52 J Health Popul Nutr Mar 2007 on average (49). The most apparent gender difference in the ageing process is women’s finite period of repro- ductive functioning. Their menopausal transition is as- sociated with mood fluctuations and a decline in sexual interest relating to hormonal change. As they age, men and women suffer from similar types of illnesses but men tend to suffer from acute illnesses for relatively short periods before they die (49). Women, by contrast, have a longer life, marked by many chronic non-life- threatening disabilities that can greatly affect the qual- ity of their lives. For example, osteoporosis, due to a natural decline in bone density after menopause, affects mainly women (50). There has been considerably more research on gender and longevity in industrialized countries than in developing countries. Senenayake points out that health policies seem to assume that men and women’s problems converge after menopause (49), whereas, in fact, they continue to be distinct. She notes, for exam- ple, that there is a lack of sex-specific data for elderly people in developing countries. However, the avail- able data reported from developing countries indicate similar gender differences worldwide: women have significantly higher rates of arthritis, osteoporosis, dia- betes, and hypertension than men (51). In a study of adult diseases in Bangladesh, Malaysia, Jamaica, and the United States, Strauss et al. found that women re- ported more health problems than men, regardless of economic status (52). Older women in both developing and industrialized countries are more likely to live alone than men (53). As noted above, isolation can severely affect the health of older people, and given the lower economic status of women, they are less likely to be able to seek help (50). A study of elderly males and females in Egypt, for ex- ample, found that females who had lived all their lives in rural areas and were living in a fair or poor residence were more likely to be disabled than women in better circumstances (54). For Egyptian males, only illiteracy was associated with disablement. This was attributed to the fact that literacy is much more prevalent among men, and those who are illiterate are, therefore, more likely to be poor. For women, living in rural areas is associated with having large families and a tendency to rely on traditional healers for births and medical needs. They are, thus, more exposed than men to poor medi- cal care for reproductive healthcare and, consequently, more at risk of infection. They also have less access to medicines to treat morbid conditions. For women but not for men, living alone was associated with increased odds of disablement (54). An interesting study by Rahman found important gender differences in elderly mortality in Bangladesh Vlassoff C (55). In a longitudinal study in the Matlab surveil- lance area, a large sample of men and women aged 60 years and older were followed for eight years to de- termine the impact of several social, economic and demographic variables. The study found that household heads, whether male and female, had lower mortality, and the presence of a partner had a significant positive impact on men, but a positive impact on women only when their husbands were the heads of the household. Moreover, the presence of an adult son was correlated with lower mortality among women but not men. These findings indicate that individual access, to resources as opposed to joint access, is an important determinant in the survival of elderly people (56). In industrialized countries, the impact of gender on the biological determinants of longevity is also evident, for example, in the quality of life of elderly people. In a study of 14,000 men and women aged 60 years and above living in their homes in Britain, the gender dif- ferences were found in living arrangements for people living with severe disabilities (56). Half of these older women lived alone compared to one-quarter of older men. Most men with severe or moderate disability lived with their spouse and received care from them, whereas most women lived alone and had to rely on help from outsiders. The British study examined self-assessed health to test the validity of the common assumption that women over-report morbidity (57). There was a little gender difference in self-assessed morbidity, once class, in- come, age, and level of functional disability were taken into account. In fact, results of multivariate analysis indicated that, when the greater functional disability of older women was included, older women reported less poor health than older men. These findings illustrate the importance of re-examining common gender-based assumptions and of assuring that comparisons between men and women are based on similar socioeconomic and demographic groups. Moreover, gender relations and their impact on biological factors are changing, as women increasingly assume positions traditionally occu- pied by men and vice versa. Several studies of the ‘will to live’ have found that women have a weaker desire to prolong life than men, in terms of refusing life-sustaining care (57-58) or a wish to die sooner if terminally ill (59-60). In a study of gender differences among men and women aged 70 years or older in Israel, the will to live was found to be affected by the state of health of the elderly, those in poor health more likely to show the gender differences referred to above (59). As in other studies, living with