Which Behaviour Affects Our Perception of Health in Older Ages?
To understand how health policies can help improve our quality of life in older ages, it is important to look at health behaviours and their relation to health outcomes. In a recent study, Liili Abuladze and colleagues examined this relationship in Estonia, where life expectancies and self-rated health among older adults are comparatively low in Europe.
The population of Estonia is ageing similarly to other developed countries—it is characterised by increasing life expectancy and the transformation of morbidity and health behaviour patterns. The factors that keep older individuals active longer are important for individual well-being, as they prolong independence, as well as for sustainable social and economic development. Health problems tend to emerge and accumulate in old age; therefore, an ageing population may have increasing health issues in the future. On the other hand, making health-conscious choices may mitigate the effects of chronic diseases, prevent a decrease in activity and help maintain good quality of life in old age. Individuals’ own understanding and perception of their health status can influence all of the above, while subjective understanding of health itself is also influenced by different factors.
Both objective health status and awareness of the behavioural factors that influence health have improved considerably over the last couple of decades in Estonia. Estonian life expectancy at the age of 65 years increased from 15.6 years in 2002 to 18.2 years in 2013 for the whole population, although still remaining below the European Union average.1 Moreover, the
Estonian gender gap in life expectancy is one of the largest in the world. Those of foreign origin comprise about one-third of the total population of the country and have contributed to the rapid ageing of the population as previously numerous young migrants matured. The foreign-origin population has a lower life expectancy and greater prevalence of disability compared with the native-born, exhibiting a morbidity and mortality-related path-dependency characteristic of the Soviet era.2
Previous studies of self-rated health (SRH), limitations with regard to daily activities and health behaviour have also shown that Estonia is in a lagging position in terms of these indicators.3–6 Estonia has the highest proportion (over 70%) of people reporting fair or poor SRH compared with other countries in the Survey of Health, Ageing and Retirement in Europe (SHARE); however, these differences have been explained limitedly by lifestyle factors (smoking, alcohol consumption, nutrition and physical activity) and education in a previous study.7 Estonia has a rather high level of activity limitations stemming from chronic diseases, with limitations rapidly gaining prevalence after the age of 50 years.5 A major political reform aiming to improve services and access to these services for people with activity limitations and decrease their inactivity in society was started in 2016. The effects of this reform are to be evaluated in the future but due to their high prevalence it is important to consider activity limitations and illnesses when studying SRH. People in the Baltic States have evaluated their health below that of Finns’ evaluations more often, reflecting the psychological and social context of the Baltic States.8 By including satisfaction with life when studying Estonian subjective health outcomes, the s oci opsychological background would be accounted for.
The population above the age of 80 years, that is, the oldest old, have usually not been included in large-scale international population-level studies, especially in Estonia. In the context of ageing societies, this group deserves more attention. Not assuming homogeneity among old adults and focusing on the 50+ aged population allow one to distinguish how different people age, starting from a period in life when most people are active and healthy.
Results show that being male, originating from a foreign country, and having activity limitations or long-term illnesses bear high risks of reporting poor health. Some of the main concerns for men include consumption of more tobacco and alcohol, and of less fruit, vegetables and dairy products. Authors recommend to develop targeted and systematic guides for monitoring protein-energy malnutrition of older adults in Estonia. Poorer self-rated health of those with activity limitations or long-term illnesses suggests an important role of previous environment and behaviour in one’s health outcomes, therefore health policies related to health behaviors should emphasise long-term perspective, rather than aiming for quick fixes.
Liili Abuladze is Project Manager at Tallinn University School of Governance, Law and Society and at Estonian Institute for Population Studies.