Characteristics of Older People: What does the 2011 Census tell us about the "oldest old" living in England & Wales?

• On Census Day 2011 there were 1.25 million people aged 85 or over who were usually resident in England & Wales. This compared to 1.01 million in 2001

• In 2011, women outnumbered men in this age group by 2:1, but there was a larger percentage increase in the number of men (45%) than women (16%) over the decade

• In 2011, about one in ten men and one in five women aged 85 and over lived in a communal establishment, with the remainder living in a private household

• For every 100 women aged 85 or over, 77 were widowed, 13 were married and 10 were either single, separated or divorced. Out of every 100 men aged 85 and over, 43 were widowed, 48 were married and nine were either single, separated or divorced

• 31% of men and 25% of women aged 85 and over in 2011 considered that they had very good or good general health. This compared to 24% of men and 26% of women who reported that they had bad or very bad health

• A larger proportion of those aged 85 and over were providing unpaid care in 2011 than in 2001; 8.8% in 2011 compared to 5.0% in 2001. Over half of those aged 85 and over who provided care in 2011 were providing 50 or more hours of care in an average week

In August 2013 the Office for National Statistics published a short story focusing on usual residents of England & Wales aged 65 or over: What does the 2011 Census tell us about older people?¹. This report continues this theme by looking at characteristics of the “oldest old” living in England & Wales, that is those who were aged 85 years or older on Census Day 2011 (who were born before April 1926). Most data published about older people come from household surveys, which exclude people living in institutions². The 2011 Census gives us a unique opportunity to look at the current demographic characteristics of all of those aged 85 or over. This includes those living in communal establishments, a type of residency which includes retirement and nursing homes, but one which is often not covered by household surveys.

Recent gains in life expectancy mean that more people are living to the age of 85 and beyond. In the future more of the population, who are now just entering old age, will live to be 85 or older; 45% of men aged 65 will live to be 85, with the comparable figure for women being 58%, if mortality rates continue at current levels. Between 1980-1982 and 2010-2012 life expectancy at age 85 increased by 1.5 years for both sexes to 5.8 years for men and 6.8 years for women³.

The oldest old are among the most vulnerable in our society, but are also among the most resilient. For some, but by no means all, their advancing years affects their physical and mental health, increases their level of dependency on others and the amount of support that they require from family, private and public institutions. The US Census Bureau noted that, “A nation’s oldest-old population consumes resources disproportionately to its overall population size”⁴.

This report compares the 85 and over population with other age groups. Grouped together by their age, the “oldest old” have many characteristics in common, especially when compared with those aged under 65 and to those aged 65 to 74 and 75 to 84. However they are also a diverse group, for example in the variations in perceived general health and the amount of unpaid care they both receive and provide. For other characteristics such as religion and ethnicity, there is now more diversity amongst the “oldest old” than 10 years ago at the 2001 Census.

This report highlights these similarities and differences at a national level and extends our knowledge of those aged 85 and over who were usually resident in England & Wales in 2011.

Notes for Introduction

1. What does the 2011 Census tell us about older people? (September 2013), Office for National Statistics

2. The disadvantages of relying on information about elderly people who just live in households is discussed in Grundy E and Glaser K (1997) ‘Trends in, and transition to, institutional residence among older people in England and Wales, 1971-1991’, Journal of Epidemiology and Community Health volume 51, issue 5, pp. 531-540 available at: http://jech.bmj.com/content/51/5/531.short

3. Interim Life Tables, England and Wales, 2010-2012, (October 2013) Office for National Statistics

4. He W and Muenchrath M (November 2011), ‘90+ in the United States: 2006-2008’ , American Community Survey Reports, U.S. Census Bureau, available at: www.census.gov/prod/2011pubs/acs-17.pdf

In 2011 there were 1.25 million people aged 85 or over who were usually resident in England & Wales, an increase of almost one-quarter since 2001. Changes in life expectancy over the decade have resulted in more women and particularly men reaching at least their 85th birthday. Two thirds of the “oldest old” (those aged 85 and over) were women and one third were men. Women in this age group had a median age of 88.2 years and men had a slightly lower median age of 87.4 years. Together they accounted for 14% of the population aged 65 and over. Changes in life expectancy over the decade have resulted in more women and particularly more men reaching their 85th birthday.

In 2011, about one in ten men and one in five women aged 85 and over lived in a communal establishment, slightly smaller proportions than in 2001. The average age of the “oldest old” living in private households was slightly younger than those living in a communal establishment. The majority of men and women in private households lived in a house or bungalow, although nearly one-quarter of women were living in a purpose built flat, maisonette or apartment. Central heating was absent from properties where 4% of the “oldest old” lived, a drop from 14% in 2001.

For every 100 women aged 85 or over in 2011, 77 were widowed, 13 were married, six were single¹ and four were either separated or divorced². Out of every 100 men aged 85 and over, 43 were widowed, 48 were married, five were single and four were either separated or divorced. The differences by sex reflect the gender differences in life expectancy. Since 2001 the number of men and women aged 85 and over who were married had increased by more than half. These changes are reflected in the small drop in the proportion of people who lived alone in 2011 compared to 2001. In 2011, 69% of women and 41% of men in private households lived alone compared to 71% and 42% respectively in 2001.

