Women Face Much Different Challenges than Men in Aging Process

USDA Photo April 17, 2007 – “Older women live longer, develop different chronic conditions, and experience a higher prevalence of functional limitations than older men,” says Kristen Robinson, Ph.D., in the introduction to her new report published by the National Center for Health Statistics – “Trends in Health Status and Health Care Use Among Older Women.”

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“Maintaining good health enables older people to remain independent, stay socially engaged, and enjoy a good quality of life. Older women, however, face distinctly different challenges to maintaining their health compared with older men,” says Robinson.

She does, however, find many favorable trends in the health status of older women.

“Longevity has continued to increase, though at a slower rate for women than men; obesity rates that were going up for both older women and men have leveled off over the past 5 years; and although a higher percentage of older women reported needing help with personal care and routine care activities than older men, evidence from several studies suggest that rates of the need for help with functional limitations have declined for both women and men.”

But, she notes, “Because women live longer and experience more functional limitations than men, the financing and provision of their health care, and specifically long-term care, is a particularly important issue for older women.

“With fewer older women than men having a spouse they can rely on as a primary caregiver, older women are more dependent upon other informal (unpaid) caregivers (i.e., adult children, other family members, and friends); have a stronger need for community-based services (i.e., senior centers and convenient transportation); and a greater reliance on formal (paid) care services (i.e., home health care and nursing home care).”

Following are highlights from the report. Robinson said awareness of this information may enable the health care needs of older women to be addressed more effectively.

Demographic characteristics

● Women are the majority in the older population.

In 2005, there were 21 million women aged 65 years and over living in the United States, compared with 15 million men. Older women represented over one-half (58 percent) of the population aged 65 years and over, more than two-thirds (69 percent) of the population aged 85 years and over, and 80 percent of the population aged 100 years and over.

Between 1950 and 2005 the number of women aged 65 years and over more than tripled, increasing from 6.5 million to 21 million (1,2). Moreover, the U.S. Census Bureau projects that by 2030, the number of women aged 65 years and over will double to 40 million, and by 2050 it will reach 48 million (3). Between 1950 and 2005, the sex ratio for people aged 65 years and over changed from 90 men per 100 women to 72 men per 100 women and for people aged 85 years and over, from 70 men per 100 women to 46 men per 100 women.

● The large majority of older women are non-Hispanic white, but the share of other racial and ethnic groups will grow.

Older women do not yet reflect the racial and ethnic diversity that exists among younger generations of women. In 2005, 81 percent of women aged 65 years and over were non-Hispanic white. This percentage increases to 85 percent for women aged 85 years and over.

● A large percentage of older women are living alone.

Because women generally marry men older than themselves, and men have lower average life expectancies, women aged 65 years and over are more likely to be widowed (43 percent) than older men (13 percent) (6). Consequently, there are more older women living alone (38 percent) than older men (19 percent), and the percentage of older women living alone increases with age.

● Overall life expectancy continues to improve, and the gap between men and women is narrowing.

In 2004, the average life expectancy at birth for women was 80.4 years compared with 75.2 years for men. The difference in life expectancy between women and men was 2.9 years at age 65 (20.0 years and 17.1 years, respectively), and a little more than 1 year at age 85 (7.2 years and 6.1 years, respectively). The gap in life expectancy at birth between women and men has decreased from 7.8 years to 5.2 years since 1979

● Leading causes of death among older women differ by race and ethnicity.

In 2004, the five leading causes of death for women aged 65 years and over were Diseases of heart (heart disease), Malignant neoplasms (cancer), Cerebrovascular diseases (stroke), Chronic lower respiratory diseases (CLRD), and Alzheimer’s disease. The leading causes of death for older men were heart disease, cancer, CLRD, stroke, and Diabetes mellitus (diabetes). Although heart disease, cancer, and stroke were the top three causes of death among all racial and ethnic groups, diabetes was a more prominent cause of death among older minority women.

● Some chronic conditions are more prevalent among older women than men.

