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Women's health across the life course and across the generations

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Professor Byles’ research focus is on how people can age well, with an eye to understanding the factors that influence and promote healthy ageing.

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Women's health across the life course and across the generations

  1. 1. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Women’s health across the life-course and across the generations – Lessons from Australia International Longevity Centre-UK
  2. 2. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Welcome Yvonne Sonsino Partner at Mercer, Innovation Leader Europac
  3. 3. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Women’s health across the life- course and across the generations Professor Julie Byles Director, Australian Longitudinal Study on Women’s Health, School of Medicine and Public Health, The University of Newcastle - Australia
  4. 4. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Women’s health over the life-course and across the generations – Lessons from Australia Professor Julie Byles Global Innovation Chair in Responsive Transitions in Health and Ageing Head, ILC - Australia
  5. 5. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Australian Longitudinal Study on Women’s Health To examine social, psychological, physical and environmental factors which determine good health, and those which cause ill-health, in women throughout adult life – physical and mental health, symptoms, diagnoses – health service use, access and satisfaction – health related behaviours – social factors related to health and well-being  To contribute to development of policy and practice in key areas for women’s health – National Health Priority Areas – Health Targets e.g. Continence, Quality Use of Medicines, National Tobacco Strategy, Obesity Taskforce, Framework for Physical Activity, Mental Health, Abuse, Dementia, End of Life ... Funded by the Australian Department of Health 1996-2021 … www.alswh.org.au
  6. 6. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 2 58 PhDs conferred 19 Masters theses 18 Honours theses 680+ peer reviewed papers 1200+ researchers worldwide 470+ active data users 100+ substudies 8 current substudies Collaborators Substudies Students Publications & Policy 50+ reports for government Input into major health policies A National Research Resource 1996-2017 20+ YEARS 58000 Women Australian Longitudinal Study on Women’s Health 58 PhDs conferred 19 Masters theses 18 Honours theses 680+ peer reviewed papers 1200+ researchers worldwide 470+ active data users 100+ substudies 8 current substudies Collaborators Substudies Students Publications & Policy 50+ reports for government Input into major health policies A National Research Resource 1996-2017 20+ YEARS 58000 Women 680+ peer reviewed papers 1200+ researchers worldwide 470+ active data users Collaborators Publications & Policy 50+ reports for government Input into major health policies A National Research Resource 1996-2017 20+ YEARS 58000 Women 2 58 PhDs conferred 19 Masters theses 18 Honours theses 680+ peer reviewed papers 1200+ researchers worldwide 470+ active data users 100+ substudies 8 current substudies Collaborators Substudies Students Publications & Policy 50+ reports for government Input into major health policies A National Research Resource 1996-2017 20+ YEARS 58000 Women Australian Longitudinal Study on Women’s Health 58 Ph 19 M 18 Ho 680+ 1200+ 470+ 100+ 8 curr Collaborators Substudies Students Publications & Policy 50+ re Input A 1996 – 2018 ….. 58 PhDs conferred 19 Masters theses 18 Honours theses 680+ peer reviewed pap 1200+ researchers world 470+ active data users 100+ substudies 8 current substudies Collaborators Substudies Students Publications & Policy 50+ reports for governm Input into major health p A National Research Resour 1996-201 20+ YEARS 58000 Women Australian Longitudin on Women’ 2 58 PhDs conferred 19 Masters theses 18 Honours theses 680+ peer reviewed papers 1200+ researchers worldwide 470+ active data users 100+ substudies 8 current substudies Collaborators Substudies Students Publications & Policy 50+ reports for government Input into major health policies A National Research Resource 1996-2017 20+ YEARS 58000 Women Australian Longitudinal Study on Women’s Health Four cohorts of women • 1921-26 • 1946-51 • 1973-78 • 1989-95 Sampled from Medicare National health insurance data base Oversampling from rural and remote areas
  7. 7. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  8. 8. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 1996 1973-78 18-23 1946-51 45-50 1921-26 70-75 14247 13716 12432 Three Cohorts, over 40,000 women, Three generations of women’s health Australian Longitudinal Study on Women’s Health, 1996 1996
  9. 9. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 2018 1989-95 23-38 1973-78 40-45 1946-51 67-72 1921-26 92-97 Four Cohorts, over 58,000 women, Four generations of women’s health Australian Longitudinal Study on Women’s Health, 2018 2018
  10. 10. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 1921-26: 3 yearly Postal Surveys … 6 monthly 70-75………85-90 ………90+ Conditions/ symptoms/ procedures, Health Care Use, medications, Health Insurance, SF-36 quality of life, depression/anxiety, smoking alcohol, BMI, physical activity, diet, sleep, life events, marital status, living arrangements, housing, abuse, manage on income, caring, support, optimism … .. continence, memory, falls, teeth, services, transport, ADLs, housing, volunteering, age discrimination, social activities Surveys and data books www.alswh.org.au