In 2011, about one-quarter of 85 year olds and over considered their general health to be very good or good with a similar proportion stating that it was bad or very bad. Single men and women and married men were most likely to say that their general health was very good or good, with women less likely than men to have very good or good general health if they were married, separated, divorced or widowed. Around half of the “oldest old” said that their daily activities were limited a lot from disability or a long-term health problem, with the proportion rising for those who stated that they had bad or very bad health.

The number of people aged 85 and over who were giving unpaid care almost doubled over the decade to 93,000 people in 2011. More than half of these people provide more than 50 hours of unpaid care in an average week. Of those providing any intensity of unpaid care, 21% stated that they had bad or very bad health.

In 2011, 103,000 people aged 85 or over lived in a care home without nursing and 69,000 lived in a care home with nursing. Within the “oldest old” population who lived in a care home, men were slightly more likely than women to be in a care home with nursing than without. Compared to those in who lived in private households, residents of communal establishments were more likely to be single or widowed, less likely to have very good or good general health and more likely to be limited a lot in activities of daily living.

Notes for Executive summary

1. Single refers to those who have never been married or in a same-sex civil partnership

2. Civil Partnerships were introduced in England and Wales in 2005. Throughout this report, figures or proportions from the 2011 Census that refer to marital status include the equivalent status for same-sex civil partners

On Census day in 2011, there were 9.22 million people usually resident in England & Wales who were aged 65 or older, compared with 8.31 million people of this age in 2001.

On Census day in 2001 there were 1.01 million people aged 85 or over. By 2011 this had increased by a quarter to 1.25 million, accounting for 2.2% of the whole population (compared with 1.9% in 2001). The “oldest old” also represented a larger proportion of the older (aged 65 and over) population, increasing from 12.2% to 13.6% over the decade. The older population has therefore not only grown larger since 2001, but has also grown progressively older.

The changes in population size within the older population are visible in the population pyramid in Figure 1. Between 2001 and 2011 there was an increase in the population at all older ages (from 65 to 99), for men and, at the majority of ages, for women. The pyramid highlights the larger population of women than men aged 85 and over, particularly in the over 90's. It also shows that there has been a smaller rise in the 75 to 84 age group, partly because fewer people were born towards the end of the First World War which caused a dip in the number of people who were in their early 80's in 2001¹. The population pyramid has a distinctly wider base in 2011 than in 2001 as men and women born in 1946 or 1947 (when the number of births peaked after the Second World War) have joined the 65 and over age group.

Figure 1: Population Pyramid, showing single years of age for 65-99, 2011 and 2001, England & Wales

Source: Office for National Statistics

Notes:

1. Please note that the units on the horizontal axis of this graph were changed, at 12:30pm on 6th December 2013. We apologise for any inconvenience

2. Population aged 100 or over are excluded from the pyramid. There were 1,900 men and 9,300 women aged 100 or over in 2011. In 2001 there were 1,700 men and 6,800 women in this age group

3. Census 2001 and 2011 data

Download this image Figure 1: Population Pyramid, showing single years of age for 65-99, 2011 and 2001, England & Wales

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Notes for The ageing population

1. Estimates of the Very Old (including Centenarians), 2002-2012, England and Wales, (September 2013), Office for National Statistics

In 2011, the 85 and over age group had the smallest population of the older age groups (Figures 2 and 3) but showed the fastest population growth since 2001, particularly for men (Figure 4). There were 407,000 men and 847,000 women who were aged 85 or older in 2011, altogether an extra 242,000 people of this age compared with 2001. The number of men aged 85 and over increased by nearly half (45%) whereas the number of “oldest old” women increased by 16% over the decade. In 2011 the median age for men aged 85 or over was 87.4 years, the same as in 2001. For women the median age increased slightly from 88.1 years in 2001 to 88.2 years in 2011. This stability is because the increase in the size of the “oldest old” population since 2001 is balanced between the increasing number of people reaching the age of 85 and joining this age group and those who are already in this age group increasingly living to an older age.

Unlike those aged under 65, where there are fairly equal numbers of men and women, there are more women than men at older ages. This is because women have a longer life expectancy than men. Since 2001 the prevalence of women over men in the older population has lessened, particularly for those aged 85 or over, as life expectancy of men has risen faster than that of women¹. Within the “oldest old” age group there were 38 men for every 100 women in 2001, rising to 48 men for every 100 women in 2011 (Table 1).

Notes for The demographics of the "Oldest Old" (aged 85 and over)

1. Interim Life Tables, England and Wales, 2010-2012, (October 2013), Office for National Statistics

Between 2001 and 2011 the 65 and over age group became slightly more ethnically diverse. The older population identifying as White British increased in size from 7.8 million to 8.5 million but the proportion of the age group they accounted for decreased from 94% in 2001 to 92% in 2011. This compares with much larger changes in the under 65 age group, which saw the proportion of the population who were White British decrease from 86% in 2001 to 72% in 2011.

The 85 and over age group was the most homogenous of the older age groups, with 96% (0.98 million) identifying as White British in 2001 and 95% (1.19 million) in 2011. In 2011, more than four- fifths of the “oldest old” age group who didn’t consider themselves White British identified with the five ethnic groups shown in Figure 5. All of these saw a growth in numbers during the decade, with the Indian and Black Caribbean ethnic groups more than doubling in size to 8,000 and 6,000 people aged 85 and over respectively. In 2001, the two White (non-British) ethnic categories in Figure 5 were of a similar size at around 12,000 people each. But by 2011 the Other White ethnic group had increased by twice as much as the White Irish category, and with 23,000 people had emerged as the largest non White-British ethnic group.

