Question

In what ways is socioeconomic status related to wellness in old age and to life expectancy?

Answer 1

Socioeconomic status (SES) encompasses not just income but also educational attainment, financial security, and subjective perceptions of social status and social class. Socioeconomic status can encompass quality of life attributes as well as the opportunities and privileges afforded to people within society. Poverty, specifically, is not a single factor but rather is characterized by multiple physical and psychosocial stressors. Further, SES is a consistent and reliable predictor of a vast array of outcomes across the life span, including physical and psychological health. Thus, SES is relevant to all realms of behavioral and social science, including research, practice, education and advocacy.

SES Impacts the Lives of Older Adults

The United States is facing unprecedented increases in the older adult population. Americans age 65 years and over comprise nearly 13 percent of the U.S. population (U. S. Census Bureau, 2010). The older adult population is projected to double between 2012 and 2060, from 43.1 to 92.0 million (U.S. Census Bureau, 2012). As the percentage of older Americans rises, so does concern for their economic stability.

SES is a key factor in determining the quality of life of older Americans, nearly 14.6 percent of whom live below official poverty thresholds (DeNavas-Walt & Proctor, 2014). Declines in health and the death of a spouse, common among older adults, are factors that can affect financial standing. As a large proportion of the U.S. population approaches retirement, greater demand is placed on Social Security, and cuts in these benefits are anticipated. These circumstances place low-income older Americans at a serious disadvantage, as they are more likely to rely on Social Security as their main source of income.

Retirement and Income

The majority of older adults do not work and have fewer options for continued income. They are at risk for rising costs of living, which may place them at an economic disadvantage and potentially at lower levels of SES.

• In 2014, 61 percent of persons age 65 years and older received at least half of their income from Social Security (Social Security Administration, 2016).
• By 2030, it is projected that 25 percent of older persons will be from ethnic minority groups. Up to 19.2 percent of older African Americans and 18.1 percent of older Hispanics live in poverty, compared with an estimated 8.7 percent of older White Americans who live in poverty (Social Security Administration, 2016).
• Social Security benefits are 90 percent of the household income of 21 percent of elderly married couples and about 46 percent of elderly unmarried individuals (Social Security Administration, 2015).
• Older individuals in the highest wealth decile can attribute the majority of their wealth to pensions, housing, and other assets, which are generally absent among those of lower SES (Butrica, Toder, & Toohey, 2008).
• Older individuals, both men and women, are working later in life and exiting the labor force gradually (Cahill, Giandrea, & Quinn, 2013).

Health and Economic Status

Recent studies indicate that the quality of care afforded to older adults with medical conditions is substandard (Wenger et al., 2003). Furthermore, older adults who work are less likely to maintain employment as their health declines.

• About one in 10 persons age 50 and older who report that a disability has reduced or eliminated their ability to work are assisted by Social Security Disability Insurance (Fleck, 2008).
• Individuals age 60 years or older with low SES (e.g., household income, net worth, etc.) who self-reported feeling lonely were found to be at greater risk of functional decline (e.g., activities of daily living; developing difficulties with upper extremities, mobility, climbing stairs, etc.) and death (Perissinotto, Cenzer, & Covinsky, 2012).
• Approximately one in three persons with a chronic illness (e.g., arthritis, diabetes mellitus, asthma, cancer, chronic obstructive pulmonary disease, stroke, hypertension, coronary heart disease or psychiatric issues) and low SES is unable to afford food, prescribed medications, or both (Berkowitz, Seligman, & Choudhury, 2014).

Low socioeconomic status is linked to significant reductions in life expectancy and should be considered a major risk factor for ill health and early death in national and global health policies, according to a study of 1.7 million people.

When compared with their wealthier counterparts, people with low socioeconomic status were almost 1.5 times (46%) more likely to die before they were 85 years old. Among people with low socioeconomic status, 55,600 (15.2% of men and 9.4% of women) died before the age of 85, compared with 25,452 (11.5% of men and 6.8% of women) of people with high socioeconomic status.

The study also estimated that that 41% of men and 27% of women had low socioeconomic status and that this was associated with reduced life expectancy of 2.1 years, similar to being inactive (2.4 years). The greatest reductions were for smoking and diabetes (4.8 and 3.9 years, respectively). Comparatively, high blood pressure, obesity and high alcohol consumption were associated with smaller reductions in life expectancy (1.6, 0.7 and 0.5 years, respectively) than low socioeconomic status.