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AGEING IN AOTEAROA THE NEW ZEALAND HEALTH WORK AND RETIREMENT STUDY Health and Ageing Research Team (HART) Massey University AGEING IN AOTEAROA © 2023 The authors Published by To Our Participants Health and Ageing Research Team (HART), School of Psychology, Manawatū Campus, Massey University hart@massey.ac.nz The reproduction of any content of this book is prohibited without permission of the publisher by the New Zealand Copyright Act. This applies to any form of reproduction. Concept: Susanne Röhr Authors (alph.): Fiona Alpass, Vicki Beagley, Rosemary Gibson, Hannah Phillips, Susanne Röhr, Christine Stephens, Brendan Stevenson, Polly Yeung Text editing: Carol MacDonald, Vicki Beagley Photos: private (pages 18, 19, 20, 262), Susanne Röhr (pages 10, 28, 31, 32, 38, 40, 42, 44, 46, 246, 248, 250, 254, 256, 258, 260), Anja Römer (page 252), otherwise sourced at pexels.com, oneshot.co.nz, shutterstock.com, truestock.co.nz, and stockphoto.com Design: Yvonne Sommer (Click Design Ltd), Susanne Röhr Cover art: Grant Finch (“Late Afternoon”, 2023) “H(ART) Collection 2023”: NZHWR participants featured with their artwork provided written informed consent to print their artwork and disclose their names in this publication. They remain the owners of their artwork. “Meet Our Participants”: NZHWR participants provided written informed consent to print their portraits and to share their stories in this publication. This is strictly separate from any NZHWR survey data, which remain de-identified in all cases at all times. First digital edition Released in June 2023 ISBN 978-1-7385873-1-5 AGEING IN AOTEAROA The New Zealand Health, Work and Retirement Study Health and Ageing Research Team (HART) Massey University CONTENTS Foreword 8 Preface 11 Introduction 15 Behind the Scenes 29 Meet Our Participants 37 Health and Age 49 Life Course 57 Housing and Neighbourhoods 65 Work 75 H(ART) Collection 2023 85 Caregiving 167 Measuring Māori Identity 177 Older Chinese in New Zealand 187 Social Connections 195 Loneliness 203 Alcohol Consumption 211 In Times of Crisis 221 10 NZHWR Key Messages 230 Future Avenues 233 Meet Our Team 245 HART Publications 265 FOREWORD One key finding is that people who own their homes have better health and wellbeing than those who rent. Here, home ownership may be a proxy for generally better economic circumstances. But it may reflect something else. Security of tenure of housing may be part of psychological security. So may perceived safety of the A few years ago I was at a meeting on ageing involving Americans and Europeans. A neighbourhood. Indeed, one of the reasons that wealth at older age is related to US economist probed about older age in the Netherlands. better health is psychological security. Living a life of dignity requires a base of “What happens to economic wellbeing if there is a shock?”, the American asked. psychological security. As I illustrated, above, in the exchange between the Dutch and “What kind of shock?”, responded the Dutch economist. American economists, social policies can be crucial in providing that security. It is a message that this report emphasises. “Say, catastrophic illness”, said the American. “That’s looked after by the health care system, free at the point of use. It doesn’t Healthy ageing has more to do with circumstances throughout the life course than constitute an economic shock”, said the Dutch economist. it does simply with individual behaviours at older ages. Social policies that improve living and working conditions are the route to greater equity of health and wellbeing “Job loss?”, asked the American. at older ages. “We have a good pension system, that maintains a reasonable standard of living.” “Eviction?” Equity here implies dealing with the disadvantage associated with socioeconomic position. In Aotearoa New Zealand, it also means paying special attention to the “Tenants are protected.” disadvantage experienced by Māori at all ages. It is welcome that the gap in life The Netherlands is a “normal” country. People with lower income have a worse time expectancy has narrowed. Life expectancy for Māori has improved a little more of it through the life course, including worse health and functioning at older ages. rapidly than for non-Māori, but Māori disadvantage is still large. I come back But the social environment, and associated public policies, really matter for the to the theme of living a life of dignity through the life course. For Indigenous quality of lives at older age. These policies provide a good deal more protection in New Zealanders, as for other groups, this will include flourishing within cultural the Netherlands than they do in the US. traditions and freedom from discrimination and racism, as well as having favourable socioeconomic conditions important for all New Zealanders. Social and What is true for other countries is true for Aotearoa New Zealand, as illustrated in environmental policies are crucial. this important report from the New Zealand Health, Work and Retirement Study (NZHWR). When my colleagues and I began the English Longitudinal Study of Ageing A particular strength of the current report is that the evidence accrued from detailed (ELSA), twenty years ago, we pointed out that a typical view of older age was as a longitudinal research is complemented by another kind of evidence: the texture of time of misery, relative poverty, social isolation, and poor health and functioning. the lives of real people. Both types of evidence are important if we are to understand This present report shows, as did ELSA, that life at older age is far from the typical the causes of inequities in health and wellbeing at older ages, and the steps needed picture of popular image. There is huge variation but it is not random. Circumstances to make a difference. through the life course have a cumulative effect in leading to inequalities in health, All of this is enhanced by the beauty of the artwork. wellbeing, and functioning at older ages. The three domains that are the focus of this Aotearoa New Zealand study – health and wellbeing; social connectedness and This NZHWR study, with its perspective, rich longitudinal data and insightful case participation; and economic wellbeing and participation – are closely related. histories makes a welcome contribution to a growing movement to address the social determinants of health. My perspective is equity of health and wellbeing. It is clear that loneliness and social isolation, and poorer economic circumstances, are potent drivers of inequalities Professor Sir Michael Marmot in health at older ages. This study provides rich detail: good quality work and Director Institute of Health Equity satisfaction with housing are important to health and wellbeing at older ages. UCL (University College London) 8 9 PREFACE Population ageing is a critical and unprecedented demographic change occurring worldwide. The Aotearoa New Zealand population of people aged 65 and over is projected to double over the next 30 years. Those over 65 will constitute 25% of the population by 2040, while the number of oldest-old (those aged 85 and over) will expand more than five-fold to constitute 5% of the population. This demographic shift has attracted attention to the importance of supporting the health and wellbeing of older persons. This century has seen changes in the focus of debates as well as real structural and attitudinal changes toward ageing. International policy responses previously focused on encouraging and facilitating older people to maintain positive health-related behaviours and to remain engaged in society and economic activity. However, the publication of the 2015 World Health Organization (WHO) Report on Ageing signalled a shift towards recognition of the social and physical environment as important supports for ageing well. Aotearoa New Zealand has responded rapidly to this shift with the launch in 2019 of Better Later Life – He Oranga Kaumātua 2019 to 2034, the government’s strategy for the ageing population. The guiding principles of this strategy include valuing people as they age, recognising diversity, taking a whole-of-life approach, and taking collective responsibility for planning for later life. This collective responsibility includes paying attention to the social and physical environments in which people age, rather than the previous focus on individual responsibility. The Health and Ageing Research Team (HART) has contributed to the development of these shifts in focus. Our research has not focused on what older people can do to keep themselves healthy, but rather on what society can do to support the wellbeing of all, including older people as an important and integral part of our society. Thus, our findings are not directed towards individuals, who already know that eating well, exercising physically and mentally, and maintaining social health is good for us. Rather, our work is directed towards social policymakers who have the power to 11 influence the development of social and physical environments that support these healthy behaviours. Our research has shown that it is vulnerable groups with fewer resources and lifelong disadvantages who need additional support to maintain wellbeing into older age. We have also shown that deprivation in childhood impacts health in older age, through pathways such as education and employment that support or hinder people’s ability to maintain healthy practices. Moreover, our work indicates that it is the broader environment, such as attitudes to older workers or housing and neighbourhood design, that influences wellbeing. The New Zealand Health, Work, and Retirement study (NZHWR), a longitudinal survey, has been an important contributor to this knowledge. NZHWR data and findings have been used by multiple organisations and cited in numerous reports; including the New Zealand Ageing Strategy, for the Health Promotion Agency on older adults’ alcohol and other drug use harms, by the Retirement Commission, and the WHO towards operationalising the Healthy Ageing concept. HART members assisted The Ministry of Business, Innovation and Employment (MBIE) to develop the Mature Workers Employment Toolkit and are Project Steering Group members for The Ministry of Social Development (MSD) research “Age-related discrimination against older workers”. The NZHWR findings are shared directly with participants and the public through various media. Our over 670 stakeholders and end-users