In 2011, the majority of older people stated that they were Christians; 7.4 million (80%) of the 65 and over age group and 1.0 million (83%) of the 85 and over age group¹. The 85 and over age group had the largest proportion of Christians of all age groups (Table 2)².

The number of older Christians increased over the decade, as the size of the older population increased overall, but the proportion of the older age groups following this religion fell slightly. Between 2001 and 2011, there was a decrease of 4.9 percentage points in the proportion who were Christian in the 65 year old and over age group and 0.9 percentage point decrease for the 85 and over age group. These percentage decreases in the proportion of the population who identified as Christian were much smaller than the 14.0 percentage point decrease for the under 65's age group. Further investigation of the reduction in the proportion of Christians in all age groups can be found in “Full Story: What does the Census tell us about religion?"³.

In 2011, 71,000 people aged 85 and over stated that they did not follow a religion. This accounted for nearly three quarters of those who answered the question on religion and did not state Christianity as their religion.

Figure 6 shows that, for the 85 and over age group, the religion with the largest population after Christianity was Judaism. The number of Jewish women aged 85 and over decreased over the decade, possibly because many of the Jewish women who came to England & Wales as refugees in the 1930's and 1940's were no longer alive⁴. However, the overall Jewish population aged 85 and over remained stable at 11,000 because the number of men in this category increased, as the number of men in the “oldest old” age group increased overall because of a rise in life expectancy.

Between 2001 and 2011, there was an increase in the number of people aged 85 and over stating non-Christian religions (featured in Figure 6). The fastest rate of growth was to the Muslim and Hindu religions, both of which increased in population size by around one and a half times over the decade. The largest absolute increase was in the number of 85 year olds and over stating that their religion was Muslim, an extra 3,000 compared to 2001.

The question on religion was voluntary in the 2001 and 2011 Censuses. The non-response rate for those aged 85 and over was 8.9% in 2011, a drop of 2 percentage points since 2001. This compared to 7.8% for those aged 65 and over and 7.1% for those aged Under 65 in 2011. Almost one quarter of those who did not answer the question on religion lived in a communal establishment in 2011. This possibly reflects the difficulty support workers had in filling in the Census form for those residents unable to complete the form for themselves, either because of lack of information or pressure on the carers to complete the form in the quickest time possible. It may also explain why the non-response rate dropped during the decade as a smaller proportion of the oldest old were living in communal establishments in 2011 than in 2001 (see section on residency type).

Notes for Ethnicity and religion

1. The voluntary question on religion in the 2001 and 2011 Censuses asked “What is your religion?” and included an option to record not having a religion. A space to write in a particular religion was provided for those who did not feel that the options given covered their circumstances. The 2011 Census Questionnaires (2013) are available on the Office for National Statistics website

2. The numbers and proportions refer to people’s religion rather than their ethnicity or culture

3. ‘Full Story: What does the Census tells us about Religion?’ (May 2013), Office for National Statistics

4. Graham D, Schmool M and Watermann S (2007) ‘Jews in Britain: a snapshot from the 2001 Census’, Institute for Jewish Policy Research, No. 1, available at: www.jpr.org.uk/publication?id=362

A person’s usual residence can be categorised as either being a private household or a communal establishment¹. In 2011, about one in ten men and one in five women aged 85 and over lived in a communal establishment, with the remainder living in private households.

Table 3 shows that the majority of people aged 85 and over lived in private households in 2001 and 2011. Between the censuses the number of people living in private households increased by 249,000, a rise of 31%. At the same time the number living in a communal establishment decreased by 7,000 people, a drop of 3.5%. These data reflect the governments’ ongoing policy to support older people living at home for longer², for example in their policy “Providing housing support for older and vulnerable people” which was last updated in April 20133. It may also be linked to recent rises in the healthy life expectancy for this age group, which are discussed later in the Health section.

Figure 7 compares the proportion of the “oldest old” population living in each type of residency by sex. In 2001, 88% of men and 77% women aged 85 or over lived in private households. By 2011 these proportions had risen to 91% and 82% respectively.

The age profile of people aged 65 and over is older for those living in communal establishments than for those living in private households. In 2011, for every 20 older people living in a private household, 11 were aged 65 to 74, seven were aged 75 to 84 and two were aged 85 and over. This compares to those living in a communal establishment, where two were aged 65 to 74, six were aged 75 to 84 and 12 were aged 85 or over.

Table 4 shows the median ages for the 85 and over age group by sex and residency type. Overall the median age was higher for women than men and higher for those who lived in communal establishments than for those who lived in private households. There was a bigger difference in the median ages of men and women for those living in communal establishments in 2011, 1.0 years compared to 0.6 years for those who lived in private households. Between 2001 and 2011 the median age in nearly all of these categories increased, with the largest increase being for women living in communal establishments.

Private households

The majority of those aged 65 and over who lived in a private household in 2011 lived in a house or bungalow rather than a purpose-built flat, maisonette or apartment. However this proportion declined with age, particularly between the 75 to 84 and 85 and over age groups, and was lower for women than men (Table 5). In 2011, 514,000 women and 303,000 men aged 85 and over lived in a house or bungalow, compared to 161,000 women and 59,000 men who lived in a purpose build flat, maisonette or apartment.

