Successful ageing from old to very old: a longitudinal study of 12,432 women from Australia

Abstract

Objectives We examined the development of disease and disability in a large cohort of older women, the extent to which these conditions exempt them from being classified as successful agers and different trajectories of disease, disability and longevity across women’s later life. Methods We used survey data from 12,432 participants of the 1921–26 birth cohort of the Australian Longitudinal Study of Women’s Health from 1996 (age 70–75) to 2016 (age 90–95). Repeated measures latent class analysis (RMLCA) identified trajectories of the development of disease with or without disability and according to longevity. Bivariate analyses and multivariable multinomial logistic regression models were used to examine the association between participants’ baseline characteristics and membership of the latent classes. Results Over one-third of women could be considered to be successful agers when in their early 70s, few women could still be classified in this category throughout their later life or by the end of the study when they were in their 90s (~1%). RMLCA identified six trajectory groups including managed agers long survivors (9.0%) with disease but little disability, usual agers long survivors (14.9%) with disease and disability, usual agers (26.6%) and early mortality (25.7%). A small group of women having no major disease or disability well into their 80s were identified as successful agers (5.5%). A final group, missing surveys (18.3%), had a high rate of non-death attrition. Groups were differentiated by a number of social and health factors including marital status, education, smoking, body mass index, exercise and social support. Conclusions The study shows different trajectories of disease and disability in a cohort of ageing women, over time and through to very old ages. While some women continue into very old age with no disease or disability, many more women live long with disease but little disability, remaining independent beyond their capacity to be classified as successful agers.

Estimating the effect of health assessments on mortality, physical functioning and health care utilisation for women aged 75 years and older

“…Ascertainment of physical functioning outcomes was less complete as this was dependent on participation in the survey. Attrition rates for ALSWH are around 10% for each survey and have been reported elsewhere [30][31][32][33].…”

Onset and progression of chronic disease and disability in a large cohort of older Australian women

“…Consequently, we were unable to measure the health status of those who did not participate in the subsequent surveys after the baseline survey. It is likely that these women had higher rates of morbidity (also observed in the current study) and potentially with more disease and disability problems [1]. Given that, the length of life with chronic disease but no disability and life with disability could be underestimated in our study.…”

“…There is a high probability that many older people will develop disease, they will live with disease for many years, and they are likely to develop disability and to live with disability for more years. An earlier study on this cohort identified a small proportion of women as 'successful agers' who had no disease and disability until their age 90-95 [1]. The Georgia aging study on centenarians also classified some small percentage of people as 'escapers' who have no disease and disability [26].…”

“…In accordance with substantial gains in life expectancy over past decades, there has been an increasing interest on optimizing good health and functioning in the older population [1,2]. It is the ideal for individuals to age without major chronic disease and/or disability, with consequent reductions in health care costs as well as the need for long-term care [3].…”

Housing and Care for Older Women in Australia

“…The later period of life can be associated with increasing burden of disease and disability, decline in physical function, decreased capacity for well-being and quality of life, reduced social participation and increased needs for health and social care. However, as shown by , Leigh (2017), and others, there is great heterogeneity of ageing experience, although many people will experience some decline in physical function as they age (14,15). Figure 1 shows the conceptual relationships between physical functioning, housing pathways, and the needs for care as people age (care pathways).…”