receive regular HART updates through newsletters, policy reports, seminar/webinars, and our Twitter @MasseyHART. An annual newsletter to NZHWR participants describes activities and key findings. The HART website is in plain language and relevant to a broad audience. The site has attracted 53,200 visits between July 2014 and December 2021. The website includes descriptions of the NZHWR study and metadata, associated journal articles, reports and newsletters, and links to recorded seminars/webinars, including presentations from visiting international scholars. The team leaders have shared findings with national media (over 130 interviews since 2017) and are frequently invited to discuss results with local interest groups (e.g., Age Concern, Royal Society, New Zealand Association of Gerontology). The ability to follow people across time has provided powerful evidence for the effects of environmental conditions (such as in the neighbourhood and at work) on loneliness, mental health, physical health, and quality of life. Such a study depends on the willingness of our participants to contribute their personal information for the sake of developing this knowledge. We acknowledge and thank our survey and interview participants for making this work possible by giving their time, patience and interest. We are pleased to dedicate this book to them. Professor Christine Stephens and Professor Fiona Alpass 12 13 INTRODUCTION The NZHWR study of ageing began in 2006. It was the first of its kind in Aotearoa New Zealand and remains the longest ongoing cohort of ageing research in the country. Every two years, the NZHWR study surveys thousands of New Zealanders aged 55 years and older to examine their experiences of health and wellbeing in consideration of their social, economic, and physical environments. This chapter looks back at the study’s beginnings, how it evolved, where it is at today, and provides a comprehensive overview of study-related figures and outputs. 15 HOW IT ALL BEGAN Institute for Social Research and met with Dr Heidi Geyer and her team who gave a valuable overview of their data collection and data management protocols. These As social scientists working in the School of Psychology at Massey University, Fiona meetings provided many valuable insights into running a longitudinal study with and Chris were aware of a global demographic shift. Populations were ageing in ways similar warnings and recognition of how well the HART was doing with such limited that meant there would soon be more people over 65 than children in the world. This resources in Aotearoa New Zealand. new phenomenon had many social and economic implications which were important to Chris as a health psychologist and to Fiona as an organisational psychologist. At the same time, they were lucky to meet Dr Nancy Pachana, a clinical psychologist COMING OF AGE with a focus on gerontology who was interested in working with older people and researching their needs. Now a Professor at the University of Queensland, at the All the warnings were correct, but thanks to a succession of wonderful HART staff, time Nancy was a vibrant member of the School of Psychology at Massey University Andy Towers, Jack Noone, Brendan Stevenson, Jo Allen, Hannah Phillips, and Vicki who encouraged all to take ageing seriously as a topic for psychology. Following Beagley (the longest serving), the team has overcome these issues to the point at Nancy’s departure, Chris emailed members of the School to ask who would be which they can celebrate 20 years of the HART and the NZHWR study in its 18th year. interested in forming a group to discuss research on ageing. Helen Pennington, a This development has also included an expansion of HART, welcoming more developmental psychologist who has since retired, and Fiona answered, and the researchers of whom Brendan Stevenson, Andy Towers, Jo Allen, and Jack Noone HART and the NZHWR study were born. remain valued members. In addition, there have been very important contributions from other academics, chiefly Mary Breheny, Joanne Taylor, Juliana Mansvelt, Sally The initial study was based on a survey that Fiona was developing about retirement. Keeling, Ágnes Szabó, Polly Yeung, Steve LaGrow, Eljon Fitzgerald, and most recently The pilot survey was funded by the School of Psychology. But the team wanted Susanne Röhr and Rosie Gibson. Notably, the team is well supported by the HART to make this a longitudinal study focused on the long journey into older age and Māori Advisory Group which is convened by Brendan Stevenson (Ngā Puhi, Ngāti developed a bid to the Health Research Council (HRC) for funding two waves of a Hine, Ngāti Pōrou) and currently includes Natasha Tassell-Matamua (Te Atiawa, Ngāti biennial survey, with the aim to establish a cohort whose members they could follow Makea ki Rarotonga), John Waldon (Tuhoe, Ngāti Kahungunu, Ngāti Pōrou), Roland up in the future. The bid was successful, and they were able to hire Andy Towers, Fitzgerald (Ngāti Pōrou, Rangitāne), Ruma Karaitiana (Rangitāne, Ngāti Kahungunu, a research officer and data manager. For the first wave of the NZHWR study, 6,661 Ngai Tara, Kāi Tahu), and Penny Poutu (Ngāti Maniapoto). participants were recruited and 3,454 of these agreed to be contacted again. The critical contributors to this team are the participants. Participants have been extraordinarily generous in sharing their time and many intimate details of their At the same time, the HART began developing a broader team of local, national, lives. The stories of triumphs and difficulties shared over the years are met with and international collaborators. One of the first advisors was Professor Christina appreciation and sympathy. Participants also share their suggestions for areas of Lee from the University of Queensland, who was the National Coordinator on the research which the HART tries to take on board. Australian Longitudinal Study on Women’s Health at that time. She had been part of this longitudinal study since its initiation in 1995. Christina visited Massey University The work of the whole team has been recognised by ongoing funding from HRC, with a great deal of useful advice, and they formed a very helpful collaboration with MBIE, and other bodies which signals the value of the longitudinal study as an the Australian group. Christina also had some warnings about the difficulties of investment for Aotearoa New Zealand. The HART has also been gratified by the development of links to international research groups and most recently to joint running a longitudinal study which prepared them for the work ahead: the problems work with the WHO in support of the United Nations Decade of Healthy Ageing of good data management at every level, the importance of maintaining relationships (2021–2030). Massey University recognised the contributions of the HART in 2012 with participants, and the difficulties of maintaining ongoing funding because of with the award of the Research Team Medal. a lack of sustained funding for any longitudinal studies. In 2006, Fiona and Andy also visited the home of the Health and Retirement Survey, an extraordinarily large One of the greatest pleasures comes from introducing research students and early longitudinal study of older people in the United States. Here they were hosted by career academics to the HART world and watching them succeed. In the future, Professor Bob Willis of the Survey Research Center at the University of Michigan’s Chris, and then later, Fiona are preparing to hand the leadership of the team over 16 17 18 19 to Susanne and Rosie, who are already leading the research into exciting new and important areas of knowledge. The HART will be recruiting more midlife participants so that they can focus on the critical factors that affect ageing in today’s rapidly changing social and physical environment. As we develop the study we plan for a stronger focus on cognitive functioning and brain health under Susanne’s leadership, the greater use of data from other sources such as the Ministry of Health and Accident Compensation Corporation (ACC), and the wider use of technology to collect information with our participants. THE NZHWR STUDY: FACTS AND FIGURES At its core, the study is a survey of the experiences of ageing in Aotearoa New Zealand completed every two years by a large sample of New Zealanders aged 55 years and over, who are randomly selected from the electoral roll. An over-sample of people of Māori descent is undertaken to ensure adequate representation of this important group. The survey is designed to investigate ageing within three broad areas: health and wellbeing (e.g., physical, emotional, cognitive); social participation (e.g., family support, social capital, participation); and economic participation (e.g., meaning of work, employment, retirement). Each survey also has a section providing a more in-depth examination of an issue of current concern in Aotearoa New Zealand. For example, in 2016, the survey had a focus on housing and neighbourhood quality, and in 2021, on COVID-19, and in 2022, the inclusion of questions from the WHO Study on global AGEing and adult health (SAGE). In addition to the biennial survey, the study has conducted off-wave surveys to assess retirement (2009) and social connectivity (2013), conducted over 1,903 face- to-face assessments of cognitive performance (2010 and 2012), in-depth qualitative interviews on a range of issues, including aspects of employment and caregiving, and over 800 telephone interviews regarding participants’ early and mid-life experiences (2017). The majority of participants have provided consent for the study to link to their anonymised national health records. To date, the study has involved 12,949 participants. The centrepiece of the study remains the original cohort. In 2006, 6,661 New Zealanders responded to the initial survey, and around 46% of these indicated that they were interested in participating in a longitudinal cohort and were re-approached for participation every two years. These original participants were aged 55-70 years, had an average age of 61 years and 54% were female. When asked what ethnic groups they belonged to, 50.7% responded New Zealand European, 46.5% Māori, and 2.8% other ethnicities. 