Health and Wellbeing | The State of Ageing 2023-24

What does the chart show?

• Around four-fifths of the total population in England reported being in either good or very good health in Census 2021, with almost the same proportions for men and women.
• The proportion rating their health as good or very good declines with age while the proportion rating their health as fair, bad or very bad increases with age. But even among centenarians, a quarter reported having good or very good health.
• Still, almost 400,000 men and 460,000 women aged 50-64, in the years approaching pension age, report being in bad or very bad health.

We also know that:

• The proportion of people at all ages older than 50 who reported being in very good health increased between 2011 and 2021, while the proportion reporting fair, bad or very bad health – even at the oldest ages – declined.
• It is important to note that this data is derived from people’s own assessment of their health. Though self-rated health is highly associated with objective measures of health, this census data was also collected during the COVID-19 pandemic which may have impacted the way in which people responded to the survey. For example, people's self-perception of their health may have been positively skewed because of the experience of the pandemic and the catastrophic levels of death and ill health that we witnessed. It’s also possible that COVID-19 related deaths of Disabled people and of those in the poorest health may have affected the relative size of the less healthy population. If so, this effect should be apparent in the next release of health state life expectancy data which is expected from the Office for National Statistics in early 2024.
• Recent analysis using the objective measure of diagnosed illness rather than self-reported health predicts worsening health in the future, with the amount of time people are projected to live with major illness expected to increase from 11.2 years in 2019 to 12.6 years in 2040.
• But other recently published research also concludes that people are ageing better overall. Using frailty data as a proxy for healthy ageing, analysis of successive waves of data from the English Longitudinal Study of Ageing found a decreasing prevalence of frailty over time. However, the researchers found the improvement to be unequal, being highest for those with the highest levels of wealth.

What does the chart show?

• Census data collected in 2021 shows inequality in rates of self-rated health for men and women by Index of Multiple Deprivation, across all older age groups:
  • In the most deprived areas, fewer than a quarter of men and women aged 50-54 report being in very good health compared with half of those in the least deprived areas.
  • In fact, for women aged 50-59 in England, there is a 28-percentage-point difference in rates of very good health between the least and most deprived areas (with a 24-percentage-point difference for men in this age group).

What do the charts show?

• People living in the least deprived areas of the country live longer than those in the most deprived areas, whether measured at birth or at age 65:
  • Life expectancy at birth for the men in the most deprived areas is 73.5 years, almost ten years less than in the least deprived areas (where it is 83.2 years). For women, the difference is eight years (86.3 vs 78.3 years).
  • When men in the least deprived areas reach the 65-69 age group, they can expect to live another 21 years, which is five years longer than men in the most deprived areas (15.5 years). For women, the difference is also five years (23.2 vs 18.1 years).
• The better-off not only live longer but spend more of their lives in good health:
  • At birth, men and women in the least deprived areas can expect 18.2 and 18.8 years more in good health, respectively, than those in the most deprived areas. 
  • At age 65, men and women in the least deprived areas have twice as many years ahead of them in good health as those in the most deprived areas (13.5 vs 6.6 years for men and 14.3 vs 7.1 years for women).
  • That means that, at the age of 65, men in the most deprived parts of the country can expect to spend 43% of their remaining life in good health, compared with 65% for those in the least deprived. The corresponding proportions for women are 39% and 62%, respectively.

We also know that:

• Life expectancy dropped by more than eight months for women (from 79 to 78.3 years) and by five months (from 73.9 to 73.5 years) for men in the most deprived decile between the 2011-13 and 2018-20 periods.
• Over the same period, life expectancy increased by five months for women (from 85.9 to 86.3 years) and by four months for men (from 82.9 to 83.2 years) in the least deprived decile.
• This signifies a widening in inequality in life expectancy between the least and most deprived areas. The gap between the least and most deprived deciles in life expectancy increased steadily from 6.9 years in 2011-13 to eight years in 2018-20 for women and from nine to 9.7 years for men.

What does the chart show?

