Three Aspects of Health, Well-Being, and the Effective Functioning of the Elderly

The aging of the baby-boom generation has focused increasing attention on a variety of issues that influence the health, well-being, and effective functioning of older individuals. Responding to the need for a better understanding of the special concerns of this population, researchers at the RAND Center for the Study of Aging recently examined three factors that had not previously received adequate attention: (1) the effects of childbearing on women's health later in life, (2) the relationship between poor vision and well-being of older individuals, and (3) the effect of socioeconomic and health issues on the driving patterns of the elderly.

Childbearing and Health

Childbearing has often been thought to have a beneficial effect on a woman's health, primarily because it reduces the risk of breast, endometrial, and ovarian cancer. This advantage may arise from the woman's increased contact with the medical system, making her more likely to seek health care when she needs it. Beyond that, it has traditionally been assumed that childbearing provides quality-of-life benefits during a woman's later years because a woman with adult children may receive levels of social support that are higher than those available to women without children. However, contrary to such traditional beliefs, the results of a RAND study indicate that childbearing may have an overall negative effect on the health and well-being of women as they grow older.^[1]

The study describes the relationship between a woman's history of pregnancies and her eventual health and socioeconomic situation. Based on data from a nationwide survey of families and on supplementary information on the childbearing histories of women aged 50 and older, the research shows that women who bore six or more children are likely to suffer poorer health in later years than those women who had fewer children or no children at all. The study also indicates that the women who gave birth to at least six children will most likely be disadvantaged in other important ways—having lower levels of education, household income, and general wealth.

Additionally, the new research identifies two other contexts in which reproductive history is associated with poor health status: women who lost a child during the first year of its life and women who delivered their first child before they reached 18 years of age both had an increased likelihood of poor health at age 50 and beyond. Overall, the findings suggest that continued research into reproductive patterns should lead to a growing understanding of the health and welfare of women over the full cycle of their lives.

Vision Problems

Quality of vision has long been considered a profound influence on the well-being of older individuals. Few studies, however, have attempted to examine the relationship between self-reported "trouble seeing" and other serious issues. Using a national survey of adults aged 50 and over, RAND researchers looked into this relationship and found that the consequences of vision problems are more serious than had been believed.^[2]

The researchers found that elderly individuals who complain about deterioration of vision, even with glasses or contact lenses, are also likely to have trouble maintaining social contacts and continuing their normal activities. The impact of "trouble seeing" (a subjective evaluation that describes an individual's sense of deteriorating vision and does not typically suggest legal blindness) is so severe, in fact, that it has a greater effect on general health and quality of life than such debilitating conditions as paralysis, incontinence, heart disease, kidney disease, or diabetes.

The crucial nature of vision problems for the elderly suggests that policymakers may wish to make Medicare-covered cataract surgery more readily available to senior citizens. At present, before such surgery can be approved, individuals must demonstrate that their cataracts are serious enough to cause basic functional limitations such as an inability to bathe, dress, use the toilet, walk within the home, and eat. Given these new findings about the far-reaching impact of poor vision on the lives of older people, it seems likely that earlier approval for surgery would help seniors stay healthier, more active, and more socially involved.

Additionally, the researchers propose that future surveys measuring disabilities should include general questions about a person's capacity to continue normal life activities. Questions of this type would help those who study the problem more fully understand the impact of a specific condition or disease and enable them to gain insights into how this impact may be mitigated. Such results might then inform policymakers about which interventions would bring the greatest benefits to the elderly.

Driving Patterns

Why do some elderly people give up driving while others continue to drive? And once individuals stop driving, who assumes the responsibility for driving them?

In the first study of its kind, RAND researchers attempted to answer such questions by examining a range of interrelated lifestyle and health factors that affect driving decisions of those aged 50 and over.^[3] Using extensive data from reports on driving habits included in a health supplement questionnaire of a nationwide survey, the study considered age, sex, race, education, marital status, household income, and the number of adults living in a home. Additionally, researchers accounted for health status and for an individual's area of residence, differentiating for region of the country and for urban versus rural environment.

The results show that, contrary to earlier assumptions, most seniors do not stop driving because of a single health factor such as a chronic illness, but because of a variety of lifestyle and health issues. In general, the elderly who quit driving fall into two categories: those who decide that driving has become too dangerous and those who can rely on other means of transport. The first group consists mainly of the oldest individuals as well as those with visual impairments or major neurological conditions. The second group is largely made up of individuals living in urban areas and persons sharing households with other adults (such as grown children, spouses, relatives, or friends) who can provide transportation for nondrivers. The study indicates that, in most cases, these helpful drivers are the same adults who offer most of the informal support given to functionally impaired elderly people.

Those more likely to continue driving in old age do so for a wide range of reasons. On the one hand, this group includes arthritis sufferers and others who have difficulty preparing meals. On the other hand, healthier, better educated, and married individuals also tend to continue driving longer, as do those living in the West and North Central regions of the country.

The decision to stop driving marks a major transition in the lives of older persons, making them dependent on public transportation or on other adults willing to drive them. As the ranks of aging Americans continue to grow, such dependence will become a more important factor across the population, bringing with it an increasing need to monitor the connection between nondriving and the general well-being of individuals in their later years.

Notes

• [1] Raynard Kington, Lee Lillard, and Jeannette Rogowski, "Reproductive History, Socioeconomic Status, and Self-Reported Health Status of Women Aged 50 Years or Older," American Journal of Public Health, 87(1):33-37, 1996.
• [2] Raynard Kington, Lee A. Lillard, Jeannette Rogowski, and Paul Lee, "The Functional Associations of 'Trouble Seeing,'" Journal of General Internal Medicine, 12(2):125-128, 1997.
• [3] Raynard Kington, David Reuben, Jeannette Rogowski, and Lee A. Lillard, "Sociodemographic and Health Factors in Driving Patterns After Fifty Years of Age," American Journal of Public Health, 84(8):1327-1329, 1994.