20 21 THE ORIGINAL LOCATION OF 2006 COHORT 2006 COHORT 6,661 participants Aged 55-70 Northland 438 Auckland 394 Waitemata 650 Counties Manukau 561 Waikato 672 Bay of Plenty 471 Lakes 257 Tairawhiti 170 Taranaki 211 Whanganui 151 Hawke’s Bay 316 Capital and Coast 352 Midcentral 272 54% women Nelson Marlborough 214 Average age 61 Wairarapa 75 Hutt 198 West Coast 58 Canterbury 618 South Canterbury 85 Otago 285 50.7% NZ European, 46.5% Māori, 2.8% of other ethnicities Southland 186 22 23 All districts of Aotearoa New Zealand are represented in this sample of respondents. NZHWR In 2022, which saw the 9th biennial NZHWR survey, 1,156 participants of the original cohort continued to respond to the survey. IN NUMBERS Additional cohorts have been recruited to the study over time to both broaden and maintain the capacity of the NZHWR and to investigate how different age groups are impacted by events and policies that have occurred during their life course. Over the study duration, the majority of the participants have moved from being engaged 12,949 total 9 biennial surveys full-time in the workforce into retirement, or at least its modern equivalent. The continued participation of these older New Zealanders in the study has allowed the participants development of a resource which is unique in its ability to describe key transitions associated with later life. The continued primary aim of the NZHWR study is to grow the scientific knowledge- base on issues of ageing in Aotearoa New Zealand. Now in its 18th year, the longevity of the study has paid off in terms of cumulative productivity. The outputs of the study have been growing steadily, with peer-reviewed results and insights published and disseminated through 111 journal articles, over 55 reports and 18 book chapters. In addition, several doctoral and masters students, supervised by HART 111 publications 16 years of members, have completed research theses utilising NZHWR data. The development observation of research skills relevant to ageing in these students remain some of our most important achievements as their progress represents a meaningful increase in research capacity in the field of ageing in Aotearoa New Zealand. The study has provided annual reports to funding bodies, as well as reports to Treasury and the Health Promotion Agency. The reports provided insights into, for example, the economic issues for older persons, their connectedness to health and social resources in a digital age, choices around housing, and the experiences and recovery following the Canterbury and Seddon earthquakes of 2010, 2011, and 2013. Reports tailored to provide information relevant to policy issues for older people, 18 book such as the acceptability of tele-health, the balance of work and care provided by chapters older caregivers, and the impact of housing tenure on the wellbeing of older adults, 55+ reports have been disseminated to end-users. The project has enabled local researchers to engage in high-profile international collaborations with world leaders in ageing research, placing Aotearoa New Zealand research on a world stage and promoting discussion around issues of ageing for older New Zealanders in these settings. 1 book 24 25 The continued primary aim of the NZHWR study is to grow the scientific knowledge-base on issues of ageing in Aotearoa New Zealand. Now in its 18th year, the longevity of the study has paid off in terms of cumulative productivity. Importantly, the development of research skills relevant to ageing in PhD and masters students remains one of the most valuable achievements as their progress represents meaningful increase in capacity in ageing research in Aotearoa New Zealand. 26 27 BEHIND THE SCENES Conducting a longitudinal cohort study like NZHWR is a complex endeavour and requires a multidisciplinary team. Typically, scientific publications and reports are the visible elements of a study. But there is a lot of work going on “behind the scenes” to eventually get to those. Vicki Beagley and Hannah Phillips are the Research Officers of the NZHWR study and are responsible for the technical aspects of the study. In sharing what they do, they provide an exclusive insight into running NZHWR. 29 Vicki and Hannah have different but fully complementary roles. Hannah creates The surveys and consent forms are scanned with a specialised scanner that has the datasets from each survey wave, manages the participant database and is been calibrated to record the responses to each survey question. The qualitative responsible for sharing the survey data responsibly with external researchers. Vicki responses from within the survey, including any written text that a participant has organises the printing, mailing, receipting, and scanning of the surveys, and interacts added, are entered manually into another program to be combined with the rest of directly with the participants. If anyone dials the HART’s 0800 free phone number, the survey data at a later point. The scanner generates a PDF copy of each survey Vicki will answer the call. Vicki and Hannah work together on the annual newsletter and consent form, which are backed up on two secure hard drives. The physical which is usually sent out in November. Vicki gathers all the required information copies of the surveys and consent forms are secured in a locked room and eventually and draws up the draft newsletter, and Hannah does all the formatting, editing, and destroyed once archiving is complete. preparations for printing. Every second year, the NZHWR survey is developed across many meetings and after consultation with the Māori Advisory Group. Hannah and Vicki work together with the team to format the questions and fit them together onto the survey pages. After the draft survey has been prepared, Vicki organises for 20 to 25 people to read and fill out the survey and advise of any errors or areas that need amending. The survey is revised and adjusted many times by Hannah for clarity and to correct any identified errors. Vicki liaises with the staff at the printing service in Wellington as well as the Massey University mail room to advise them of the large volume of incoming mail. The first 30 receipted surveys are put through quality assurance where the data is both scanned and entered manually, then both sets of data are compared to ensure the scanned data is accurate. Due to the strict confidentiality requirement, Vicki and Hannah are the only team members with access to the participant database. To maintain a representative sample, as the existing participants age, every two years a new cohort of participants, aged 55 and older, is selected from the electoral roll to add to the sample. All existing participants who are deemed to still be active in the study are recruited for the new survey wave. The participants are allocated a new ID code specific to that wave of the survey, and the participant lists are encrypted and sent securely to the printing service with the survey materials ready for distribution. Meanwhile, Hannah prepares to receive and clean the data to make them available for researchers to use. After scanning, the data are stored in hundreds of text files. These data must be imported into statistical software to build the dataset. RECEIPTING PROCESS, SCANNING AND QUALTRICS The qualitative data are imported and combined with the scanned data, and each Each participant has a longitudinal ID code for linking their data across waves, and participant is linked with their original longitudinal ID code, so their responses can Hannah and Vicki are the only members of the team who can link the two together. be merged across all survey waves. Their reported gender and date of birth are This ensures that the participants’ identifying information (e.g., name, address) are compared with previously held records to ensure the same person is responding stored separately from their survey data and are not able to be connected. Upon across waves and the text data have been linked to the correct participant. Each receipt, the surveys are stamped with their receipt date, then entered into the variable is checked for any out-of-bounds responses, and should any arise, the database management system to mark that the participant has returned the survey. PDF for that particular survey is checked to amend the record. Once the dataset is If required, the participant’s contact details and activity status are updated. complete, it is made available for researchers to use. 30 31 When a researcher contacts the study to use the data for their analysis, Hannah Originally the surveys were hand-delivered to a typist who manually entered the checks their request and ensures that they are not requiring identifying information. data into a computer program, but since 2018 this work has been conducted using If ethnicity data is required, the request must be justified and approved by a member a specialised scanner and software. One huge challenge for Vicki was to master the of the Māori Advisory Group before the data can be shared. Hannah compiles the scanning program which, to put it mildly, is very “clunky”. However, with each survey dataset and generates a set of unique ID codes for use only within that dataset to wave it got easier and the process became more accurate and streamlined. The most protect the participants’ identity and ensure that the data cannot be linked with other recent 2022 survey was a lot of work, but she found it very enjoyable as most of the datasets. The dataset is then encrypted and securely shared with the researcher. computer problems had been ironed out and everything ran very smoothly. COVID-19 caused many problems in all aspects of the survey and data collection in 2020 and 2021. As Aotearoa New Zealand was entering its first lockdown, the 2020 survey was partway through its design process, and the whole team had to quickly adapt to working collaboratively from home. Designing, testing, printing, and distributing the survey had to occur remotely. Receipting and scanning the surveys would have been particularly challenging, but the day before lockdown, Vicki grabbed all the hardware and set herself up in her dining room, and the surveys were delivered each day by the mail room staff. Although it was a bit cumbersome getting surveys to and from work (and dealing remotely with computer issues), the system worked very well. Hardly any time at all was lost, when things could have come to a complete standstill. As Vicki deals directly with the survey, she gets a lot of satisfaction from the many positive comments that participants write on the back of the survey. With the increasing use of the internet, emails, and mobile phones, it has become easier than ever to track those whose addresses