the amountof time spent volunteering for people whoalready volunteer. However, retirement initself does not increase the proportion of thepopulation who are volunteering. In fact, ahigher proportion of those who are in paidwork volunteer.

It also seems that volunteering during olderage is heavily influenced by volunteeringexperiences prior to retirement, whichsuggests that volunteering should bepromoted throughout one’s working life, as well as in later life.

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Should you volunteer?

“Involvement in paid work andvolunteering roles is likely tohave a positive impact onwellbeing if these roles are ofgood quality. But, particularlyin the case of paid work,involvement in these rolesmay well have a negativeimpact on wellbeing if theyare of low quality.”

Adjusted for age, gender, mobilityand wide range of social factors

Decrease in depression

Qualityof life

Lifesatisfaction

Compared with non-volunteers, volunteers have an improvement to their wellbeing over time.

Does volunteering improve wellbeing?

4 out of 10 people volunteer

Rates of volunteering are particularly high amongst the richest fifth of the population

compared with 1 out of 10 among the poorest fifth.

Impact of wealth on volunteering

In addition, we show, once again, that theshadow of inequality looms large.

For instance, those in the poorest third of wealth distribution have levels of frailty that are equivalent to levels for people ten or moreyears older in the richest third of the wealthdistribution. And this inequality seems to have been increasing over the first decade of this century.

Most importantly, our studies have shownthat the increase in frailty levels for morerecent cohorts is most prominent among thepoorest individuals, with little evidence of anydifference in frailty across cohorts among the

most affluent. So, the increase in levels of frailtyin later life is driven by an increase in levelsamong the poorest in our older population.

These findings emphasise the need to addressinequalities in later life.

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A key question within ageing research is howincreases in life expectancy relate to health inlater life. Is it the case for instance, that thenumber of years spent in poor healthdecreases as life expectancy increases,because of general improvements in health?Or is it the case that the number of yearsspent in poor health stays the same, or evenincreases proportionally alongside an increasein life expectancy?

And if the latter is the case, to what extentis this explained by wider inequalities thatsomeone has experienced throughout their life?

These are key questions because they havesubstantial implications both for the levels ofhealth and social care needed to support olderpeople, and for the wellbeing of older people.

Our research

In this context predicting and understandingrisk of frailty has emerged as a key aspect ofour research on population ageing andinequality, as it has in other research and inclinical practice.

This is because frailty provides a summationof the impact of a range of physical,psychological and cognitive conditions andimpairments on an individual. It reflects age-related declines in biological systemsthat lead to a range of adverse outcomes such as falls, fractures, hospitalisation,institutionalisation and mortality.

As such frailty is a useful way of consideringthe health challenges of a growing populationof older people. It can provide an indication ofan individual’s capacity for independent livingand the risk of suffering an adverse event thatmight precipitate a need for greater levels ofcare in the future.

Levels of frailty in a population are also auseful indicator for policymakers as theypredict need and can provide predictionsacross segments of the population, acrossdifferent regions in the country, and give anindication of how levels of frailty might change into the future. They also predict how poor health might change with increasesin life expectancy.

Our research on changing levels of frailty overtime presents a pessimistic conclusion.Rather than levels of frailty decreasing formore recent cohorts they are, in fact, higher.The implication is that with increasing lifeexpectancy we are also witnessing increasesin the period spent in ill health.

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Is the health of olderpeople improving?

“Wealth-related inequalitiesin levels of frailty widenedbetween 2002 and 2010.Among the poorest... morerecent cohorts appear to have higher levels of frailtycompared to earlier cohorts,while this is not the case forthe wealthiest...”

Chart

TBC

Poorest RichestAge50 60 70 80 90

Major differences can be seen between the two wealth groups, the poorest third showing a much higher level of frailty within each age cohort,

such that they have a level of frailty equivalent to that for those ten or

more years older in the richest third. In addition, for the poorest third,

levels of frailty are often higher for more recent cohorts compared with

previous cohorts, as shown by the blue circles around higher lines for

more recent cohorts. This indicates progressively higher levels of frailty

over time for the poorest third of the population and a consequent

widening of inequalities.

Each line represents the poorest or richest third of the population and a particular age cohort.

Increase in frailty for different age and wealth groups

Principal Investigator: James Nazroo

Professor James Nazroo is a sociologist and authority on social inequalities in health and wellbeing in later life. His researchis particularly focused on describing thepattern on inequalities in later life, the factorsoccurring in later life and across the life coursethat drive this inequalities, and how thischanges over time. He is a Co-Director ofMICRA and Co-Principal Investigator of theEnglish Longitudinal Study of Ageing (ELSA).

The Frailty, Resilience and Inequality in LaterLife (fRaill) programme of research has beenspecifically concerned with providing anintegrated understanding of the processesthat lead to both positive and negativeoutcomes in later life, and how these areshaped by inequalities.

www.micra.manchester.ac.uk/fraill

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Our programme of research demonstratesthat the ‘golden generation’ label applied totoday’s population of older people is a myth.

Instead there remain clear – and growing –socioeconomic inequalities in wellbeing andhealth outcomes in later life. Our research hasillustrated the mechanisms through which thisoperates – namely economic wellbeing,quality of work and processes of retirement,engagement in other productive activities inlater life, and social and cultural engagement,all of which have biological, physiological andpsychological consequences.

As such, a resounding message from ourrange of studies is that effective policyresponses to the challenges of populationageing should not be seen in isolation fromthe need to address social, economic andhealth inequalities in later life.

Indeed, a life course approach to studyingthese issues has opened up new researchdirections that enable us to link individual livesover the life span to the varying and changingsocial structures that shape all our lives.