The 2011 Census also asked a question about tenure. In 2011, 69% of the 65 and over age group who resided in a private household lived in a property that was owned outright, and another 9% in one where a mortgage or loan on the property was still being paid off. This included older people who were living in a private household belonging to other people, such as their children, as the 2011 Census did not ask which member of the household was responsible for paying the mortgage. For the under 65 age group the equivalent proportions were 17% and 45%, reflecting that they have not had the extra years and the financial capabilities of the older population to complete a mortgage and acquire property.

The 2011 Census included a question which asked those who rented their accommodation about their landlord. Social rented included those where the accommodation was rented from a local authority, housing association, housing co-operative, charitable trust or registered social landlord4. In 2011, 16% of people aged 65 or over lived in property that was socially rented with another 4% renting from private landlords.

Compared with the 65 to 74 and 75 to 84 age groups, the 85 and over age group had a lower proportion of property ownership and higher proportion who rented their property from a social landlord (Figure 8).

In 2011, in the 75 to 84 and 85 and over age groups there were noticeable differences by gender with men more likely to own a property and less likely to rent. For example, within the 85 and over age group, three quarters of men lived in a property that was owned (rather than rented) compared to two-thirds of women. There were similar proportions of men and women aged 85 and over in accommodation that was privately rented (around 4%), but there was a larger proportion of women living in socially rented accommodation than men: 24% for women compared to 18% for men.

Compared with 2001, a smaller proportion of older people lived in a private household without central heating in 2011. In 2001, 7% of those under the age of 65 and 10% of those aged 65 and over lived in a private household without central heating compared to 2% and 3% respectively in 2011. In both censuses the proportion not having central heating in the home was highest for those aged 85 or over, at 14% in 2001 and 4% in 2011. Despite the obvious improvement over the decade, this meant that in 2011 14,000 men and 27,000 women aged 85 or over did not have a form of gas, electric, solid fuel or another type of central heating system which generated heat for more than one room. This suggests that they were relying on individual sources of heating such as plug-in electric fires, an open fire or a paraffin heater.

Communal establishments

The 2011 Census collected information on the number of people living in different types of communal establishment. For older people the two main types were “Care homes with nursing” and “Care homes without nursing”. Table 6 shows that the numbers of people resident in either type of care home increased with age as people enter into residential care in later life. In each of the older age groups there were more people living in care homes without nursing than with nursing or in other types of communal establishments.

Table 7 shows the proportional division between care homes with and without nursing care for men and women in 2011. For those aged 65 to 74, 45% of men and 46% of women who were resident in a care home, were living in one which provided nursing care.

For women this proportion decreased with age until for the 85 and over age group only 39% of those living in a care home, were in a home that provides nursing care. This sounds counter-intuitive, however of those who are in care homes, those in a care home with nursing are there because they have a specific health problem which may lead to death at a younger age than those residents in care homes without nursing care.

The proportion of residents in care homes without nursing increased with age. This could be because those women aged 85 or over are more likely not to have a partner⁵ or spouse who could provide support for them within their own home. A different pattern is seen for men where the proportion in a care home providing nursing care rises to 49% for the 75 to 84 age group before returning to 45% for those aged 85 and over. The same patterns were also observable in the 2001 data. The differences by sex may relate to men having a lower life expectancy and lower healthy life expectancy than women.

Notes for Residency

1. In the 2011 Census a household was defined as: “…one person living alone, or a group of people (not necessarily related) living at the same address who share cooking facilities and share a living room or sitting room or dining area”. A communal establishment was defined as “…an establishment is an establishment providing managed residential accommodation”. Further details on definitions can be found in the 2011 Census Glossary of Terms, (October 2013) Office for National Statistics

2. Grundy E and Glaser K (1997) ‘Trends in, and transition to, institutional residence among older people in England and Wales, 1971-1991’, Journal of Epidemiology and Community Health volume 51, issue 5, pp. 531-540 available at: http://jech.bmj.com/content/51/5/531.short

3. ‘Providing Housing Support for Older and Vulnerable People’, (April 2013), Department for Communities and Local Government, available at: www.gov.uk/government/policies/providing-housing-support-for-older-and-vulnerable-people

4. Information on derived variables is available in the “2011 Census variables and classification document - Part 4” (2013), Office for National Statistics

5. In this case “partner” refers only to men

The marital status¹ and living arrangements of those aged 65 and over were analysed in: What does the 2011 Census tell us about older people?² This section concentrates on the marital status and living arrangements for those aged 85 and over, by sex and residency type, and how these have changed since 2001.

Marital status

In 2011, widowhood³ was the most likely marital status for women aged 85 and over, with marriage⁴ the most likely status for men. There were 655,000 women aged 85 and over who were widowed in 2011 compared to 175,000 men (Table 8). More men (197,000) than women (111,000) aged 85 and over were married in 2011, but more women than men were single⁵.

In 2011, for every 100 women aged 85 or over, 77 were widowed, 13 were married, 6 were single and 4 were either separated or divorced⁶. Out of every 100 men aged 85 and over, 43 were widowed, 48 were married, 5 were single and 4 were either separated or divorced. The difference in marital status by sex is partly due to men being more likely to be living with a women younger than themselves and because of men’s lower life expectancy compared to women.