have changed as in earlier years there was only a landline, and if people moved, they relinquished their phone number. The retention rate is therefore much higher now than in the first few years of the study. Vicki enjoys working with the team and tells people she has the “best bosses in the world”. The main IT and admin support staff also make her job enjoyable, as nothing The survey is usually sent out biennially. During “non-survey years”, there are various is ever a problem for them, and they respond positively to any requests. There is smaller studies conducted, and Vicki usually manages these. One memorable study a lot of variety in the work, especially during years when surveys are not sent out, was the “Lifecourse History” study. Initially, Vicki phoned 1,200 participants who had due to the interesting studies she helps conduct. Vicki also really enjoys interacting with the participants and chatting with them when they call to receive or share been active since 2006 to gauge their interest in being part of this study. Interview information. sheets were sent to those participants who agreed to take part. Vicki coordinated the study and had 13 students across Aotearoa New Zealand conducting telephone Hannah loves the challenges and problem-solving that arise from data management interviews that lasted one to three hours. The goal was to complete at least 500 and gets a lot of satisfaction from figuring out a way to write a piece of syntax to interviews, but the study concluded with more than 800 completed. Vicki was struck solve a problem. She enjoys learning about other researchers’ work when they by the willingness of these participants to share their stories, some of which were submit data requests and is always on hand to help answer any questions about the deeply personal, and some were telling their experiences for the very first time. data as needed. 32 33 In 2012, a participant interview took place in a boat in the beautiful Wyuna Bay near Coromandel township. Another participant was born in the same town as both of Vicki’s in-laws. Asking about her married name, the participant laughingly told Vicki that she used to babysit her husband, and that her father was the Master of Ceremonies at the wedding of Vicki’s in-laws. Aotearoa New Zealand is but a village. 34 35 MEET OUR PARTICIPANTS 36 37 RUMA KARAITIANA Ruma joined the NZHWR study in 2006, just as he was beginning his fourth chief executive role. As his work often involved people completing surveys, he felt that he should become a part of NZHWR, too. Since Ruma had supervised scientific papers and enjoyed the research process, he feels positively inclined to research, just as a general principle. At that time, he looked at where he was in life, his age and background and just thought that he might be quite a useful contributor to the research. As the study was longitudinal and set out to maintain a large sample, this should be interesting over time. Coincidentally being a member of the study’s Māori Advisory Group gave him a deeper insight into the research. For the first twelve years of his life, Ruma was raised by a single mother before the days of benefit support. It left them quite impoverished, and they did not eat every day. Ruma’s father was a musician. He came back from the war damaged and alcohol-dependent. The only thing that worked for him was his music. He was very successful and had New Zealand’s first gold record “Blue Smoke”, still popular today. Like many who came back from the war, his father was a subsistence farmer and was expected to go back on to the land, but he found it difficult to handle. So he left his whānau and travelled on the road performing. This is where he met Ruma’s mother, a beauty pageant finalist. It was the beauty queen meets rockstar story. Ruma’s pākehā mother was instructed to bring Ruma back to the whānau to be raised and he became a whāngai son to his grandmother for three years. After leaving school, Ruma won a scholarship to study law but went to teachers’ college instead. After a short time teaching, he moved on to other roles and changed his job every three years or so. Gradually moving from sales to governance in the building sector, to owning a restaurant, on to board and chief executive roles. He then became very interested in education at a governance and operational level. After a stint in Wellington, Ruma and his wife moved back to Palmerston North to be closer to whānau and mokopuna. This is when he became heavily involved in Treaty settlements. Ruma keeps fit by walking 5 km each day but admits to finding ageing frustrating as his energy levels have dropped. He is actively considering relinquishing his current board roles. Slowly moving more and more away from work, Ruma is rekindling his interest in the arts. He used to paint for relaxation but has not held a brush for a while. Who knows, it might be a hobby now that Ruma is eyeing up retirement. 38 39 JUDY JENSEN Judy would have been living in Waverley when she received her first NZHWR survey back in 2006, and just thought “yeah, okay”. Someone seemed to be interested in knowing about her life. She continued to complete the surveys over the years thinking that what she has to say must indeed be interesting for some people if they keep sending them to her. She currently lives on a lifestyle block with her partner and a few animals. In her childhood, Judy was not allowed to go to secondary school and was educated by correspondence, although her parents did all her work. So, she initially stayed home on the farm. They were not easy days for Judy. She eventually ran away from home at the age of 15 and stayed with someone she kind of knew. Judy was very eager to find work and start making her own living. Then she could not be made to go back home. Judy quickly found a job in a restaurant, and later as a cleaner. After three years, she married a local dairy farmer, and they shifted to a sheep and beef farm. The farming life became Judy’s passion, and she enjoyed cooking for the staff that she managed. They were by then on a 15,000-acre farm. Whilst there, Judy and her now former husband adopted and raised two children. Later she worked on an asparagus farm, rearing calves, as an artificial insemination technician and in a sales representative role. She loved working with animals because they do not talk back. Sometimes, she found managing staff challenging as they did not always have the same hard-working ethic Judy expected from herself. So unsurprisingly, it was a hard decision to finally retire at the age of 72. Not voluntarily though, the physical element of Judy’s job was taking its toll. The newly found free time does not leave any room for boredom. These days, Judy enjoys singing country music, rock’n’roll and ceroc dancing, and she even travels across the country to participate in competitions. Judy started playing golf just before she retired, and continues to improve her handicap, now down from an initial 54 to an impressive 27. Being vice captain of the local ladies’ golf team gives her enjoyment, especially the organising that it requires. To keep fit, Judy enjoys maintaining the large garden and tends some sheep on the property. She has started going to a gym twice a week, this makes her feel better both physically and mentally. Judy does have a few health issues which she manages with her doctor and osteopath. Both her birth parents died in their sixties, so she is grateful to have outlived them. Today, we see Judy happy and content on her lifestyle block, whilst keeping busy with her singing, dancing, golf, animals, and fishing, another one of her many hobbies. 40 41 BRUCE CHAMBERS When asked why he decided to participate in the NZHWR study, Bruce just thought it was “something good to be involved in”. Back then, he was busy with work and family, but he was impressed by the long-term nature of the study, particularly if it would mean working out what was needed in the health system. With his involvement over the years, he now feels obligated to the study, like a job that you started and want to finish. But he does enjoy filling out the surveys. Bruce started his working life in Lower Hutt as a refrigeration apprentice. When he met his wife, who was from Karori, he was living in Christchurch and the young couple soon married. While living together in Christchurch for about six years, they had their two children. The family then spent about four years on a rural farm in Feilding. During that time, it was hard to make a good living. One major obstacle for Bruce when he was well into adulthood was that he had difficulty with reading and writing. Whilst working on the farm he enrolled in a farm management course by correspondence. It meant lots of writing, and only by Bruce’s strong work ethic and desire to succeed was he successful, learning to read and write and obtaining his diploma at the same time. Mondays, he used to read the assignment word by word, Tuesdays he used to write it, Wednesdays, he would use a dictionary to check every word, Thursday was finalising day, and Friday he posted it off. A huge effort. Once they left the farm, they owned a garage for a while and moved on to Levin where he did various jobs including real estate, working on classic cars, and in a motorbike shop doing repairs. He also spent around 20 years either on the Ōtaki Borough Council or the local community board, something he could not have done, had he not learned to read and write. After a period of ill-health, Bruce had to give up work. He still does not feel mentally or physically ready for retirement. He misses the social side of work. A cuppa now and then at his old work helps. These days see Bruce taking a lot of medications and attending frequent health checks. Bruce finds he worries now unduly about things, which did not worry him in the past. One of Bruce’s most enjoyable and rewarding jobs was working in the classic car shop for thirteen years. It is a passion that he has preserved into his retirement. He spends a great deal of his time tinkering with cars and motorbikes in his garage behind the house. Proudly, Bruce has rebuilt a dragster and a classic car. Having just returned from the “Americana” classic car show in New Plymouth, Bruce is newly fired up to continue working on his cars. He also used to ride motocross bikes. Safe to say, Bruce is passionate about anything mechanical. If he is not working on rebuilding a car or a motorbike, he is making bird feeders, maintaining the