  11. 11. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Have we missed anything?  Free text comments  Qualitative data – allows us to get a sense of how women cope with their everyday, as they age and relation to life events  Eg. Kennaugh R, Byles J, Tavener M. Beyond widowhood: Do prior discovered themes that describe the experiences of older Australian widowed women persist over time? Women and Health, 2016; 56(7): 827-42.  56% of the women  1,239,859 words  women who wrote tended to have lower physical function, poorer general health and lower social function than women who did not write- except for women > 82-87, where there were no differences.  Wide range of experiences  Consistent narrative
  12. 12. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. ALSWH offspring, linkages and other extensions Australian Longitudinal Study on Women’s Health INTERnational Collaboration for a Life Course Approach to reproductive health and chronic disease Events: Interlace (NHMRC) DYNOPTA Men, Women and Ageing: MWA (NHMRC) MBS/PBS Hospital data Cancer Registry ACAP/HACC/R AC Blood, Body Mass/ bone density, Blood Pressure Mothers and their Children’s Health: MatCH (NHMRC) Internet surveys and mobile apps Substudies Qualitative data 1989-95 – 1 yearly 1973-78 – 3 yearly 1946-51 – 3 yearly 1921-26 – 6 monthly Future health services use and aged care needs Pooled data Linked data New cohortsPhysical data Data collection/ Further Follow up Projections
  13. 13. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 1996 1973-78 18-23 1946-51 45-50 1921-26 70-75 14247 13716 12432 Three Cohorts, over 40,000 women, Three generations of women’s health Australian Longitudinal Study on Women’s Health Baseline Survey 1996 1996
  14. 14. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Age and health-related quality of life SF36 0 10 20 30 40 50 60 70 80 90 100 1973-78 1946-51 1921-26
  15. 15. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 2018 1989-95 23-38 1973-78 40-45 1946-51 67-72 1921-26 92-97 Four Cohorts, over 58,000 women, Four generations of women’s health Australian Longitudinal Study on Women’s Health Change in Physical Function Scores 2018
  16. 16. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Changes in SF36 PF scores (trends) 1973-78 1946-51 1921-26 Menstrual, Contraception Fertility, PCOS Pregnancy, BMI, diet, smoking Mental Health Menopause Arthritis Breast Cancer Hypertension Work/retirement Chronic disease, multimorbidity, disability, Falls, need for care, bereavement, social isolation Social circumstances, health behaviours, health care use
  17. 17. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Deaths by April 2016 1973-78 1946-51 971 7% 1921-26 9318 75% - 20% Coronary Heart Disease - 11% CVD - 6% other heart disease - 7% Alzheimer/Dementia - 4% COPD - 3% Diabetes (all cancers 23.5 %) 118 1% - 17% Breast Cancer - 10% Lung Cancer - 5% Colorectal Cancer - 5% CVD - 5% Ovarian Cancer
  18. 18. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Changes in Physical Function Surveys 1-6 6MF Vigorous activities Walk 1km Climb stairs Carry groceries Walk 100m Bath/ feed self 9% need help with daily tasks 34% need help with daily tasks 17% provide care 13% provide care >50% drive car ~77% live in house 19% live in apartment <35% drive car ~ 58% live in house 20% live in apartment 15% retirement village 1921-26 cohort: Are these women ageing well? Successful ageing? Healthy Ageing? 17% diabetes 70% arthritis 17% asthma 40% heart disease 70% hypertension 12% stroke (29% dementia)
  19. 19. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. ALSWH Survey Participated in the Survey Died Until Survey Not participated in the survey No need of help with daily task (%) Physical function score>40 (%) No major chronic conditions* (%) Successful ageing (%) Survey 1 70-75 12,432 - - 9137 80.42 60.24 52.22 Survey 2 10,434 639 1,359 8958 80.24 33.40 30.54 Survey 3 8,647 1351 2,434 8696 73.72 23.32 21.14 Survey 4 7,158 2407 2,867 8754 67.66 17.27 15.28 Survey 5 5,560 3737 3,135 83.29 60.68 14.91 12.64 Survey 6 85-90 4,055 5387 2,990 77.99 52.95 11.69 9.45 *includes arthritis of any kinds, heart diseases, stroke, diabetes, asthma, and cancer (excluding skin cancer), and the conditions are considered as enduring i.e. if Yes at one earlier survey, then Yes for all later surveys “Successful” Ageing S4
  20. 20. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Successful ageing and physical function (S4 79-84) 0 10 20 30 40 50 60 70 80 90 Vigorous walk >1K Climbing several stairs Moderate Bending walk 1/2K Lifting Climbing one flight of stairs Walk 100m Bathing SF36 items limited a lot Successful Not
  21. 21. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Successful ageing and ADL disability (S4 79-84) 0 5 10 15 20 25 30 35 40 Toilet Eating Grooming Dressing upper body Dressing lower body Bathing Walking in house Transfer Difficulty on ADL Successful Not
  22. 22. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. http://www.who.int/ageing/events/world-report-2015-launch/en/ Healthy ageing
  23. 23. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Patterns of change in physical function (n= 5928 surviving women) ) 14% 33% 38% 15% Leigh L, Byles JE, Mishra GD. Change in physical function among women as they age: Findings from the Australian Longitudinal Study on Women’s Health. Quality of Life Research. 2017; 26(4): 981-991.
