Differences between older women and men in healthy ageing
Authors:   , Sialino Lena Dirkje 
Published: November 2023

Although women live longer, they experience relatively more unhealthy years (i.e. disabilities in ADLs) during their life and with an earlier onset compared to men, also referred to as the gender health-survival paradox. The female disability disadvantage pinpoints older women as an important target group for prevention strategies that stimulate healthy ageing.
THIS THESIS CONSIST OF THREE MAIN OBJECTIVES:
1. To identify differences between older women and men in four domains of healthy ageing and investigate potential socio-demographic subgroups (age, educational level, migration background and birth cohort) for a more pronounced difference.
2. To explore contributing determinants to the female disadvantage in physical and self-rated health by investigating differences between older women and men in sensitivity and exposure.
3. To identify motivators and barriers for a healthy lifestyle and investigate perspectives on determinants of healthy ageing among older (migrant) women and men separately.

DIFFERENCES BETWEEN OLDER WOMEN AND MEN IN HEALTHY AGEING DOMAINS
Our longitudinal analysis among older adults aged 55 years and older demonstrated that women have a significantly worse mental health (Chapter 2), worse (height-adjusted) physical performance (Chapter 3) and worse self-reported physical functioning (Chapter 6) compared to men of the same age. There was, however, no significant difference observed in self-rated health among Dutch older adults (Chapter 4) and there was a female advantage in cognitive functions of memory and processing speed (Chapter S1).
The female disadvantage was not consistently more pronounced during ageing or for different educational levels, migration backgrounds or birth cohorts, with respect to mental health (Chapter 2), physical performance (Chapter 3), self-reported physical functioning (Chapter 6), self-rated health (Chapter 4) and cognitive functioning (Chapter S1). However, there was a significant female disadvantage in self-rated health among Turkish-Dutch and Moroccan-Dutch older adults (Chapter 7) , which was not observed in Dutch older adults (Chapter 4).
CONTRIBUTING DETERMINANTS TO THE FEMALE DISADVANTAGES IN PHYSICAL FUNCTIONING AND SELF-RATED HEALTH
Our multivariable longitudinal analysis demonstrated that a higher prevalence of various socio-demographic and health-related determinants among women compared to men contributes to the female disadvantage in physical performance and self-reported physical functioning in older adults and in self-rated health among older migrants, especially more pain (exposure theory) (Chapter 5,6,7). In addition, a higher sensitivity to a higher BMI and lower physical activity contributes to the female disadvantage in physical performance (sensitivity theory) (Chapter 5).
PERSPECTIVES OF OLDER ADULTS ON LIFESTYLE AND HEALTHY AGEING
Our qualitative interview studies among older Dutch, Turkish-Dutch and Moroccan-Dutch women and men aged 55 years and older showed that personal health was consistently mentioned as a motivator for healthy ageing across all healthy lifestyle factors (Chapter 8, S2). Other motivators and barriers varied across different lifestyle factors and to some extend by migration background and sex. The majority of women and men did not perceive sleep as a lifestyle factor but rather as a non-modifiable personal trait.
CONCLUSIONS
In conclusion, this thesis provides information regarding the target group where the female disadvantage is most apparent (who), which determinants should be targeted to decrease the female disadvantage (what) and insights in motivators and barriers for lifestyle determinants related to women’s and men’s health (how). The results provide essential information to reevaluate current strategies and preventions aimed to increase healthy ageing with a diversity focused view to improve health among older women and men. This seems to require an integral approach, stimulating gender equality in career and pay, health and lifestyle improvements to stimulate equity and diminishing the female disadvantages in healthy ageing.