garden, mowing the lawn, or going for the occasional walk. 42 43 ELIZABETH MARTIN Liz has been a NZHWR participant for over 16 years. Over time she has been quite amazed at how her answers have changed. It is a good way for her to reflect on life. Whenever a new survey finds its way into her mailbox, Liz just sits down on her own quietly and fills it in. Whatever answer comes into her head, right at that minute, she puts it down. Liz just hopes someone likes to hear her views (we very much do, Liz!), and she is still happy to participate. When her family emigrated from Glasgow, the young Liz was pulled, screaming and kicking. They landed in Wellington in May and moved to a house in Hastings, which had a garden with peaches, nectarines, and gooseberries, which she didn’t think existed. As opposed to not wanting to come to Aotearoa New Zealand initially, Liz was now in love with it as her sister had also moved to Hastings. Things turned when Liz got a boyfriend. Her mother was not happy about it and sent her back to the UK. At 18, she was having her OE. A year later, Liz married her first husband in Scotland. They eventually moved to Aotearoa New Zealand with their three children. Her first job was in a mental health hospital. Liz felt rather vulnerable in her work, but she decided to stick with it as the family was saving for a house, all her pay went into savings. Liz’s husband was a civil engineer, and they eventually moved into a house in the Bay of Islands. That relationship did not last. A while later, Liz remarried a man who worked for the Ministry of Transport, which brought her to live in Auckland where she had three different jobs. They lived there for 28 years, and upon the retirement of her husband, moved to Whangarei. For her husband, it was a hard decision to leave Auckland. But one day Liz saw her dream rural house for sale and just bought it. It took another whole year to work on her husband to leave for the countryside life. When they finally did, they enjoyed two and a half years of absolute bliss there, until Liz’s husband became terminally ill. Three and a half years later, he died. Liz could not bear to live in the house anymore. Too many memories of the best time with the love of her life. She moved to Wanganui, close to her son who was a single father. Pragmatic as Liz always was, she bought a house sight unseen and moved in, and now lives in a lovely granny flat behind the main house. Her son, partner and grandsons get the bigger space. Liz deals with arthritis, but the walks with her dog, swimming and weekly classes for arthritis make it bearable and are good ways to help herself. As much as she can, Liz continues to practice knitting and is quite artsy. She has collected some interesting pieces over her life which are proudly displayed in her flat. Liz is a social person. She has never in her whole life lived on her own and could not do without the chats over tea with friends. Bringing her warm and chatty nature, Liz volunteers a couple of afternoons a week at the local hospice. 44 45 CLIVE LOW Clive decided to participate in the NZHWR study because he enjoys writing and thought it sounded interesting. Once he started, he felt there was no reason why he should not continue. Clive was educated in Nelson, as the family shifted there for his father’s work until they eventually moved to Wellington. Clive spent most of his working life as a manager, but initially worked on the wharf, making a decent living at the time. He later worked for the New Zealand Forest Service in Otago as an overseer and later as a foreman when he earned his diesel certificate. After that, he worked for the Ministry of Works in Te Kūiti. Clive and his wife retired when they turned 50. Then the adventures began. He decided to bike to Bluff and talked his wife into biking to Christchurch and back. They enjoyed cycling so much, they decided to go overseas and do some more. Somebody said, “Why don’t you move to Australia, because it’s better money?”. So they did and lived in Sydney for a year, saved a bit of money and moved on to the UK to live in South Wales with a friend. A bit later, the couple took a train to Siberia and continued their journey by working and living in San Francisco for a few months. Strangely enough, they found the United States more foreign to them than any of the other European countries. Hosting an exchange student from Japan led to another big adventure into the land of the rising sun. They returned home in 1989, bought a lifestyle block and lived there for ten years. It had a big shed and thus lots of space for Clive to make things. He built a caravan for the family to take trips with their three adopted children across the country. At the age of 56, Clive kind of got tired of the early retirement and became a warrant of fitness inspector – which he continued for 24 years before retiring again at the age of 80. When his wife took ill, they moved into town to be nearer the hospital. The house needed a lot of work to cater to his wife’s needs, but as Clive is a handy man, he did it all up. Clive gets a great deal of enjoyment from his garden. He collects composting material from the local beach and runs a very active worm farm and a vegetable garden. He makes walking sticks from manuka that he sources from the bush and gives them away. To give each stick a unique feature, he gets badges and buttons from the local hospice shop to embellish them. Clive also makes sculptures of local birds from old materials he recycles, such as pūkeko birds from tin. His garden is a display of his craftsmanship. Clive has financially supported the local Red Cross by growing hundreds of trees from seed. He says these activities help to keep him fit. At his busy 87 years of age, Clive is adamant he wants to live to be 100, to get a birthday card from the King. 46 47 HEALTH AND AGE Three important aspects of wellbeing valued by older people are physical, mental, and social health. Physical health includes freedom from illness and disability and the maintenance of good physical functioning. Mental health encompasses good spirit and freedom from chronic experiences of negative mood. Social health is about positive social relationships, engaging with other people, and participating in society. Achieving good physical, mental, and social health supports healthy ageing; however, many people report good quality of life and high levels of wellbeing, while coping with physical, mental, and social difficulties. Indeed, not all people arrive at an older age in good health, and many have experienced lifelong disabilities or health difficulties. Furthermore, older age is often a time of change and social loss, and the inevitable physical changes of older age must be acknowledged. 49 HEALTH PROFILES HEALTHY AGEING NZHWR research identified five distinct longitudinal health profiles of older New The “positive ageing” focus, in Aotearoa New Zealand and internationally, promotes Zealanders based on self-reported changes in their physical, mental, and social healthy, active, and optimal ageing. Although the concept of “positive ageing” health over a ten-year period (2006 to 2016): has been influential in research and policy-making, it has been critiqued for the implications that people who have disabilities or chronic illnesses cannot age well. • “Vulnerable health” (8.7%) with very poor physical and mental health, and low social health. An alternative perspective explained in the WHO 2015 World Report on Ageing and • “Mental and social health limitations” (11.8% ) with good physical health but poor Health focuses on the process of developing and maintaining functional ability that mental health along with low social health. enables wellbeing in older age. Functional ability arises from the interaction of the • “Declining physical health” (17.5%) with good mental health and social health but intrinsic capacity of the individual and relevant environmental characteristics. poor physical health, which declined over time. Policy to support healthy ageing in Aotearoa New Zealand must recognise that • “Average good health” (31.4%) with lower than average social health but average people arrive at an older age with different levels of health and functioning that physical and mental health which remained stable over time. are the cumulative result of a lifetime of structural and physical effects. The focus must shift from physical and mental health as sole outcomes to wellbeing and the • “Robust health” (30.6%) with good physical and mental health and high levels of importance of the environment in maintaining functional ability. social health. Discussions around ageing and health emphasise flexibility and adaptation to life This means two-thirds of older New Zealanders reported good health (“robust changes as key factors influencing the ability to achieve optimal wellbeing in old age. health” or “average good health” groups). A substantial proportion of those In recent data collection waves, the NZHWR study has focused on environmental with physical health limitations have good social health and good mental health influences (such as housing, neighbourhoods, and access to economic resources) on (“declining physical health” group). people’s ability to access support and participate in the wider community without Participants with a “robust health” restrictions. profile were more likely to survive over the ten-year period. Those with a “vulnerable health” profile were at COGNITION a disproportionately higher risk of mortality than those characterised by While not considered a normal part of ageing, cognitive decline is of concern for any other health profile. This suggests many older adults and can be an early indicator of dementia. Understanding that limitations in physical health, cognitive decline and impairment in relationship with ageing has significant policy mental health, and social health are implications in terms of health care planning and expenditure. Additionally, it is not simply additive but a complex important to understand which areas of cognitive functioning, such as memory, interaction of risk factors and effects. attention, and language, may have different relationships with health. To understand which sociodemographic factors may influence healthy ageing, the NZHWR researchers conducted face-to-face cognitive assessments with 1,000 longitudinal health profiles were examined for differences in terms of participant participants in 2010 and with 903 again in 2012. Participants in “robust health” and age, sex, and education. Age did not appear to be a strong indicator of health status “average good health” displayed better cognitive functioning compared to other among this group of older persons. Overall, men generally reported better health groups; with evidence of poorer memory and verbal fluency performance for the outcomes over time than women, and higher lifetime education attainment was “vulnerable” and poorer memory, verbal fluency and language performance for those associated with better health outcomes in older age. with “mental and social limitations”. 