Inequity in aging: International study

• A novel study found that societies worldwide accommodate aging men more than they do aging women.
• This research suggests that different gender roles and norms create different experiences in aging.
• It analyzes and quantifies systemic biases in aging against women.

Women’s longer life expectancy, increased risk of illness, and lower financial and physical security create unique needs between men and women in aging.

An August 2021 article in The Lancet: Healthy Longevity highlights differences between the sexes in societal roles and their impact on quality of life.

The authors call it a “first step” in determining policy gaps regarding resource allocation for older people.

Cynthia Chen, Ph.D., is a Fellow at the University of Southern California Schaeffer Center in Los Angeles and an assistant professor of Health Economics in the Saw Swee Hock School of Public Health at the National University of Singapore.

As an expert in the economics of aging, she was the lead author of this study.

Domains of successful aging  

Chen and fellow researchers created an “Aging Index” using information collected between 2015 and 2019. This data came from 18 member nations of the Organization for Economic Co-operation and Development (OECD).

The index measured five domains associated with successful aging societies: well-being, productivity and engagement, equity, cohesion, and security.

The team calculated the index and domain scores for men and women. They then compared the scores between sexes and nations.

High and low scorers 

Northern European countries, the Netherlands, and Japan earned high overall scores for both sexes. Eastern and southern European countries had lower overall scores. The study cited a good overall index score as at least 66 for men and 55 for women.

The United States and the United Kingdom did not perform so well, achieving index scores no higher than 57 for men and 47 for women.

Despite achieving a good overall index score, the Netherlands demonstrated the widest gap between the scores for men and women. Other countries with wide disparities included Denmark, Austria, and Italy.

Although Ireland, Poland, and Spain did not achieve as good overall index scores, they demonstrated the smallest difference between men and women.

Men have the upper hand 

The Aging Index shows that societal aging factors tilt in favor of older men in every participating country.

Older men are more likely to be more financially secure and less socially isolated than older women.

A UNECE (United Nations Economic Commission for Europe) Policy Brief on Ageing also notes that women are at risk of being “disproportionately disadvantaged by the consequences of population aging […] at the detriment of their own health, earnings, and savings, which can accumulate to a greater risk of poverty, social isolation and unmet care needs in their own advanced age.”

Higher life expectancy offset by ill health 

The average life expectancy for women in the OECD nations is over 3 years longer than for men.

The longevity differences could be due to lifestyle choices. Biology may play a role, too. In most mammalian species, females live longer than males.

However, this does not necessarily result in an advantage. As women get older, they face higher incidences of illness and less life satisfaction than men, according to the study.

We are falling short 

Medical News Today interviewed Dr. Scott Kaiser, the Director of Geriatric Cognitive Health for the Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, CA. He offered this assessment:

“What I think this brings into light is how we are falling short in terms of […] assuring a healthy, well, secure older age for our loved ones and for our future selves.”

He has observed that the United States fares particularly poorly in supporting women with resources to age well.

Dr. Kaiser believes a social movement is needed to eliminate these inequities: “We should be up in arms…” Changes require the participation of individuals, families, doctors, and governmental institutions.

The study’s limitations 

The authors admit that, since the study is cross-sectional, it could not pinpoint trends over time. They look forward to performing a longitudinal analysis in the future to build on the current findings.

In some countries, comparable sex-specific data was not always available or was insufficient for some measures.

The authors also recognized that each country varies in its approach toward each domain:

“Although other experts might weigh the measures or domains differently compared with this group of experts, there is no generally accepted definition of what constitutes a successfully aging society.”

Moreover, the results might not apply to the status of older people in low-income countries.

Guidance for policies and programs 

The current study’s results highlight the need for sex-specific considerations as societies design aging-related strategies.

Chen and her cohorts feel that governments should channel more funds toward healthcare for older women. They also suggest implementing minimum income standards and pensions to make senior care more affordable.

However, Dr. Kaiser feels that the U.S. spends too much on healthcare versus social services, especially compared with other nations:

“What we can do is change our mindset and decide, as a society, the extent to which we value older people and our commitment towards them […] We need to recognize that healthcare really only accounts for a small slice of what’s going to yield a good result in terms of healthy aging across a population.”

Dr. Kaiser also emphasized that aging issues affect everyone:

“Don’t just think about [aging] as an old people vs. young people issue but think about it holistically across the lifespan […] Everybody’s aging every day of their lives. The things that we do throughout our life… impact the way we’re going to age.”

MNT also spoke with Margarita Alegria, Ph.D., a professor at the Departments of Medicine and Psychiatry at Harvard Medical School in Boston, MA.

Alegria, who is also Chief of the Disparities Research Unit in the Department of Medicine at Massachusetts General Hospita,explained that the findings “emphasize how societies can establish a hierarchy of valuing older men more than older women, placing a greater burden on older women’s opportunity to remain healthy.”

She explained that the study “also highlights that these differences can be attributed to domestic policies and institutional supports leading to disparities. Learning from the policies in countries that have eliminated or reduced that gender gap (for instance, Denmark, Sweden, Finland, Norway, the Netherlands, and Japan) can help ensure healthy aging across gender groups. The poor performance of the U.S. in terms of well-being for both men and women should raise alarms.”

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