Between 2001 and 2011⁷, for those aged 85 and over, the number of men and women by marital status increased for every category except for women who were single (which decreased in size) (Table 9). The number of “oldest old” men and women who were married increased by more than half (an extra 71,000 men and 39,000 women) between 2001 and 2011, while the number of men and women either separated or divorced doubled. The number of widowed men aged 85 or over increased by one third (an extra 44,000 men), while the number of widowed women in this age group increased by one seventh (an extra 78,000 women) as more people reached this age before losing their spouse. As a result, over the decade a slightly smaller proportion of the “oldest old” population was widowed and a slightly larger proportion was married. This differed from the 65 and over age group as a whole, which saw a proportionally smaller increase in the size of the population of men and women who were married, separated or divorced and a decrease in the size of the population who were single or widowed.

In the 85 and over age group the number of women who were single decreased over the decade, from 67,000 in 2001 to 52,000 in 2011. At the same time the number of single men increased from 18,000 to 21,000. Women in the “oldest old” group in 2011 who were born before April 1926 saw higher rates of marriage compared with those born in or before 1916 (who were 85 or over in 2001)8, explaining the reduction in the number of single “oldest old” women over the decade. The lower rates of marriage among those born before 1916 may be due to some women staying single after losing a future marriage partner in the Second World War.

Table 10 analyses the marital status of the oldest old by their type of residency. The percentages for all residency types very much reflect those for private households, because the large majority (85%) of the “oldest old” lived in a household in 2011.

Living arrangements

Compared to those living in private households, a much smaller proportion of men (27%) and women (6%) who were residents in a communal establishment were married and a larger proportion were widowed or single in 2011. These differences reflect the support that married people are able to give to each other, which enables them to stay in their private household longer than a single or widowed person aged 85 or over. Research in Northern Ireland (McCann et al, 2011) found that being married resulted in a reduced risk of admission to a care home, because of the level of commitment and willingness to provide personal care for a spouse⁹.

For those living in private households it is also possible to analyse living arrangements, such as cohabitation or the number of married or separated people who are not living together.

In the 85 and over age group , men were much more likely to be living as a couple than women; in 2011, 49% were living with a wife or partner (47% in 2001) compared to 14% of women (11% in 2001) (Figure 9). A less pronounced gender difference (72% men compared to 48% women) occurred in the 65 and over age group in 2011.

Between 2001 and 2011 the number of “oldest old” people living with and married to a husband or wife rose by just over half for both sexes (Table 11). But the proportion of couples who were married decreased from 96% in 2001 to 94% in 2011, as the number of people who were cohabitating doubled to 16,000. The rise in the levels of cohabiting may be linked to the rise in the number of this age group who were divorced and the greater cultural acceptance by older people of living as a non-married couple compared with 2001.

Living alone

In 2011 there were 150,000 men and 474,000 women aged 85 or over living alone; that is 69% of all women aged 85 and over who lived in a private household were living alone, compared to 41% for men. These proportions were slightly lower than in 2001, where 71% of women and 42% of men lived in a private household on their own. For both sexes the proportion of people living in a private household on their own increased by age and was higher for women than for men (Figure 10).

For the aged 65 and over age group 41% of women lived alone in a private household compared to 22% of men. The proportion of men living alone remained unchanged over the decade whereas the proportion for women dropped by 5 percentage points from 46% in 2001. The reduction in the size of the 65 and over female population living alone in private households occurred mainly in the 65 to 74 and 75 to 84 age groups. This reflected the decreases seen in the proportions who were widowed between 2001 and 2011 (see section on marital status) (Figure 10).

Widowhood was the most common marital status among those living alone for nearly all the older age groups by sex and accounted for 8 out of 10 men and 9 out of 10 women in the “oldest old” age group (Figure 11). The exception was for men aged 65 to 74 where almost half of those living alone were either married but living apart, separated or divorced, one quarter were single and just over one quarter were widowed . The 65 to 74 age group saw the greatest gender difference in the marital status of those living alone with the 85 and over age group having the smallest difference.

For those not living as a couple in a private household or living alone, the alternative was to live in another private household, such as with other family members or share with someone who was not a relation. In 2011 for both men and women aged 85 and over, 4 out of 5 who were not living as a couple in a private household lived on their own, with just 1 in 5 living in a private household with other people who were not their partner or spouse. Of those living in private households, single men aged 85 and over were slightly more likely to be resident in an “Other household” than single women: 25% for single men compared to 22% for single women. Widowed people who lived in a private household were slightly more likely to live alone than in an “Other household” than those who had not been widowed; 19% of people aged 85 and over who were widowed lived in an “Other household” compared to 23% who had not been widowed in 2011.

Notes for Marital status and living arrangements

1. Civil Partnerships were introduced in England and Wales in 2005. Throughout this report, figures or proportions from the 2011 Census that refer to marital status include the equivalent status for same-sex civil partners

2. What does the 2011 Census tell us about older people? (September 2013), Office for National Statistics

3. In 2011 widowhood included those who were a surviving same-sex civil partner

4. In 2011 this includes same-sex civil partnerships

5. [In 2011 single refers to those who have never been married or in a same-sex civil partnership][5]

6. [In 2011 this includes those who are separated or dissolved from a same-sex civil partnership][6]

7. [The 2001 and 2011 figures on marital status are not exact comparisons, as the 2011 figures included civil partnerships][7]

8. [Table 2 in ‘Marriage statistics, cohabitation and cohort analysis’ reference table][8], in '[Marriages in England and Wales (Provisional)][9]', (June 2013), Office for National Statistics