50 51 In terms of verbal fluency, in 2010, those in “robust health” performed better than all However, these factors did not explain most of the differences in cognitive other groups, and by 2012, those in “vulnerable health” performed worse than those functioning between U.S. and Aotearoa New Zealand populations. The national in “average good health”. advantage remained when all measured risk factors were statistically accounted for, meaning that further exploration of the life course factors that influence late-life On assessments of language ability, those with “mental and social limitations” cognitive functioning is needed. performed worse than all other groups. However, in 2012 this group only performed significantly worse than those in “robust” and “average good health”. Visuospatial performance was significantly worse for those who were “vulnerable” HEALTH BEHAVIOURS and those who had “mental and social limitations” compared to those in “robust Alcohol use, smoking, and physical activity influence health across the lifespan. health”. Regular alcohol and tobacco use are strongly associated with early mortality while maintaining regular physical activity supports health and longevity. Despite public The groups did not differ in performance on attention tasks. Those who were health efforts to promote physical activity and reduce smoking rates in Aotearoa “vulnerable” and those who had “mental and social limitations” performed worse on New Zealand over the last two decades, these rates have remained unchanged in memory tasks than those in “robust health”. This difference was not apparent at the those aged 50+. In addition, the rate of hazardous drinking in older New Zealanders 2012 assessment. has increased. While these results demonstrate consistency in the relative cognitive functioning of The general rates of alcohol use, smoking, and physical activity across ten years of the health profile groups over the 2010-2012 period, the data was collected during the NZHWR study were examined within the five health profiles: participants’ early old age. Further assessment is needed to track progress in the • Drinking alcohol was much more common among those in “robust health” and far long-term to better understand the demographic, health, and social characteristics of less common in those in “poor health”. those who experience cognitive decline as the cohort enters advanced ages. • Reduction in smoking was greater for those in “robust health” compared to those Cognitive functioning is a significant aspect of health, and many skills of daily living in “vulnerable health” or with “mental and social limitations”. become disrupted with the progression of cognitive decline. As the population • Moderate physical activity was more common and stable for those in “robust rapidly ages, health services and policymakers must be concerned with the health” compared to those with “declining physical health” or those with the prevention of cognitive decline. poorest health. Existing poor health may be compounded by concurrent health behaviours; people in the best health were more likely to be physically active and non-smokers than INTERNATIONAL BENCHMARKING those in poorer health (who might benefit the most from positive health behaviours). These patterns likely reflect the combined influence of socioeconomic status, health, Using data from the 2010 waves of the NZHWR study, the cognitive health of older and mortality. Drinking was more common among those with higher socioeconomic adults in Aotearoa New Zealand and the United States (U.S.) was compared and status and better health. In the NZHWR study, those in “robust health” and “average differences in risk factors for cognitive decline examined. good health” had higher socioeconomic status and better health than those in “vulnerable health”. Those in “vulnerable health” also experienced increased Older New Zealanders displayed better cognitive functioning than those in the mortality, suggesting that the reduction across time in the drinkers in that group may U.S. sample. This advantage can be partially explained by age and sex differences also be due to the death of drinkers in that group. NZHWR data on health behaviours and, to some extent, by differences in risk factors. All examined risk factors were suggest that an older adult’s long-term health is reflective of their likelihood of significantly related to cognitive functioning and supported the role of education, drinking and smoking and their tendency to be physically active. Those in the best self-rated health, stroke, diabetes, depression, smoking, exercise, and alcohol use as health are more likely to be physically active, to drink, and to be non-smokers than explanatory variables for differences in cognitive functioning among older adults. those in poorer health. 52 53 Looking at NZHWR data across a decade, different trajectories of physical, social, and mental health point to the diversity of older people. Recognising this diversity has important implications for maintaining the health of vulnerable groups, acknowledging that many older people in Aotearoa New Zealand are ageing well, and supporting the positive contributions of an ageing population. 54 55 LIFE COURSE As the population ages, there is increasing interest in how to maintain health in later life. Fending off infirmity is regarded as a double win: better for older people and better for society. To this end, simple health interventions that focus on individual choices and actions in older age are widely promoted in the media. However, ageing is a life-long project. Health in older age depends on the available resources, life-long practices and experiences that are part of individual life histories. 57 CHILDHOOD BEGINNINGS social participation over their entire life course. NZHWR findings show that lower levels of loneliness in later life were associated with being a woman, being married or The five trajectories of physical, mental, and social health identified in the NZHWR in a de facto relationship, and higher adult life socioeconomic status (for men but not study showed that many older people were in robust or average good health. for women). These findings suggest that lifelong exclusion from material resources, These groups were ageing well, maintaining good physical and mental health and which is related to belonging to particular social groups, is a risk factor for late-life remaining socially engaged. However, there was a small but important group of older loneliness. To tackle late-life loneliness, it is therefore important to consider how people with significant health limitations who reached later life in poor health. life course socioeconomic circumstances, in particular, inequalities in accessing and accumulating financial resources, contribute to outcomes in later life. These differences do not simply arise in later life; they reflect a lifetime of experiences which shape people’s thoughts, feelings, and behaviours. The NZHWR The pathways that lead to health outcomes begin with childhood circumstances study found that the strongest influence on health in older age was childhood which in turn affect subsequent socioeconomic circumstances in adulthood and later socioeconomic status which predicts the standard of living in later life and is strongly life. It is these adult social and economic circumstances that impact mental, physical linked to physical and mental health. Even health behaviours, such as alcohol and social health as people reach older age. consumption, were best predicted by childhood family and socioeconomic factors. Once these health behaviour patterns are set early in life, they tend to persist over the life course. SOCIOECONOMIC CIRCUMSTANCES Late-life loneliness has become a growing public health concern with a considerable The NZHWR study found that the resources that people have and how well these body of evidence demonstrating its negative effects on mental and physical health. resources meet their needs (i.e., socioeconomic status) strongly predict health However, people do not suddenly become lonely or isolated as they enter older outcomes in later life. This finding reflects a weight of evidence internationally that adulthood; they develop social relationships and accumulate resources that enable access to resources shapes the health of older people and influences how long they live. NZHWR participants experiencing material hardship in later life tended to experience lower levels of physical, mental, and social wellbeing. Variations in economic living standards are related to the health and wellbeing of older people, the economic resources available to people (related to access to such things as goods and services, transport, savings, adequate housing, and forms of insurance) but also influence the freedoms and choices available to people as they age. Opportunities to accumulate assets to support material wellbeing in later life are shaped by factors such as employment, income, costs of living, and events such as illness, injury, and financial shocks. Although the majority of NZHWR participants reported a reasonably comfortable standard of living, they did so from a socioeconomically diverse range of communities. Participants varied considerably in their socioeconomic circumstances. Māori ethnicity was consistently associated with socioeconomic disadvantage as was female gender, but to a much lesser degree. Material hardship in later life was also related to not owning a mortgage-free home in later life, not being in the paid workforce long-term, being single, having or having held a non-professional occupation, and not having a tertiary qualification. 