Chronic conditions are often defined as diseases or illnesses that afflict people for at least 3 months and are rarely cured. In 2004–2005, age-adjusted estimates show the diagnosed chronic conditions that were more prevalent among older women compared with men included hypertension (51 percent for women, 45 percent for men); arthritis (51 percent for women, 40 percent for men); asthma (11 percent for women, 9 percent for men); and chronic bronchitis (6 percent for women, 5 percent for men).

The “ever-diagnosed” conditions that were more prevalent among older men than older women included heart disease (33 percent for men, 26 percent for women); cancer (23 percent for men, 18 percent for women); diabetes (17 percent for men, 15 percent for women); and emphysema (6 percent for men, 4 percent for women).

> Older women are more likely than older men to have a health problem that requires special equipment such as a cane, a wheelchair, a special bed, or a special telephone. In 2004–2005, 19 percent of women aged 65 years and over (age adjusted) had a health problem that required special equipment compared with 15 percent of men

● Osteoporosis is a silent threat to women.

Using data from the third NHANES, it is estimated that 5 million noninstitutionalized women aged 50 years and over in the United States had osteoporosis in 1988–1994. An additional 14 million women aged 50 years and over were at risk for the disease due to their low bone mass (a condition called osteopenia). Numbers would be higher today, given the aging of the population, even if age specific rates have not increased.

● A higher percentage of older women needed help with personal care and routine care needs than older men.

Personal Care

Overall, among the noninstitutionalized population, a higher percentage of older women needed assistance with personal care and routine care needs than older men. In 2005, 8 percent of women aged 65 years and over (age adjusted) reported they needed help with personal care needs, compared with 5 percent of men.

The percentage of people who needed help with personal care needs was higher for older age groups. In 2005, 4 percent of women aged 65–74 years reported that they needed assistance with personal care needs compared with 20 percent of those aged 85 years and over. Similarly, 3 percent of men aged 65–74 years reported they needed assistance, compared with 17 percent of those aged 85 years and over

Routine Care

A higher percentage of older women were also more likely to have reported that they needed help with routine care needs, such as everyday household chores and shopping, than older men. In 2005, 15 percent of women aged 65 years and over (age adjusted) reported that they needed help with routine care needs, compared with 9 percent of men.

The percentage of people who needed help with routine care needs was higher for older age groups. In 2005, 8 percent of women aged 65–74 years reported that they needed assistance with routine care needs compared with 37 percent of those aged 85 years and over. Similarly, 4 percent of men aged 65–74 years reported they needed assistance compared with 27 percent of those aged 85 years and over

Health risk factors and behaviors

Smoking

● Less than 10 percent of older women are current smokers.

Between 1965 and 2004–2005, the percentage of noninstitutionalized women aged 65 years and over (age adjusted) who were current cigarette smokers rose from 8 percent in 1965 to 13 percent in the mid-1980s, and then decreased back to 8 percent in 2004–2005.

The percentage of older men who smoked decreased from 25 percent in 1965 to 9 percent in 2004–2005

Alcohol consumption

● Older women are less likely than older men to be heavy drinkers.

Older men are considerably more likely than older women to have had five or more drinks in 1 day at least once in the past year. In 2005, 7 percent of noninstitutionalized men aged 65 years and over reported having had five or more drinks in 1 day at least once in the past year compared with 1 percent of women.

Obesity

● Like the rest of the population, older men and women are heavier now than they were a decade ago.

As with other age groups, the percentage of people aged 65 years and over who are obese has increased since 1988–1994. In 2003–2004, 36 percent of noninstitutionalized women aged 65–74 years and 24 percent of women aged 75 years and over were obese. This is an increase from 1988–1994, when 27 percent of women aged 65–74 years and 19 percent of women aged 75 years and over were obese.

Older men follow similar trends; 24 percent of men aged 65–74 years and 13 percent of men aged 75 years and over were obese in 1988–1994, compared with 33 percent of men aged 65–74 years and 23 percent of men aged 75 years and over in 2003–2004 (23). Over the past 5 years, the trend has leveled off, with no statistically significant change in obesity for older men or women between 1999–2000 and 2003–2004.

Physical activity

● Older women and men have low levels of physical activity.

