Biosocial determinants of healthy ageing in Spain

Resumen

This dissertation explores biological (physical) and social characteristics associated with health later in life, integrating gender/sex considerations and a life course perspective. We use data from 50-years-old and older Spanish and other European adults from two different sources: the Active Ageing Longitudinal Study \Estudio Longitudinal de Envejecimiento Activo" (ELEA) in Spain, and the Survey of Health, Ageing and Retirement in Europe (SHARE). This study includes cross-sectional and longitudinal (both prospective and retrospective) designs and embraces a broad set of variables such as demographic characteristics, socioeconomic and health indicators, early health and socioeconomic conditions, etc. Results are presented in five original papers. Cross-sectionally, we found that, compared to men, part of the overall poorer health among women was surely determined by a gender effect and may have had an early origin, probably related to traditional gender roles established early in life. Additionally, we found marked socioeconomic gradients in health and mobility indicators like frailty and balance performance. Health behaviours like physical activity and obesity seemed to play a similar and small role in explaining the link between socioeconomic status and frailty and balance in older adults. Longitudinally, in a prospective study of the predictors of disability for two years, we found that a decline in function was associated with an increased number of chronic diseases and symptoms of depression among Spanish men, whereas among women it was associated with decreased cognitive performance. Finally, in a retrospective study with a life course approach, we found a direct association between childhood and adult health among older Europeans, whereas the impact of the socioeconomic status in childhood was more indirect and operated through the own socioeconomic status in adulthood. This suggests that in order to improve adult health, efforts can be made in ameliorating child health. Moreover, poor childhood health was a stronger predictor of adult health -having more negative effect- in Northern compared to other European countries. This finding may be useful for planning interventions based on country-specific evidence, and contributes to the understanding of the mechanisms underneath the health dynamics over the life course. The results of this study add to the evidence of the importance of including a multidisciplinary and life course perspective when evaluating health and well-being in later life. They might also contribute to enhance health and reduce health inequalities by suggesting effective interventions meant to improve the quality of life of older adults.