58 59 The NZHWR surveys provide insight into experiences of economic wellbeing Low childhood socioeconomic status appears to have a detrimental effect through associated with different health profiles. The findings suggest that economic midlife and early older age. Equally, those with high socioeconomic status in disparities in living standards exist between older adults with good and poor health childhood benefit from a protective effect through midlife and early older age. profiles, such that those with the poorest long-term health are also experiencing Beyond early old age, living standards become more important for predicting later the highest levels of economic hardship. However, over the ten-year period, life mental and physical health. these disparities do not increase as participants transition into their 60s; the age The findings also demonstrated different pathways for different social groups traditionally associated with retirement. which emphasises the importance of paying attention to diverse experiences. The average experience of the population does not necessarily reflect the experiences of different, especially marginalised groups which may be obscured. The patterns in LIVING STANDARDS IN RETIREMENT the findings suggest that gender and ethnicity are associated with different lifetime socioeconomic trajectories. Economic living standards for NZHWR participants generally increased over time, and this may in part reflect the impact of the receipt of New Zealand Superannuation. The complexity of these relationships is due both to the interrelationships between While in 2006, around a quarter (27%) of participants were older than 65, by 2010 socioeconomic status and health and to the dynamic nature of socioeconomic status this had increased to over half of participants (54%). By 2016, all participants of the across the life course. Adverse childhood effects can be offset by life course factors original 2006 cohort were aged 65 or older and 95% reported drawing a New Zealand such as education, occupational status, and material wealth. Improvements in life Superannuation or veterans pension, and this did not vary across the health profiles. course factors can support people to traverse older age with optimum levels of health and wellbeing. However, the ability to enjoy sustained lifetime health benefits The NZHWR study indicates three major trajectories of living standards as adults from improvements in childhood advantages depends on gender and ethnicity; approach and pass the age of pension eligibility in Aotearoa New Zealand. A majority Māori men and women and non-Māori women did not attain the same health of people were characterised by good living standards prior to pension eligibility, benefits from higher childhood socioeconomic status and education as non-Māori which were maintained with age. Around 8.8% were characterised by experiences men. of hardship but improved living standards with age. A small proportion (5.5%) were characterised by declining living standards prior to reaching the age of pension eligibility and continued hardship in later life. IMPLICATIONS NZHWR findings suggest that the social safety net of universal health care and NZHWR research points to the need to consider lifelong impacts on health in older superannuation may, to some extent, buffer vulnerable persons from potentially age, and the importance of recognising how the diverse experiences of different negative economic impacts of older age. socially structured groups produce different pathways to late-life wellbeing. The findings show that the environments and health practices that influence healthy ageing generally reflect a lifetime of inequitable access to resources, rather than the CUMULATIVE DISADVANTAGE result of individual abilities or choices. Healthy ageing depends on childhood circumstances, educational opportunities, Recognising the factors that produce vulnerability shifts the focus from healthy employment history, disabling health conditions, and housing tenure. These are behaviour in later life to environments that support health for all across the life patterned by ethnicity, gender, relationship history, and caregiving responsibilities. course. To complicate matters more, they all act together. Educational opportunities are shaped by ethnicity; the chances of staying in employment depend on caregiving Evidence suggests that increases in age of pension eligibility may disproportionately responsibilities and gender. impact material and non-material wellbeing among disadvantaged adults. 60 61 NZHWR results point out that the pathways leading to health outcomes in later life begin in childhood. The conditions during childhood affect socioeconomic circumstances over the life course: educational opportunities, employment, and housing tenure. These are patterned by ethnicity, gender, relationships, and caregiving responsibilities. Healthy ageing thus reflects a lifetime of access to resources, rather than being the result of individual abilities or choices. 62 63 HOUSING AND NEIGHBOURHOODS As people age they spend increasing amounts of time at home, and current “positive ageing” policies focus on supporting older people to age in their own homes rather than in care facilities. Yet increasing housing pressures in Aotearoa New Zealand raise important issues around how all older people can be supported to age in the community. 65 NO PLACE LIKE HOME HOUSING AND HEALTH Home ownership is high and stable amongst older New Zealanders. The majority of Housing (including tenure type, housing difficulties and support, and social the NZHWR 2006 cohort (75%) owned their home, and most (91%) remained home environments and neighbourhoods) has a significant impact on the health and owners over the ten-year follow-up period. wellbeing of older people. A house can carry particular importance to older occupants, as they may have lived A comparison of types of housing tenure and housing satisfaction in 2016 across the there for many years and formed connections with the place and people associated longitudinal health profiles demonstrated the relationship between housing quality with it. Decisions about where to live in later life are significant and complex, yet little and suitability and health status. is known about why people choose to age in particular places in later life. • People whose physical, mental, and social health were consistently poor over time Through detailed interviews, 143 older New Zealanders shared how they came to live were more likely to be renting. where they did and why they believed these places were suitable and appropriate for them at that stage of their lives. • Those in “vulnerable health” and those with “mental and social limitations” were more likely to be worried about finding a suitable place to live. Some older people spoke of decisions to age in “sensible” places with good access to services and with clear plans for change as their physical health declines. Others • Those with long-term poor physical, mental, and social health were most likely to lived proudly in places that might be regarded by others as unsuitable regarding report problems with safety, keeping warm, house maintenance and cleaning, and access to services, comfort, and support with functional decline. For these older least likely to be satisfied with their housing. people, not wanting to move is related to the importance of place and community and about maintaining continuity in their lives. These individuals anchored their life These comparisons suggest that those people who enter older age with health and stories and identities in their home places, familiar, constant environments which social support limitations are more likely to have difficulties with their housing. Those minimised threats of ageing and change. whose health has shown a decline over the last ten years report similar levels of satisfaction with their housing as those who are in ongoing “robust health”, which suggests that initial good health, which is associated with more secure housing buffers those who experience changes in health in older age. Those who have longer- term health issues will require more support to be housed well as they age. NZHWR findings draw attention to the housing difficulties of older people with existing health vulnerabilities (rather than those whose health is presently beginning to decline). There are marked differences in housing tenure, and in the support that housing provides, for those with multiple health vulnerabilities, and those who have particular mental or physical health issues. These more vulnerable groups of older people require targeted support to remain able to live in the community. Survey data from the 2020 wave of the NZHWR study indicate that while the majority of people aged over 75 are well-housed, there is a smaller group who experience difficulties with housing. These smaller groups are more likely to be renting and have poorer housing conditions which are in turn related to poorer mental health, lower quality of life, and greater likelihood of falls. People who experience these conditions are also more likely to have lower living standards or socioeconomic status. 66 67 Longitudinal analyses of NZHWR data have demonstrated the long-term effects and sense of neighbourhood security, accessibility, and trust in neighbours were all of housing on health: the positive impact of home ownership itself and sense of related to less loneliness. The findings also suggest that people’s perceptions of their security (over and above economic living standards) on psychological wellbeing for own housing are related to how they feel about their neighbours and the quality of older adults. The gaps in psychological wellbeing between homeowners and tenants their neighbourhood. increased over time. Although home ownership is still the norm and preferred tenure among New A house can provide a sense of freedom, autonomy, control, and status for Zealanders, in a housing market where demand outstrips supply and achieving home occupants, which are key indicators of quality of life in old age. However, NZHWR ownership is increasingly difficult, renters are especially vulnerable and are likely to research indicates that older renters in Aotearoa New Zealand do not derive the perceive a reduced sense of control over their housing decisions. same benefits from their homes as owners and are at greater risk of mental health decline. Data collected between 2010 and 2014 showed that while quality of life increased, depression symptoms decreased for homeowners. For tenants, lower NEIGHBOURHOODS levels of quality of life and higher levels of depression remained stable. In addition, homeownership can act as a protective factor against the harmful effects of There is growing recognition that neighbourhood quality impacts older people’s wellbeing, mortality, disease prevalence, mental health, and health-related emotional loneliness in old age. behaviours. Age-friendly cities and age-friendly community movements acknowledge A survey of older Kāpiti Coast residents in 2019 identified neighbourhood as a vital the importance of physical and social aspects of neighbourhoods in promoting factor in people’s feelings of loneliness. Reports of higher satisfaction with housing, health and wellbeing among ageing populations. 