Life course influences on quality of life in early old age

Abstract

A growing literature demonstrates life course influences on health in early old age. The present paper is the first to examine whether similar processes also influence quality of life in early old age. The question is theorised in terms of structured dependency and third age, and the life course pathways by which people arrive at these destinations in later life. The issues are investigated in a unique data set that contains health and life course information on some 300 individuals mostly aged 65–75 years, enhanced in 2000 by postal survey data on quality of life. Several types of life course effect are identified at conventional levels of statistical significance. Long-term influences on quality of life, however, are less marked than those on health. Quality of life in early old age appears to be influenced primarily by current contextual factors such as material circumstances and serious health problems, with the influence of the life course limited mostly to its shaping of an individual's circumstances in later life. The implication for policy is that disadvantage during childhood and adulthood does not preclude good 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?