In 2004–2005, 22 percent of noninstitutionalized people aged 65 years and over (age adjusted) engaged in regular leisure-time physical activity. Men were more likely to exercise than women, although regular physical activity levels were low for both men and women. For example, 20 percent of women aged 65 years and over (age adjusted) participated in physical activity, compared with 25 percent of men.

Influenza and pneumococcal vaccinations

● Vaccination rates for both older men and women are below the Healthy People 2010 targets of the U.S. Department of Health and Human Services.

The U.S. Department of Health and Human Services recommends that people aged 65 years and over receive an influenza vaccination each year and a pneumoccoccal vaccination at least once after they reach age 65.

The Healthy People 2010 target for people aged 65 years and over receiving both influenza vaccination each year and a pneumoccoccal vaccination is 90 percent, which neither men nor women have achieved. Older women and men are equally likely to receive an influenza vaccination. In 2004–2005, 62 percent of noninstitutionalized women and men aged 65 years and over (age adjusted) reported receiving an influenza vaccination during the past 12 months.

Women, however, are slightly more likely to receive a pneumococcal vaccination than men. In 2004–2005, 58 percent of women and 55 percent of men aged 65 years and over (age adjusted) reported ever receiving a pneumococcal vaccination

Health care

Utilization of medical care

● Older women have hospital stays less often than older men.

In 2005, 97 percent of noninstitutionalized women aged 65 years and over said they had a usual place to go for medical care, whereas less than 3 percent said they failed to obtain needed medical care during the past 12 months due to financial barriers. Older men reported similar rates.

Older women also visited office-based physicians at about the same rate as older men. In 2003–2004, women aged 65 years and over had 674 office-based physician visits per 1,000 (age adjusted), compared with 679 visits per 1,000 for men. But in 2004, men aged 65 years and over had higher hospital discharge rates (4,820 per 10,000) (age adjusted) than women (4,036 per 10,000) (11).

Source of payment

● Older men and women rely on different sources of payment for their health care.

Although most older people are covered by Medicare, that program pays for only slightly over one-half (53 percent) of the health care costs incurred by older Americans. Medicare-covered services are subject to cost-sharing through deductibles and coinsurance. About 90 percent of Medicare enrollees also have supplemental insurance coverage, Medicaid, or are in a Medicare HMO, so these plans often cover Medicare cost-sharing.

Older women use more health services than men ($12,176 compared with $11,329 (age adjusted) per person in 2003) and because women use more long-term care, which Medicare does not cover, a greater amount of their care is paid out of pocket or by Medicaid.

In 2003, out of pocket payments (out of pocket payments include direct payments to providers by sample person or proxy. These payments are for coinsurance amounts, co-payments, deductibles, balance billings and charges for non-Medicare covered services not paid for by public or private insurance plans) for personal health care were $2,445 and Medicaid payments were $1,272 for women aged 65 years and over (age adjusted), compared with $1,953 and $722 for men.

Home health care and long-term care

● Older women utilize more home health care and long-term care than older men.

Older women have higher average expenditures for home health care services and long-term care than men because they make up a higher proportion of the older and frailer population, need more help with both personal care needs and routine needs, and are less likely to have a spouse available to help them.

In 2000, the rate of home health care discharges for any service was 1,521 per 10,000 for women aged 65 years and over (age adjusted) compared with 1,230 per 10,000 for men.

Likewise, in 2004, there were almost 1 million women aged 65 years and over living in nursing homes compared with fewer than 400,000 men. The rate of nursing home utilization increases with age. For example, the rate of nursing home residence in 2004 was 10 per 1,000 population for women aged 65–74; 42 per 1,000 population for women aged 75–84; and 165 per 1,000 population for women aged 85 years and over. The overall rate of nursing home utilization for women aged 65 years and over has decreased over time, from 68 per 1,000 population in 1973–1974 to 40 per 1,000 population in 2004 (age adjusted)

Editor’s Notes:

>> For the complete report, click here (12 pages, pdf)

Source: Kristen Robinson, Ph.D., Office of Analysis and Epidemiology. Trends in health status and health care use among older women. Aging Trends, no 7. Hyattsville, MD: National Center for Health Statistics. 2007.

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