Life course influences on quality of life in early old age
Introduction
There is a growing literature which demonstrates life course influences on later health (Kuh & Ben-Shlomo 1997; Kuh & Hardy 2002). Clinically significant increases in systolic blood pressure, for example, are found among those in early old age1 who grew slowly when they were children (Montgomery, Berney, & Blane, 2000), especially if after childhood they worked for many years in occupations with low job control (Berney, Blane, Davey Smith, & Holland, 2000). Material and psycho-social deprivation during childhood, which slow growth, followed by repetitive and highly supervised work in adulthood illustrate the process of life course accumulation of disadvantage. It is biologically plausible that health at later ages is influenced by this social process of accumulating disadvantage. The body can be seen as a mechanism which stores the past benefits and dis-benefits to which it has been exposed, either because damage at a critical period of development causes irreparable loss (Barker, 1994) or because the effects of various types of damage accumulate over time (Mann, Wadsworth, & Colley, 1992).
The present paper is concerned with the question of whether quality of life in early old age similarly is influenced by earlier events. Although it appears less rooted in biology than health, life course influences on quality of life would be plausible. In addition to health, with its own well-documented life course influences, quality of life in early old age is known to be influenced by family contact and financial well-being (Farquar, 1995; Bowling, 1995; Ginn & Arber, 1999; Evandrou & Falkingham, 2000), which also could have their origins in earlier adulthood. The level and type of family contact in early old age, for example, could be affected by such factors as death of spouse, number of siblings and offspring and the geographic and social distance from kin. Financial well-being in early old age, similarly, might be influenced by earlier levels of labour market participation and the level of salary or wage, and the associated occupational pension rights, attached to these occupations.
The two main traditions within British social gerontology have tended to differ in the emphasis given to either poor or good quality of life at older ages. The idea of structured dependency (Townsend, 1981; Walker, 1981) describes the marginalisation from social and market relationships which follows statutory labour market exit and the consequent forced dependence on deliberately low levels of pension. In contrast, the idea of the Third Age (Laslett, 1996) points to more recent developments; in particular, the increase in disability-free life expectancy (Bebbington, 1991) and the spread of occupational pensions (Banks & Emmerson, 2000; Blundell & Johnson, 1998). Today, as a result, a significant proportion of the population of countries like Britain can expect to spend from 10 to 20 years after labour market exit in reasonable health and comparative affluence. Whatever the conceptual status of these ideas (Bury, 1995; Gilleard & Higgs, 2000), at their simplest they have the virtue of summarising real and conflicting tendencies within contemporary society. Structured dependency and Third Age can be reconciled by seeing them as the ideal type extremes of a spectrum which stretches from dependency to agency in quality of life in early old age. Conceptually, an individual's location on this continuum could be influenced by their current social circumstances and by experiences in the earlier stages of adult life; for example, whether these years were passed in primarily working class and middle class occupations and social environments.
The present paper explores these issues empirically. Its central concern is to investigate whether quality of life in early old age is influenced by circumstances and events from earlier in adulthood; or whether current, contextual influences are the dominant factors?
Section snippets
Sample
Our respondents are drawn from a unique sample. As children they were surveyed between 1937 and 1939 by a team of medical and nutritional scientists under the direction of Sir John Boyd Orr. The sample was drawn from 16 locations in Britain and comprised 1352 families selected to be broadly representative of the British population. A range of social, dietary, health and anthropometric data were collected about these families and, particularly, their children.
In 1996 almost all of these records
Results4
Table 1 reports the relationships between quality of life in early old age, measured by CASP-19 score and various measures of socio-economic position in early old age. CASP-19 scores are not related to either social class (based on last significant period of employment) or receipt of an occupational or private pension, the measures which relate back to the years of working life. In contrast, CASP-19 scores are related inversely to the more proximal indicators of material disadvantage in early
Discussion
The present paper has used data from a 60 year follow-up study to examine influences on quality of life in early old age. These life histories allow identification of changes, such as social mobility; and the quantification (in years) of exposure to a variety of hazards, such as air pollution, and circumstances such as years in receipt of welfare benefits. The analyses use a measure of quality of life in early old age (CASP-19), which was developed for the present study. The measure is based
Acknowledgements
The work reported in the present paper was supported by ESRC research grant L480254016, as part of its Growing Older programme. We wish to thank Lee Berney, Maria Evandrou, Katrina Hilari, Aubrey McKennell and Roger Thomas for their invaluable assistance as the members of our project's Advisory Group; Age Concern England and Age Concern Scotland for their help with setting up the focus groups; David Gunnell and his colleagues at Bristol University for initial access to our study subjects; our
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