• Rates of good and bad health vary widely between ethnic groups, with differences emerging as early as age 25.
• For both men and women aged 50-64, Chinese people have the lowest rates of bad or very bad health (3% of both men and women) while Bangladeshi people have the highest (13% of men and 22% of women).*
• The prevalence of poor self-rated health increases rapidly with age in every ethnic group, but the rate of increase is particularly pronounced among Pakistani and Bangladeshi people from the age of 35-49.
• Consequently, health inequality between ethnic groups grows across the life course, becoming especially pronounced in later life. The proportion of Bangladeshi women aged 50-64 reporting bad or very bad health is the same as for Indian women aged 75-84 and White British women aged 85 and over (22%).
• Any data reporting which describes health outcomes for ‘Black, Asian and Minority Ethnic Communities’ as a single category is inadequate and obscures these significant and important differences.

 We also know that:

• Research using patient records indicates that people from some minority ethnic backgrounds (namely Indian, Pakistani, Bangladeshi, Black African, Black Caribbean, and those who identify as Other Black, Other Asian and Mixed) have a higher prevalence of multiple long-term conditions than their White counterparts.
• Management of multiple conditions presents particular challenges. And it is forecast that by 2040, levels of multimorbidity will have risen for all age groups. The largest increase is expected among the oldest – those aged 85 years and over – who are projected to have an average of 5.7 conditions in 2040, up from 5.2 in 2019. If older people from minority ethnic backgrounds are at particular risk of multimorbidity, these forecasts are consistent with the increasing ethnic diversity of our older population.
• The inequalities we see by ethnic group are, in good part, a reflection of the socioeconomic inequality that exists between minority ethnic groups and the White majority. Previous research has shown – using income, level of education and occupation as measures of socioeconomic position – that White, Irish, and Chinese people occupy the highest socioeconomic positions in the UK, and that Pakistani and Bangladeshi people occupy the lowest. This socioeconomic pattern mirrors the inequality seen in rates of bad or very bad self-rated health.
• However, even after accounting for differences in socioeconomic position, poor health is still more common among Pakistani, Bangladeshi, Black Caribbean, and Indian people when compared to people of White ethnicity.
• This is because we must also account for the experience of racism and its effect on health. Racism is indirectly linked to health outcomes through the structural oppression that disadvantages people from minority ethnic backgrounds in terms of education, work and where they live. But racism also has a direct impact on health outcomes via the physiological and mental stress that it produces. 

What do the charts show?

• Inequality in health is also evident by geography:
  • At a regional level, the largest proportion of people in both the 50-64 and 65 and over age groups who are not in good health is in the North East (29% and 48%, respectively). The smallest is in the South East (20% and 38%, respectively).

We also know that:

• Disparities are even starker at the local than regional level:
  • Whereas just 3% of 50-64-year olds in Wokingham in Berkshire, and Hart in Hampshire, are in bad or very bad health, 15% of people in this age group living in Tower Hamlets are in bad or very bad health.
  • Among people aged 65 and over, the lowest rate of bad or very bad health (7%) is seen in the City of London and the highest (35%) in Tower Hamlets.

A number of factors drive these differences in the health of people living in different parts of the country. These include environmental factors (including working conditions), educational and lifestyle factors and infrastructure challenges (many villages and small towns lack frequent and reliable public transport and high-speed internet). The impact of deindustrialisation has also been mooted as a factor: one study has shown that areas in the north that have experienced a strong transition away from employment in physically demanding occupations have particularly low levels of physical activity. All, however, are ultimately linked to other socioeconomic factors, including levels of wealth: poorer places are simply less healthy.

What does the chart show?

• Health inequality is also evident when we look at sexual orientation:
  • Up to the age of 64, the proportion of both men and women reporting good or very good health is highest for straight or heterosexual people, and lowest for bisexual people.
  • In the 16-49 and 50-64 age groups, rates of bad or very bad health are about twice as high for bisexual as for straight men and women (for example, 15.8% and 14% for bisexual men and women aged 50-64, compared with 8.1% and 7.1% for straight men and women).
  • However, the pattern changes somewhat for the oldest age group (65+) where lesbians and gay men have the highest rates of very good or good health and there is very little difference between groups in rates of bad or very bad health.

We also know that:

The health of older LGBT people will have been shaped by experiences of prejudice and discrimination across the life course, and the physiological stress that that triggers. For some older LGBT people there is evidence of social isolation and loneliness, with their known effects on physical health. Societal attitudes have changed significantly across the lifetimes of older LGBT people – and so older LGBT people’s experiences will depend very much on how old they are, where in the country they have lived, and when they came out. These differences in their experiences may account for the differences we see between people aged 50-64 and those aged 65 and over.

What does the chart show?

