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Are we living longer, healthier lives?

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Singapore has one of the highest life expectancy in the world; women live an average of 83 years and men live an average of 75 years. We may be living longer, but are we living more years in poor health?

In our study1 done on older Singaporeans, we found that although we are living longer with more healthy years, we are also living more years with diseases, disability, and mobility limitations. There are also differences between men and women.

While women outlive men, they also tend to spend proportionately more years in poor health with chronic diseases (e.g. hypertension), impairments and disabilities. Men are more susceptible to life threatening diseases (e.g. heart attack, strokes)

This means that life expectancy alone is no longer a sufficient indicator of population health as people are living longer but not necessarily in good health. More years spent in poor health affects an individual’s quality of life and also translates into higher health care costs. Healthy life expectancy is another concept to measure quality of life at old age by considering the number of years a person can expect to remain healthy.

Prevalence of diseases, impairments, and functional disabilities

Health expectancies for diseases

Our study shows that women live longer at all ages and can expect more years without diseases than men for all the diseases examined.

Chart 1 shows that the remaining lifespan of women at 65 years old is around three years longer compared to men of the same age. Our findings also affirm that men generally have more life threatening diseases (e.g. heart attack and strokes) whereas women tend to suffer from more chronic and debilitating conditions. Women will spend a slightly higher proportion of their remaining life expectancy with hypertension (49%) as compared to men (45%). Nevertheless, the prevalence of hypertension is high among both men and women. This is a cause for concern as hypertension is a major risk factor for various other health problems.

Chart 1: Life expectancy at age 65 years old by years without and with diseases by gender and type of diseases


Source: Yong, Saito, and Chan (2010)

Health expectancies for impairments

Because of longer life expectancy, women generally have more years of life with and without impairments than men. Chart 2 shows that women are more susceptible to bone/joint, eye/vision, and walking problems. The largest gender difference is for bone/joint problems, where women can expect a substantially larger proportion of life with bone/joint problems (37%) compared to men (22%). The substantially higher prevalence of bone/joint problems among women may be due to lower bone density and fewer muscle mass as compared to men.

Chart 2: Life expectancy at 65 years old by years of life with and without impairment by gender and type of impairments

Health expectancies for functional disabilities

Similarly, the higher life expectancy of women also means that they have both more years of life without and with all form of functional disabilities compared to men of the same age, as seen in Chart 3. The largest gender differences at age 65 are for bathing and dressing.

Chart 3: Life expectancy at 65 years old by years of life without and with functional disabilities by gender and type of functional disabilities

Gender differences in mobility limitations

Older individuals with mobility limitations often restrict their activities and social participation which can bring about isolation, anxiety and depression. Also, older people with mobility limitations are less likely to age in place and more likely to be institutionalised. So what is the relationship between increased longevity and mobility limitations for older Singaporeans?

Proportionately more older Singaporeans (65 years and older) have mobility limitations today compared to 10 years ago (Chart 4). In particular, the proportion of women aged 80 and above who experienced mobility limitations rose sharply over the period, compared to males of their age.

Chart 4: Change in the proportion with mobility limitations by age and gender between 1995 and 2005


Note: Computed from 1995 and 2005 NSSC.

Life expectancy alone is no longer a sufficient indicator of population health as people are living longer but not necessarily in good health.

Conclusion

Although Singaporeans are living longer, we are also living more years with diseases, disability, and mobility limitations. The oldest–old (80+) and women fare worse than men.

Similar findings are also found in other countries, e.g. Japan and the United States in the 1990s (Crimmins, Hayward and Saito 1996; Chan, Zimmer and Saito 2011). The similarities point to the fact that although we have succeeded in preventing death from potentially lethal chronic diseases, we have not delayed the onset of these diseases hence more time is spent in ill health or with disability as life expectancy increases.

Ageing policies need to take on a gendered perspective in order to meet the differing needs of older male and female Singaporeans.

By 2030, there will be a significant increase in the number of oldest-old Singaporeans, and majority will be women. Our study findings point towards the need for policy-makers, healthcare providers and experts to consider the following:

  1. Greater impetus for preventive/promotion health strategies to be instituted across the life course. Poor health at younger ages will accumulate into significant health problems in later life. Health promotion strategies targeting the younger population that focus on these key chronic conditions will be a step towards ensuring better health at older ages.
  2. Gendered approach on health policies. There are significant differences in health care needs between older men and women. While women outlive men, they also tend to spend proportionately more years with chronic diseases (e.g. hypertension), impairments and disabilities. Men are more susceptible to life threatening diseases (e.g. heart attack, strokes). Therefore, ageing policies need to take on a gendered perspective to meet the differing needs of older men and women.
  3. Enabling ageing in place; more senior-friendly community. The sharp increase in prevalence of mobility limitations calls for a need to look into developing and redesigning our infrastructures to enable seniors to move around with ease and age in place. Enhancing the provision of community care services will also relieve caregiving pressure from families. Singapore has already embarked on numerous pilots to test how community-based health care can be best enhanced and how urban environments can be best redesigned.

Families will play an increasingly important role in providing caregiving support so that seniors can age in the comfort of their own homes and in the company of their loved ones. To strengthen intergenerational bonds, our beliefs in Confucius values such as filial piety must be preserved and emphasised among the younger generations, whether in schools, at homes or in the community.

While it is good news that Singapore’s rapid economic progress, together with medical advancements and increased standards of living, has allowed Singaporeans to enjoy significant improvements in life expectancy, we should also strive towards increasing the healthy life expectancy of our seniors so that they can truly enjoy good quality of life during their silver years, as we have envisioned under the Action Plan for Successful Ageing. As a small country, Singapore has come a long way in achieving where we are today. I am confident that if everyone - self, government and community-at-large - put our minds to it, our seniors will do well in being the healthy active-agers that the world can learn from.

1 Yong, V., Y. Saito, and A. Chan. 2011. “Gender differences in health and health expectancies of older adults in Singapore: an examination of diseases, impairments and functinal disabilities.” Journal of Cross-Cultural Gerontology 26:189-203; Yong, V., Y. Saito, and A. Chan. 2010”Changes in the prevalence of mobility limitations and mobile life expectancy of older adults in Singapore, 1995-2005”. Journal of Aging and Health 22:120-140

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