  24. 24. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Patterns of change in physical function (n= 5928 surviving women ) 14% 33% 38% 15% Baseline factors associated with POOR Physical Function (Odds Ratio) EDUCATION - Higher education (OR 0.38) 62% less likely to have poor PF EXERCISE – Highest PA class (OR 0.04) 96% less likely to have poor PF Low PA class (OR 0.19) 81% less likely to have poor PF (OR 0.19) BMI - Overweight (OR 5.02) - Obese (OR 26.2) SMOKING - Current smoker (OR 2.9) Leigh, Byles, Mishra 2016
  25. 25. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. BMI and Healthy Life Expectancy Leigh L, Byles JE, Jagger C. BMI and healthy life expectancy in old and very old women. British Journal of Nutrition, 2016; 116(4): 692-9. TLE 15.75 HLE 10.63 years TLE 12.37 HLE 8.17 years TLE 14.66 HLE 8.08 years TLE 15.94 HLE 9.84 years
  26. 26. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Patterns of change in physical function (n= 5928 surviving women ) 14% 33% 38% 15% Baseline factors associated with POOR Physical Function (Odds Ratio) DISEASE Arthritis (OR 11.1), Stroke (OR 4.4), Osteoporosis (OR 4.3), Heart Disease (OR 4.9), Diabetes (OR 3.5), Hypertension (OR 3.2), Bronchitis/emphysema (OR 2.4) Asthma (OR 2.0). COMORBIDITY OR ~ 3.0 Leigh, Byles, Mishra 2016
  27. 27. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Multiple morbidity 1921-26 cohort 5% diabetes 41% arthritis 12% asthma 12% heart disease 3% stroke 48% hypertension 17% diabetes 70% arthritis 17% asthma 40% heart disease 12% stroke 70% hypertension (29% dementia)
  28. 28. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  29. 29. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. What do the women’s comments tell us about ageing well? Comments from random samples of women:  health rated good/very good/excellent (Good) at Survey 1-5 (GGGGG)  health rated Good at Survey 1 but later rated Fair/poor (Poor) (eg. GGGGP, GGGPP, GGPPP, GPPPP).  health rated Poor at Survey 1 -5 (PPPPP)  Health rated Poor at survey 1 but later rated Good (eg. PGGGG, PPGGG, PPPGG, PPPPG).
  30. 30. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Health – not without physical problems Injuries – brought on by their own activities Setbacks- likely to improve. Conditions described as minor (even if not) Positive outcomes of health care Longstanding health problems. More pessimistic about getting over events and illnesses. Vitality – Active and fit Some slowing down with ageing. Slowing down “everything is gradually wearing out” (s3) Participation _Active Passive Dancing, gardening, volunteer work reading Life satisfaction and Identity Generally satisfied with life. Belief in themselves and proud of achievements whether maternal, domestic or professional Content “Pathetic” Not bored. Good Health Poor Health
  31. 31. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Health Care – Active and involved Less active Generally satisfied with health care Trust doctors, health care systems, and therapies. Some concern with access to health care. Some using CAM: “I seek natural therapies” Difficulty accessing health care. Difficulty affording health care. Mistrust. Mobility and physical function – Can do Can’t do Adapt to increasing difficulties and limitations to physical function. Generally still able to drive Describe what they can’t do (rather than what they can do or hope to do) Talked about not being able to drive Social Positive relationships, supportive family, good friends May be caring for husband Negative as well as positive relationships Difficulty maintaining relationships Carer burden / Loss of spouse. Optimistic Less optimistic Internal locus of control “I keep well” “I don’t sit and wait for things to happen” “you reap what you sew” “hope” “grateful” ‘Lucky” “Fortunate” “I hope I will not be around for the next survey. I have no desire to stay alive when I can no longer function independently” (s3) Good Health Poor Health
  32. 32. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Impact of Ageing on Health and Aged Care Use - GP Visits - Pathology Services - Specialists visits - Hospital admissions - Aged Care 2018
  33. 33. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. https://www.alswh.org.au Byles et al. Major Report to Department of Health, 2017 Increase in number of GP visits across four cohorts Figure 3-1. Mean annual number of GP services by women across the life course (1989-95, 1973- 78, 1946-51, 1921-26 cohorts). 1 1989-95 cohortOriginal ALSWH cohorts 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60 63 66 69 72 75 78 81 84 87 90 Average age 0 5 10 15 20 MeanMBSclaims 1973-78 cohort 1946-51 cohort 1921-26 cohort
