An investigation into the health and well-being of older people in South Africa.
Populations are rapidly growing older across the globe. In South Africa, life expectancy has been on the increase over the past decade, and the proportion of older people is projected to increase dramatically over the coming years. Whilst this is a remarkable achievement, it does not mean that additional years of life will be healthy. To this end, the question being asked by researchers and policy makers is whether people are living longer and healthier lives? In order to answer this important question, health expectancies have been developed which combine morbidity and mortality data into a single index that measures population health. The health expectancies have become standard measures of population health across first world countries. Unfortunately, there is little awareness about their use in developing countries, including South Africa. The aim of this study was to estimate health expectancies based on various objective and subjective measures, in order to give a first comprehensive analysis of the health and wellbeing of older people in South Africa. The data were drawn from two nationally representative surveys namely; the WHO-Study on Global Ageing and Adult Health (SAGE) and the South African National HIV Incidence, Prevalence, Behaviour and Communication Survey (SABSSM) surveys. The results are presented in the form of five manuscripts each submitted for publication. The first manuscript estimates sexually active life expectancies and factors associated with sexual activity. The results show that older people are gaining more years of sexual activity. HIV in older women and chronic conditions in older men reduced odds of sexual activity. The second manuscript found that there was both absolute and relative compression of morbidity in older people between 2005 and 2012, based on self-rated health measure. The third manuscript estimates happy life expectancy and examines factors associated with happiness in older people. Happy life expectancy was greater for men than women, and wealth status was the strongest predictor of happiness. In the fourth manuscript, subjective and objective measures were used to estimate health expectancies. The former showed a more positive outlook compared to the latter. Gender differentials were evident in that although women live longer than men, they spent a greater part of their lifetime in poorer health than men. The fifth manuscript goes a crucial step further, to estimate the contribution of specific diseases to disability. This is important for policymakers as this identifies entry points of interventions aimed at reducing the onset and burden of disability in the elderly population. The most contributors of disability were musculoskeletal and cardiovascular diseases. The thesis concludes that the health of older people is complex and multidimensional, and therefore requires several measures to give a comprehensive analysis. When measured using subjective measures, it can be concluded that the health of older people has been improving. However, a different conclusion could be reached, if objective measures are used. It is important to continue to monitor the health status of older people, and make appropriate interventions in order to improve their health, wellbeing and quality of life.