Addressing later life inequalities will take ussome considerable way to responding to thechallenges and maximising the potential ofpopulation ageing. However, addressing theclear inequalities that exist among olderpeople, and the social injustices that underliethem, will require strong political will overcoming years.

It requires a clear understanding of the drivers of inequality and the fact that socialand health outcomes in later life are theproduct of inequalities that have developedacross the life course. But also that there arereal opportunities to address theseinequalities in later life too.

As we have shown, many factors are drivingthese inequalities which are closely related.For instance, poor working conditions and low incomes can lead to poor health in thefinal years of employment, which in turn can lead to involuntary retirement and further deterioration in socioeconomiccircumstances, wellbeing and health after retirement.

And then there are inequalities around accessto today’s modern economy and technology –with access to the internet being lower forolder people, decreasing for those who usethe internet as they get older, and being muchlower for those in poorer socioeconomiccircumstances and for women. Not havingaccess to the internet is becomingincreasingly significant as more and moreservices are automated.

Against this backdrop a criticism of the policyagenda is that the focus remains almostentirely on encouraging people to work longerand on pension reform. Not enough thought isgiven to the actual consequences of raisingstate pension ages without paying attentionto the quality of the jobs that people work in,nor to individualising pension risk withoutconsidering the implications of this foreconomic inequalities in later life.

These are precisely the kinds of issues thatpolicymakers trying to address inequalitiesamong older people need to urgently address.

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About fRaillConclusions

Research team members:

Alistair Burns, Tarani Chandola, Roy Goodacre, Michael Horan, Stephen Jivraj, Pauline McGovern,Alan Marshall, Katey Matthews, Krisztina Mekli, Neil Pendleton, Jennifer Prattley, Nicholas Rattray,Jill Sambrook, Gindo Tampubolon, Bram Vanhoutte, Iain White and Frederick Wu.

Scientific Advisory Group:

Professor Carol Jagger (University of Newcastle), Professor Rose Anne Kenny (Trinity CollegeDublin), Dr Meena Kumari (University College London), Dr George W Leeson (University of Oxford),Dr Aisling O’Halloran (Trinity College Dublin), Professor Fiona Matthews (University of Cambridge),Professor Chris Orme (The University of Manchester), Professor Chris Phillipson (The University of Manchester), David Regan (Manchester City Council), David Sinclair (ILC-UK) and Professor Andrew Steptoe (University College London).

Lay Advisory Group:

Margaret Bruce, John Dwyer, Ian Johnson, Gordon Jackson, Simon Katzenellenbogen, Jane Morris (Chair), Amy Muthra, Elaine Unegbu and Bhim Virmani.

Contributors to the report:

Rebecca Bromley, Jim Pendrill and Professor James Nazroo.

Photocredit: M

arkEpstein

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Research papersWellbeing:

Addressing inequalities in healthy life expectancy

Aging and subjective well-being in later life

Cognitive, affective and eudemonic well-being in later life:Measurement equivalence over gender and life stage

Determinants of socioeconomic inequalities in subjective well-being in later life: a cross-country comparison in Englandand the USA

Does the level of wealth inequality within an area influence the prevalence of depression amongst older people?

Duration, timing and order: How housing histories relate tolater life wellbeing (in press)

Inequalities in the Experience of Later Life: Differentials inHealth, Wealth and Wellbeing

Later-life work, Health and Wellbeing: Enduring Inequalities

Life Course Influences on Inequalities in Later Life:Comparative Perspectives

Life Course Pathways to Later Life Wellbeing: A ComparativeStudy of the Role of Socio-Economic Position in England andthe U.S.

Pathways to Wellbeing in Later Life: Socioeconomic and Health Determinants Across the Life Course of Australian Baby Boomers

Patterns and causes of health inequalities in later life: A Bourdieusian approach

Trajectories in the Prevalence of Self-Reported Illness Around Retirement

Cognition:

Cognitive Ageing in Great Britain in the New Century: Cohort Differences in Episodic Memory

National Economic Development Status May Affect theAssociation between Central Adiposity and Cognition in Older Adults

Polygenic risk for Alzheimer's disease is not associated with cognitive ability or cognitive aging in non-demented older people

Repeated systemic inflammation was associated withcognitive deficits in older Britons

Frailty and health:

Cohort differences in the levels and trajectories of frailtyamong older people in England

Does Pain Predict Frailty in Older Men and Women?

Genetic variant of Interleukin-18 gene is associated with the Frailty Index in the English Longitudinal Study of Ageing

Geographies of the impact of retirement on health in theUnited Kingdom

Growing Up in Poverty, Growing Old in Infirmity: The Long Arm of Childhood Conditions in Great Britain

Physical activity in older age: perspectives for healthy ageingand frailty

Proinflammatory genotype is associated with the frailtyphenotype in the English Longitudinal Study of Ageing

Trajectories of the healthy ageing phenotype among middle-aged and older Britons

Other:

An analysis of the demographic contributions to populationageing in England and Wales

Changes in lung function in older people from the EnglishLongitudinal Study of Ageing

Comparison of hypertension healthcare outcomes amongolder people in the USA and England

Short- and long-term determinants of social detachment in later life

Social Inequality and Visual Impairment in Older People

Systems biology guided by XCMS Online metabolomics

The consequences of self-reported vision change in later-life:evidence from the English Longitudinal Study of Ageing

The impact of volunteering on wellbeing in later life

Trajectories of vision in older people: The role of age and social position

Understanding Digital Engagement in Later Life

Volunteering, providing informal care and paid employment in later life: Role occupancy and implications for well-being

Work and Family Trajectories: Changes Across Cohorts Born in the First Half of the 20th Century

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