  34. 34. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 115 26 cohort who were in their last 12 months of life and those who were not (Figure 6-13). However, from the age of 81, the number of GP services by women in their last 12 months of life was much higher than for other women of the same age who were not in their last year of life. This difference became greater with increases in age, largely due to progressively fewer services being used by surviving women at the oldest ages. Figure 6-13. Mean annual number of GP services by women in the 1921-26 cohort, classified according to whether women are in the last year of life. YesNo12 months before death 70 75 80 85 90 95 Age 0 5 10 15 20 MeanMBSclaims 1921-26 cohort https://www.alswh.org.au Byles et al. Major Report to Department of Health, 2017
  35. 35. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Hospital use 1936 surviving women NSW Hospital Data Four-class LCA model representing hospital admission profiles from 2001-2010 for surviving women from the 1921- 1926 cohort (Dolja Gore, Harris, Kendig and Byles 2015) 17% 21% 38% 25% Not in urban areas, widowed, Arthritis, Heart disease, stroke, COPD, Poor PF, More likely to die in next 2 years Fall Less hypertension, less UI
  36. 36. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Percentage of women who were admitted to hospital each month: heart disease, with or without dementia (unpublished data) HOSPITAL USE LAST 2 YRS OF LIFE WOMEN WITH HEART DISEASE 24 months before death death
  37. 37. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. HOSPITAL USE LAST 2 YRS OF LIFE Percentage of women who were admitted to hospital each month: stroke, with or without dementia. death24 months before death WOMEN WITH STROKE
  38. 38. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Rahman 2017 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 %OFWOMEN YEAR Basic HACC High-level HACC and CACP RAC Non-user Death 74-79 85-90 ALSWH Long Term Care Use 2001-11 (n=12,432) 23% Died no RAC 30% RAC Forder et al. 2017
  39. 39. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Percentage of women in Permanent Residential Care for each month: heart disease, with or without dementia. death24 months before death
  40. 40. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Percentage of women in Permanent Residential Care for each month: stroke, with or without dementia. 24 months before death death
  41. 41. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 2018 1989-95 23-38 1973-78 40-45 1946-51 67-72 1921-26 92-97 Four Cohorts, over 58,000 women, Four generations of women’s health Australian Longitudinal Study on Women’s Health Prospects for future generations 2018
  42. 42. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 18 21 20 23 26 29 32 35 38 41 44 47 50 53 56 59 62 65 68 71 74 77 80 83 86 89 Average age at survey 20 25 30MeanBMI 1989-95 1973-78 cohort 1946-51 cohort 1921-26 cohort Trends in health risks: overtime and across successive cohorts Ow/obese 32% 20% 45% 45% 63% 47% 43% Smoke 19% 26.5% 13% 15% 5% Diabetes 1% <1% 3% 3% 12.5% 5% 17% Arthritis 20% 51% 41% 70% Smoke less .. … heavier …… more chronic disease
  43. 43. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. … 20 years on More diabetes, more heart disease, more arthritis, more asthma, decreased workability, more health care use … need for preventive health care is greater than ever. Note that there are no projections for the 1921-26 cohort as they have all reached the age of 90, which is the maximum age for our analyses. Figure 4-3: Average BMI projections from 2015 to 2035 for each cohort (1989-95, 1973-78, 1946-51, and 1921-26). The circles represent actual data from ALSWH and the lines represent the predicted change in mean BMI for each cohort separately for the next 20 years. 4.4. Projected obesity prevalence over the next 20 years Other studies have shown that excess burden on the healthcare system is largely associated with obesity rather than overweight (Korda et al., 2015). Therefore, the focus of the following analyses is on obesity and the impact of obesity on healthcare service utilisation. To forecast the prevalence of obesity by age for each cohort over the next twenty years, a generalised linear mixed model was fitted to the data using a log-log link function (Figure 4-4; Appendix 10 20 30 40 50 60 70 80 90 100 Age 20 22 24 26 28 30 MeanBMI PredictedObserved
  44. 44. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Acknowledgements ALSWH is funded by the Australian Government Department of Health. We are grateful to the women who participate in ALSWH by providing survey data.
  45. 45. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. www.alswh.org.au
  46. 46. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Discussion
  47. 47. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Women’s health across the life-course and across the generations – Lessons from Australia International Longevity Centre-UK

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