• Almost 6 million people aged 50 and over (3.4 million women and 2.6 million men) in England have a physical or mental health condition or illness lasting or expected to last 12 months or more – that is, they are considered to have a disability. This is 28% of all people aged 50 and over.
• Of this 6 million, 2.8 million people aged 50 and over (1.6 million women and 1.2 million men) find their day-to-day activities limited a lot by their disability.
• The proportion of people with a disabling condition that limits them a lot increases with age:
  • Almost a quarter of women aged 80-84, a third of women aged 85-89, and half of women aged 90 and over have a highly limiting disabling condition.
  • The proportions are a little less for men than women in every age group.
• There are more than half a million women and 450,000 men aged 50-64 – years approaching state pension age – who are limited a lot by their disability.

We also know that:

• Patterns of ill-health and disability have far-reaching implications: in every age group the proportion of people who are economically inactive due to long-term sickness has increased since the pandemic. Among the 50-64-year age group, 1.3 million are now economically inactive due to long-term sickness.

What does the chart show?

• A higher percentage of people in every age group in the most deprived areas (decile 1) indicated that they were disabled compared with the least deprived areas (decile 10):
  • The biggest difference – more than 25 percentage points – is seen for people aged 60-64: 15% of people in this age group in the least deprived areas are disabled, compared with 41% in the most deprived areas.
  • The data can be interpreted as showing that people become disabled at younger ages in the most deprived areas: 35% of people aged 55-59 living in the most deprived areas are disabled. In the least deprived areas we do not see this prevalence of disability until the age of 80-84 (38%).

We also know that:

• Disability-free life expectancy (for the period 2018-20) was 51.4 for men in the most deprived decile compared with 69.0 in the least deprived decile, a difference of almost 18 years.
• For women, the corresponding values were 50.3 years and 66.4 years, a difference of 16 years.
• Therefore, men in the most deprived areas can expect to live 70% of their lives disability-free compared with 83% for the least deprived.
• And women in the most deprived areas can expect to live 64% of their lives disability-free compared with 77% for the least deprived.
• There is a two-way relationship between disability and poverty. Poverty may result in disability through a higher prevalence of poor health linked to the social determinants of health. But disability may result in poverty as a result of the social causes of poverty, including underemployment, ineffective welfare, and higher costs of living.
  • Our analysis of data from the 8th Financial Fairness Tracker survey (abrdn Financial Fairness Trust; see Technical Report for details) shows that households that include a Disabled person are much more financially precarious than those without. For example, they are more likely to be unable to meet any of an unexpected expense and to feel that they have no control over their financial situation.
  • Moreover, on average, disabled households (with at least one Disabled adult or child) need an additional £975 a month to have the same standard of living as non-disabled households.

What does the chart show?

• People living in the most deprived areas are not only more likely than people living in the least deprived areas to have a disabling condition. They are also more likely to be limited in their ability to carry out day-to-day activities by any disabling condition they do have:
  • In fact, between the ages of 50 and 69, the percentage of Disabled people who are limited a lot by their disability is twice as high in the lowest deprivation decile as in the highest.
• It could be that the health conditions the least well-off people develop are more disabling. However, it is also possible that the severity of the conditions that people have are similar, but their impact is felt more acutely by those in the most deprived areas because they have less support and because their homes and environments are less adapted to allow them to live well with their disabling conditions. This is why we need age-friendly homes, workplaces and communities that allow people to live well and flourish with disability.

What does the chart show?

• One quarter of people aged 65 and over need help with basic activities of daily living (ADLs – activities such as having a bath or using the toilet). The proportion who need such help increases with age, from 18% of those aged 65-69 to 40% of those 80 years or over.
• A further quarter need help with instrumental activities of daily living (IADLs – activities such as shopping). This ranges from 17% of those aged 65-69 to 44% of those 80 years or over.
• The most deprived people aged 65 and over are twice as likely as the least deprived to need help with basic ADLs (44% vs 20%). This is consistent with the fact that the most deprived are more likely than the less deprived to have a disabling condition and for that disabling condition to be limiting.
• However, a high proportion of people who need help are not receiving it: almost a quarter (22%) of people aged 65 and over are not receiving the help they need to carry out basic ADLs.
• And it is those in the most deprived areas who are least likely to get help: almost two in five (38%) of people aged 65 and over in the most deprived quintile do not receive the help they need with ADLs and a further quarter don’t receive help with IADLs. Not being able to do these activities has significant implications for people’s health and wellbeing. It affects such things as levels of physical activity, ability to shop and cook nutritious meals, and leads to social isolation.