68 69 The NZHWR 2020 survey data indicate that the majority of people aged over 75 were Walking alone in the neighbourhood declined with age. There were no differences satisfied with their neighbourhood provisions, but a smaller proportion experienced between the age groups in relation to being threatened in the neighbourhood, which less social cohesion in their neighbourhoods. The findings highlight the importance was very low in all cases; suggesting that the fear, rather than the reality of danger of neighbourhood satisfaction, accessibility, and trust in neighbours for mental prevented people from walking alone. health, quality of life, and the likelihood of falls. Older people with vision or hearing impairments were more likely to be dissatisfied with their neighbourhood quality or Participants were asked if they had difficulty getting to certain places and, if so, accessibility. the cause of the difficulty. Apart from shops (10.2%), the most common place that respondents identified as being difficult to get to was a family member’s home, Two NZHWR longitudinal surveys (2016 and 2018) highlighted the importance of and this difficulty increased noticeably with age. The three most common reasons neighbourhood accessibility to important facilities and social cohesion among for difficulty getting to their shops were inadequate footpaths (20%), lack of public neighbours for physical and mental health over time. People who reported greater transport (20.9%), and health or disability (28.2%). neighbourhood accessibility and more trust among neighbours also reported better mental health two years later. Those who suffered from chronic health conditions (such as heart disease, arthritis, or cancer) and had poorer access to facilities were more likely to experience declining physical health. Good neighbourhoods support IMPLICATIONS better health for older people despite poor functional ability. A clear theme from the NZHWR study is the importance of housing and A small proportion of the sample (8%) moved house within the two years of the neighbourhood environments to the health and wellbeing of older people. Findings study. This group initially reported lower initial housing and neighbourhood indicate that secure tenure, compared to renting, contributes to better quality of life satisfaction and then had greater improvements in housing and neighbourhood over time, promoting healthy ageing. Housing satisfaction, neighbourhood qualities, satisfaction than the majority who stayed in place. This finding suggests that older and neighbourhood social cohesion are associated with quality of life and with people who are less satisfied with their housing and neighbourhoods generally longitudinal profiles of physical, mental, and social wellbeing. improved their situation, and by implication their quality of life, by moving. Those In the context of declining rates of home ownership and an ageing housing stock, who moved were less likely to own their own home; it may be easier for dissatisfied these findings highlight housing and neighbourhoods as an important point of renters to move than homeowners who may be more strongly connected to a home intervention to support the healthy ageing of future generations. and neighbourhood through a sense of belonging. Neighbourhood qualities are broader aspects of the environment that may be Neighbourhoods are an aspect of housing provision that is currently not well strongly influenced by central and local government policy and planning. Aspects of planned for. More attention must be paid to planning for social factors and neighbourhoods like design, provision of footpaths and lighting, and facilities such accessibility of neighbourhoods that support quality of life in older age. as transport, libraries, shops, and services may be provided for by intervention and regulation. People of lower socioeconomic status are also more likely to live in less well-serviced neighbourhoods, and these inequalities should be taken into account. AUCKLAND NEIGHBOURHOODS Survey data obtained during the 2010 wave of the NZWHR study provides some insight into the experiences of Auckland neighbourhoods for older city residents. Restricting activity because of perceptions of danger or inadequate transport can significantly reduce the quality of life of older people. The vast majority (91%) of people of all age groups walked alone in the neighbourhood during the day, but only less than half (47%) of people walked alone in the neighbourhood at night. 70 71 The NZHWR study highlights the importance of housing and neighbourhood environments for the health and wellbeing of older people. Findings indicate that secure tenure, compared to renting, contributes to better quality of life over time, promoting healthy ageing. Against the background of increasing costs of living, inflation, and decreasing home ownership, equitable policy strategies are needed to support healthy ageing in place for future generations. 72 73 WORK Public policies, including the removal of compulsory retirement, legislation to discourage age discrimination, and universal superannuation, contribute to Aotearoa New Zealand having one of the highest employment rates of older workers internationally. Despite policy emphasis on the importance of older workers to the economy and some legislative and organisational arrangements, challenges persist for older people in the workforce. 75 WORKFORCE PARTICIPATION Some had stepped out of or were made redundant from secure employment and became self-employed in new and diverse fields. Longitudinal trends in work and retirement status among NZHWR participants indicate that workforce participation decreases as people age, while part-time Although those starting a business after the age of 50 had vast experience, employment remains steady. transferable skills, knowledge, and networks, they often lacked confidence. What they needed most was access to relevant and timely advice, support and mentoring, In 2006, when participants were aged 55 to 70 years, two-thirds were in some form and targeted training that recognised their specific gaps, their life stage and their of paid employment, while 20% were fully retired. Workforce participation dropped motives for starting a business. over the ten-year period, with full-time employment down from 43% in 2006 to 14% by 2016. Full-time retirement increased from 21% in 2006 to 61% in 2016 (when participants were aged 65 to 81 years). HEALTH AND WORK Part-time employment remained relatively steady, dropping from 24% to 18% once all participants had reached at least the minimum age for superannuation eligibility. A comparison of the work and retirement status of participants across the five The average number of hours worked per week decreased over time in line with the longitudinal health profiles showed that older people with poorer health are less decrease in the proportion of participants in full-time employment. likely to be in any form of employment than those in “robust health” and “average good health” groups. For most NZHWR participants, particularly retirees and full-time workers, there was a match between preferred and actual work status. Overall, the “mismatched” Furthermore, workers with “robust health” over ten years were more likely to be in participants were less likely to have tertiary qualifications, were more likely to be professional occupations and derive greater satisfaction from their work. non-professionals, reported greater levels of hardship, and had poorer mental and The strong relationship between poor physical health and lower workforce physical health. Those in work, who preferred not to be, reported lower levels of job participation is complex; those in poor health are less likely to be in the workforce and career satisfaction, and a higher level of job stress. across their life course; those with lower socioeconomic status are likely to have Although older workers rated a number of work practices as important, such as poorer health and lower educational attainment, and in turn, reduced work recognition of experience, having challenging tasks, and access to new technology opportunities. Nevertheless, the relationship does suggest that the promotion of and training, relatively few reported that these were offered by their employers. workers’ health is an important step towards promoting economic activity in older workers. SENIOR ENTREPRENEURSHIP AUCKLAND SNAPSHOT Starting a business later in life offers an alternative pathway to maintain and extend the working lives of older people. The NZHWR study of senior entrepreneurs in NZHWR survey data provided a “snapshot” of the work and retirement status of Aotearoa New Zealand found that those starting a business after the age of 50 older (over 50) Aucklanders in 2010. Most were in either full-time (38.3%) or part- were generally doing better in terms of their work, health, life satisfaction, and time (17.7%) work. Those aged 65 to 74 were less likely to be in full-time paid material wellbeing. They were more likely to have less work-related stress, higher employment. The average number of hours worked by men was significantly higher job satisfaction, and were more frequently inspired in their work. These senior than for women. Employment rates were similar across ethnic groups, except that entrepreneurs were working longer, less likely to be planning to retire, and if Pacific people were not represented in part-time employment, and Asians were planning to retire, leaving it on average five years later. concentrated in full-time employment. Most were people who were nurturing an idea or a passion and simply seeking For these older workers, the rewarding aspects of employment outweighed the to create a viable business congruent with their personal aims and values. negative aspects with similar rates of work satisfaction across the age groups. 76 77