9. McCann M, Donnelly M and O’Reily D (2011) ‘[Living arrangements, relationship to people in the household and admission to care homes for older people][10]’, Age and Ageing 2011: 40: pp. 358-363 available at: [http://ageing.oxfordjournals.org/content/40/3/358.full.pdf+html][11]

[5]: http://www.ons.gov.uk/ons/rel/census/2011-census-analysis/what-does-the-2011-census-tell-us-about-older-people-.html"2011 Census Analysis - What does the 2011 Census tell us about older people?" [6]: http://www.ons.gov.uk/ons/rel/census/2011-census-analysis/what-does-the-2011-census-tell-us-about-older-people-.html "2011 Census Analysis - What does the 2011 Census tell us about older people?" [7]: http://www.ons.gov.uk/ons/rel/census/2011-census-analysis/what-does-the-2011-census-tell-us-about-older-people-.html "2011 Census Analysis - What does the 2011 Census tell us about older people?" [8]: http://www.ons.gov.uk/ons/rel/census/2011-census-analysis/what-does-the-2011-census-tell-us-about-older-people-.html "What does the 2011 Census tell us about older people?" [9]: http://www.ons.gov.uk/ons/rel/vsob1/marriages-in-england-and-wales--provisional-/index.html "Marriages in England and Wales (provisional)" [10]: http://www.ons.gov.uk/ons/external-links/other/age-and-ageing-2011.html "Age and ageing 2011" [11]: http://ageing.oxfordjournals.org/content/40/3/358.full.pdf+html

The 2011 Census investigated the health of those living in England and Wales through two different questions. The population were asked to make a self-assessment of their own health¹; in a separate question they were asked to state whether a disability or long-term health problem impacted their daily activities at all, a little or a lot.

As illustrated in Figures 12 and 13, the perceived health of men and women under the age of 65 is much better than for those aged 65 and over. For those aged under 65, 87% of men and 88% of women considered their health to be very good or good, compared with 51% of men and 47% of women aged 65 or over. At age 65, both men and women in England can expect to have 57.4% of their remaining lives in good health (Healthy Life Expectancy), which is 10.3 years for men and 11.8 years for women².

Within the older age group (65 and over) the likelihood of having very good or good general health decreased with age, as the proportions with fair, bad or very bad general health increased. For every 100 people aged 65 to 74 in 2011, 59 reported being in very good or good health, 29 reported fair health and 12 bad or very bad health. This compares with those aged 85 and over where 27 people reported being in very good or good health, 47 reported fair health and 26 bad or very bad health. Overall the self-reported general health of the ”oldest old” age group is poorer than that of younger age groups, but it also reflects the diversity in the fitness of this age group; in 2011, 339,000 people aged 85 or over still considered themselves as having very good or good general health.

Differences in perceived general health by sex become more apparent as the population ages. At ages 65 to 74 there were very similar proportions of men and women in very good or good, fair or bad or very bad general health. However in the 75 to 84 and 85 and over age groups, men had a slightly higher tendency to have very good or good health than women. The “All” category in Figure 14 shows that a larger proportion of men aged 85 and over considered their health to be very good or good compared to women of the same age group; 31% of men compared to 25% of women.

European research has shown that older women “… have on average a 25-50% higher risk of chronic illness than men. They also have a higher risk of multiple morbidity”³. An alternative explanation for this gender difference is that men and women perceive their general health differently. Spiers et al (2002) noted that “Women surveyed in 1993–1995 were more likely than men to report problems that were disabling but not life-threatening, whereas men were more likely to report potentially life-threatening problems”⁴.

Small gender differences in health are also apparent when the marital status⁵ of the oldest old are considered. Figure 14 shows the proportion of men and women aged 85 and over who were in very good or good health for each type of marital status in 2011. Single men and women had the highest proportion of each sex in very good or good health, at around 33%. For each other type of marital status a larger proportion of men than women perceived themselves to be in very good or good health. Men and women who were widows had the smallest proportion who were in very good or good health. The proportion of married men who considered that they had very good or good general health was less than one percentage point below that of single men, compared to single women where it was 7 percentage points below at 26%.

Of those aged 85 and over, single people had the greatest likelihood of having very good or good general health and the lowest likelihood of having bad or very bad general health in 2011. Single and married men have similar levels of bad or very bad health, at around 22-23% which rises to 25% for widowed men. In contrast, married and widowed women have a similar proportion with bad or very bad health at 27%, 7 percentage points more than for single women. These differences could be related to the different caring roles that men and women take in a marriage. According to The Harvard Men’s Health Watch Newsletter (July 2010), a good marriage (i.e. a happy, stress-free relationship) promoted health and longevity because married men were more likely to have a healthier lifestyle and less likely to be lonely, depressed or socially isolated than men who weren’t married⁶.

The 2011 and 2001 censuses are not directly comparable because of changes to the wording of the self-reported health question⁷. Overall the proportions of older men and women stating that their health was “good” in 2001 are lower than the “very good or good” proportions for 2011, whereas the proportions with bad or very bad general health are higher. This is particularly so for the 65 to 74 age group which had 40% stating that they had good health in 2001, compared to 59% stating that they had very good or good health in 2011. The differences in the proportions between the censuses were smaller for the 85 and over age groups than the other older age groups; 26% of men and 22% of women said that they had good health compared to 31% of men and 25% of women stating very good or good health in 2011.