We also know that:

• At least one in ten people aged 50 and over say that waiting too long for a GP appointment has affected their physical health, and a similar number say it has affected their mental health. Similar proportions say waiting for a hospital appointment has affected their physical or mental health.

• In addition, as GP appointments and consultations go online, it is the most deprived – who are least likely to have digital access – who will struggle most to get the help they need, thus trapping them in a spiral of poor health and poverty.

What do the charts show?

• As with self-rated general health, rates of disability are highest in Pakistani and Bangladeshi people and lowest for Chinese people (both the 50-64 and 65 and over age groups).
• More than a quarter of Bangladeshi people aged 50-64 and half of those aged 65 or over are disabled (compared with 10% and 22% of Chinese people, respectively).
• Among Disabled people aged 50-64, only the Pakistani group has a majority (53%) who are limited a lot by their disability.
• Among Disabled Chinese people aged 50-64, the vast majority (71%) are limited a little by their disability.
• The prevalence of disability increases with age in every ethnic group – and so too does the likelihood of the disability being limiting. However, the biggest increase between the 50-64 and the 65 and over age groups is also seen among Bangladeshi people: almost half of Disabled Bangladeshi 50-64 year olds are limited a lot, increasing to 64% of those aged 65 and over.
• However, Disabled Chinese people also show a large increase in the likelihood of disability being limiting as they age – from 29% of the 50-64 age group to 41% of people aged 65 and over.

What does the chart show?

Almost three million people aged 50 and over provide unpaid care. However, many of these carers are themselves in poor health:

• Over 240,000 unpaid carers aged 50 and over (almost 9% of carers in this age group) are in bad or very bad health themselves.
• Almost 50,000 50-64 year olds who provide 50 or more hours of care per week are themselves in bad or very bad health. This is the case for a further 32,700 65-74 year olds, 27,800 75-84 year olds and 11,300 people aged 85 or over.
• Longer hours of caring are associated with worse health: in every age group, the number of people in bad or very bad health is higher among those who care for 50 or more hours per week than those who care for fewer hours. For people aged 50-74 reporting good or very good health, the reverse is true.

We also know that:

• Research by Age UK has found that 1.3 million older unpaid carers aged 65 and over (61% of this group) have felt unhappy or depressed.
• Burnout among unpaid carers is having an increasing effect on the provision of social care support.

What does the chart show?

• The prevalence of musculoskeletal conditions increases rapidly with age, from a quarter of people aged 55-64 to half of people aged 85 and over.
• In every age group, the prevalence of musculoskeletal conditions has fallen by one to two percentage points since 2018.

We also know that:

• The Global Burden of Disease shows that musculoskeletal conditions (osteoarthritis, rheumatoid arthritis and other conditions that affect the muscles, joints and skeleton) are the largest cause of disability in people aged 50 and over in England, accounting for 30% of years spent with disability in people aged 50-69 and for 22% in people aged 70 and over.
• Analysis of data from the Labour Force Survey showed that of the 2.5 million working-age adults who were inactive because of long-term sickness, 1.35 million people identified a musculoskeletal health condition as their main disorder. And since 2019, problems with legs or feet rose by 243,000 (29%) and problems with back or neck rose by 217,000 (28%).

What does the chart show?

• At the outbreak of the pandemic, rates of moderate to severe depression were the same in people aged 16-39 as in those aged 40-69.
• With the outbreak, the rate rose in every age group and remains higher than pre-pandemic. This is especially pronounced for people aged 16-39 (for whom it is still 12 percentage points higher).
• Still, rates remain high even for people in mid-life: 15% of people aged 40-69 reported moderate to severe depressive symptoms over the September to October 2022 period.

We also know that:

• In 2023, depression, bad nerves or anxiety was the health condition most commonly reported by the working-age population (5 million people, 12%). This was also the health condition responsible for the largest number of people economically inactive because of long-term sickness in 2023 (1.35 million people, 53%).
• The cost-of-living crisis is playing a part in rates of depression:
  • Around one in four (24%) of those who reported difficulty paying their energy bills experienced moderate to severe depressive symptoms, which is nearly three times higher than those who found it easy to pay their energy bills (9%).
  • Around one in four (27%) adults who reported difficulty in affording their rent or mortgage payments had moderate to severe depressive symptoms. This is around two times higher compared with those who reported that it was easy (15%).
  • Nearly a third (32%) of those experiencing moderate to severe depressive symptoms reported that they had to borrow more money or use more credit than usual in the last month compared with a year ago. This is higher compared with around one in six (18%) of those with no or mild depressive symptoms.
• This research, which predicts an increase of 2.5 million in the number of people living with major illness in England by 2040, finds that much of that increase will be accounted for by anxiety and depression as well as chronic pain and diabetes.

What does the chart show?

• The prevalence of common mental health disorders (such as depression and anxiety) declines with age, from almost one quarter (24.3%) of people aged 18-24 to one in ten (10.9%) people aged 65 and over.
• And although the likelihood of receiving talking therapies for these disorders is very low across the population, it declines steadily with age:
  • While a little more than one in ten 18-24 year olds with probable mental health disorders receive talking therapy (12.6%), the proportion is half that for 55-64 year olds (6.9%) and lower again (4.4%) in people aged 65 and over.

We also know that:

• Ageist attitudes contribute to this pattern of treatment: many health professionals believe talking therapies are not effective for older people or that they will not engage with the process.
• Signs of depression and anxiety are often overlooked in older people due to commonly held stereotypes, such as that loneliness and depression are normal aspects of older age. In fact, the data shows that the converse is true: rates of loneliness and depression actually decline with age.
• When an older person does present with depression, the health professional is more likely to prescribe medication than talking therapy. While older people are significantly less likely than younger age groups to have access to talking therapies, they are six times more likely to be on tranquillisers. A large proportion of residents in European long-term care facilities, including in the UK, receive antidepressant medications.
• This is detrimental for a number of reasons: the first is, of course, that the person experiencing depression is not being given access to the most effective treatment, or at least to a number of treatment options. The second is that polypharmacy is already an issue for older people: Age UK reports that more than one in ten people aged 65 and over take at least eight different prescribed medications each week. There are significant risks to polypharmacy, so talking therapy should be considered as the first option before adding anti-depressants to the mix.

What does the chart show?

• Though the proportion of people with low life satisfaction and low levels of happiness are low (generally fewer than one in ten), rates are highest for people in mid-life:
  • Around 8 to 9% of people aged 50-59 have low life satisfaction. Rates then drop to below 4% for people aged 75-79 before rising again in the oldest people.
  • The highest rates of unhappiness are in people aged 20-24, followed by people aged 55-59 – more than one in ten of whom report low levels of happiness.
• The oldest people – those aged 85 and over – are the most likely to feel that the things they do are not worthwhile. Still, it’s reassuring to see that just 8% of people aged 85-89 feel this way.
• High levels of anxiety are more evenly spread across age groups. Almost a third of 20-24 year olds have a high level of anxiety. More than a quarter of people aged 40-49, 55-59 and 85-89 have high levels of anxiety.

We also know that:

• Mental health problems can exacerbate physical illness with major ramifications for health outcomes and the cost of treatment.
• By interacting with and exacerbating physical illness, mental health problems increase total health care costs by at least 45% per person.
• The effect of poor mental health on physical health results in costs to the NHS of at least £8 billion a year.
• The stress caused by financial pressures is no doubt having an impact on physical health, but there are direct routes through which physical health is being impacted too. Our analysis of data from the 8th Financial Fairness Tracker survey (abrdn Financial Fairness Trust; see Technical Report for details) shows that one in ten people aged 50-69 have eaten less than they felt they should because there wasn’t enough money for food; two in five have cut down on electricity and on other expenses to afford food; and one in ten Disabled people aged 50-69 have been hungry but not eaten because there wasn’t enough money for food.
• This quantitative data is confirmed by research from the Manchester Urban Ageing Research Group looking at the lived experience of older people from minority ethnic backgrounds. It finds that the cost-of-living crisis is having a disproportionate impact on older Black, Asian and other minority ethnic groups, who tend to be poorer, have lower quality housing, lower pensions, and are often in poorer health.

*The ‘cost-of-living crisis’ refers to the fall in ‘real’ disposable incomes (that is, adjusted for inflation and after taxes and benefits) that the UK has experienced since late 2021. With prices steadily increasing, household incomes have not kept up with living costs.