The perceived improvement in the health of the older age groups could just be related to the differences in the wording of the question between 2001 and 2011. The 2001 Census form asked for an assessment of the person’s health over the last twelve months while the 2011 form did not give a time frame. Therefore it is possible that the impact of winter ailments on general health were taken into account in 2001 but were not considered in 2011. It may also indicate a real improvement in the perceived general health of older age groups within the last decade. One reason for this could be because those within the 65 to 74 age group are on average younger than in 2001. The median age of the 65 to 74 age group dropped from 69.3 years in 2001 to 69.0 years in 2011, as the number of people entering this age group increased, a direct consequence of the rise in post-war fertility in 1946. The 65 to 74 age group may also be medically fitter than this age group may have been at an earlier time. This would be partly because they had fewer years alive before the creation of the National Health Service in 1948, when health care became accessible to all, than those in the older age groups. This cohort are also likely to have had better living conditions throughout their lives than previous cohorts.

Notes for General health

1. The '2011 Census Glossary of Terms' stated for that general health ‘…is a self-assessment of a person’s general state of health. People were asked to assess whether their health was very good, good, fair, bad or very bad. This assessment is not based on a person's health over any specified period of time”, (October 2013), Office for National Statistics.

2. ‘Healthy Life Expectancies at Birth and at Age 65 in the United Kingdom 2008-2010’ (August 2012), Office for National Statistics.

3. ‘(SHARE) The Survey of Health, Ageing and Retirement in Europe’,( 2005) available at: www.share-project.org/ cited in Wait S and Harding E, ‘The State of Ageing and Health in Europe’, (June 2006), International Longevity Centre and The Merck Company foundation available at: www.ilcuk.org.uk/images/uploads/publication-pdfs/pdf_pdf_4.pdf

4. Spires N, Jagger C, Clarke M, Arthur A, (2003) ‘Are Gender Differences in the Relationship Between Self-Rated Health and Mortality Enduring? Results From Three Birth Cohorts in Melton Mowbray, United Kingdom’, The Gerontologist, Volume 43, Issue 3 available at: http://gerontologist.oxfordjournals.org/content/43/3/406.abstract

5. Civil Partnerships were introduced in England and Wales in 2005. Throughout this report, figures or proportions from the 2011 Census that refer to marital status include the equivalent status for same-sex civil partners.

6. ‘Marriage and Men’s Health’, (July 2010), Harvard Men’s Health Watch, Harvard Health Publications, Harvard Medical School, available at: www.health.harvard.edu/newsletters/Harvard_Mens_Health_Watch/2010/July/marriage-and-mens-health

7. The 2001 Census form asked “Over the last twelve months would you say that on the whole your health has been good, fairly good or not good?” Copies of the 2001 Census Questionnaires (572.8 Kb Pdf) (2008) are available on the ONS Website

The second 2011 Census question that related to health asked people to self-report on the impact of long-term health problems or disabilities¹ on their ability in carrying out daily activities. For adults it provided an indication of a person’s independence and an insight into their ability to cope with the tasks of daily living. Those under 65 were less limited in coping with daily activities than those aged 65 and over; 89% of both men and women under 65 years of age were not limited in their daily activities at all compared to 50% of men and 44% of women aged 65 or over.

Just over half of those in the “oldest old” age group in 2011 reported that their daily activities were limited a lot, either from a disability or long-term health problem. Almost a third said that their daily activities were limited a little. A higher proportion of women (59%) than men (51%) said that their daily activities were limited a lot, with a smaller proportion not reporting any problems at all (13% for women to 15% for men). This could be because on average men are slightly younger than women; the median age for men aged 85 and over was 87.4 years whereas for women it was 88.2 years (Table 4). Figure 15 shows the steady decline by age group in the ability of older people to carry out daily activities in 2011.

The results from the 2011 Census are not directly comparable with those collected in 2001 because of changes to the equivalent question². In 2001, respondents were only asked to say whether or not a long-term health problem, illness or disability “did” or “didn’t” limit their daily activities. Three-quarters of those aged 85 or over stated that their daily activities were limited, with women having slightly lower proportion than men.

Figures 16 and 17 investigate the relationship between general health and limitations to daily activities due to long-term health problems or a disability for those living in private households and those resident in communal establishments.

Double the proportion of 85 and over living in a private household considered their health to be good or very good (29%) compared to those who were a resident in a communal establishment (15%). Of those with good or very good health, those in private households were almost four times more likely not to have any limitations on their daily activities compared to residents of communal establishments.

In both types of residence, around half of all people aged 85 and over perceived their health to be fair. However, three-quarters of those with fair health who were resident in communal establishments were limited a lot in their daily activities, compared to around half of those in private households.

Of the oldest old living in private households, 24% perceived their health to be bad or very bad compared to 35% who were resident in communal establishments. In both locations the great majority of those with bad or very bad health (over 90%) stated that they were limited a lot in their ability to carry out daily activities.

Overall, health is poorer and its impact on daily activities is greater for those resident in communal establishments than in private households. This is as expected given that residents of communal establishments had a higher median age than those who were living in private households in 2011. Failing health and the need for round the clock care is often the principal reason for the “oldest old” moving from a private household into a communal establishment. Despite this, in 2011 a substantial number (232,000, 22%) of those aged 85 and over living in private households reported bad or very bad health and had severely restricted daily activities.

Notes for Limitation of daily activities

1. “A long-term health problem or disability that limits a person's day-to-day activities, and has lasted, or is expected to last, at least 12 months. This includes problems that are related to old age.” 2011 Census Variables and Classification Information - Part 3, (November 2013), Office for National Statistics

2. In 2001 the UK population was only asked whether or not they had “any long-term illness, health problem or disability which limits your daily activities or the work you can do?” 2001 Census Questionnaires (2008), Office for National Statistics

A question on time spent on the provision of unpaid care was asked in both the 2001 and the 2011 Censuses. On both occasions it was defined as help given to “family, friends or neighbours or others because of long-term physical or mental ill health or disability, or problems related to old age. This does not include any activities as part of paid employment.”¹. The respondent had the choice of one of three options to record the amount of time spent on unpaid care in a usual week; 1 to 19, 20 to 49 or 50 plus hours.

Analysis on the provision of unpaid care by all age groups was published by ONS in May 2013²; in this all older people were grouped together in the 65 and over age category. This section extends the earlier analysis by looking at the provision of unpaid care by those living in a private household and how it differs by sex and self-reported general health for those in the older age groups and specifically for those aged 85 and over.

A greater proportion of people aged 65 or over who lived in private households provided unpaid care to one or more people in 2011 than in 2001. In 2011, there were 1.28 million or 14.4% of the older population undertaking this role, compared to 0.94 million or 11.9% in 2001. As shown in Figure 18, a rise in the proportion of people providing unpaid care occurred in each of the older age groups. For those aged 85 and over, the number of people giving unpaid care to others more than doubled from 41,000 in 2001 to 93,000 in 2011. This increase is in part due to the overall rise in the numbers in this age group. However the proportion of people aged 85 and over providing unpaid care also rose from 5.0% to 8.8%. The prevalence of care giving decreases with age; the 85 and over age group had the smallest proportion of people providing unpaid care of all the older age groups in both 2001 and 2011.

In 2011, the proportion of the population aged 65 and over who lived in a private household and provided unpaid care varied by sex and by age group (Figure 19). For older men, the proportion that carried out any amount of unpaid care was stable at around 15% regardless of their age group. The proportion of women providing unpaid care dropped by around 6 percentage points between 10 year age groups, so that by the age of 85 and over only 1 in every 20 women provide it. In contrast, women aged 65 to 74 provided the largest proportion of unpaid care, with 1 in every 6 women in this age group carrying out this activity in a usual week.

In the 65 to 74 age group a greater proportion of women than men provided unpaid care, as for younger (under 65) age groups, but this reverses from the 75 to 84 age group onwards. The gender gap widens further for those aged 85 and over with 55,000 (14.8%) of all men in this age group and 39,000 (5.6%) of all women providing unpaid care in 2011. These differences by age group reflect the fact that women aged 85 and over are more likely to be widowed³ than men of this age group and therefore are less likely to have the opportunity to care for their spouse than men⁴. It may also be related to a decrease in men and women providing unpaid care outside the home at this age because of a decrease in their own ability to perform activities of daily living. Additionally, others that 65 to 74 year olds care for, such as parents or siblings, are more likely to be deceased by the time the carers become 85 years or older.

Of those older men and women living in a private household who provide unpaid care, the proportion providing 1 to 19 hours declines with age, while the proportion providing 50 plus hours rises. This higher level of care provision is consistent with providing for an infirm partner or spouse. For those aged 85 and over who provided any unpaid care in 2011, the majority did so for 50 hours or more each week, compared to around a third of men and women in the 65 to 74 age group (Figure 20). This means that 31,000 men (57% of the “oldest old” male unpaid care providers) and 21,000 women (53% of the “oldest old” female unpaid care providers) on average provided around 7 hours of unpaid care on a daily basis. Care giving of this level of intensity would be hard work at any age but would be particularly demanding for those aged 85 and over.

In 2011, there were 10,000 men and 8,000 women aged 85 and over providing unpaid care who stated that they had bad or very bad health. As shown in Figure 21 the proportions in bad or very bad health were slightly higher (4-6 percentage points) for those who did not provide unpaid care, possibly because their poor health prevented them from providing it.

For both men and women aged 85 and over, the proportions with very good or good and fair health were slightly higher for those who were providing unpaid care than not providing unpaid care. In 2011, around 1 in 3 men and women aged 85 or over who provided any intensity of unpaid care said that their health was either very good or good.

The proportion of people in very good or good health declined with age and the number of hours spent providing unpaid care. At the age of 65 to 74, at least half of the people providing 1-19 or 20-49 hours of unpaid care were in very good or good health. By the age of 75 to 84 this was only the case for those providing 1 to 19 hours, with the majority of those providing 20 to 49 or 50+ hours having fair, bad or very bad health. The oldest old were most likely of all the older age groups to be providing unpaid care when they themselves were not in very good or good general health. However, 1 in 5 men and 1 in 4 women in the 85 and over age group who provided 50+ hours of unpaid care weekly did consider themselves to be in very good or good general health in 2011.

In each of the older age groups the likelihood of having bad or very bad general health increased with the amount of care provided. This relationship is most noticeable for 65 to 74 year olds where 6% of men and 5% of women who carried out 1 to 19 hours of unpaid care a week considered themselves to have bad or very bad health compared to 18% of men and 15% of women who carry out 50+ hours a week. For men in the 75 to 84 and 85+ age groups, the proportion in bad or very bad health also increased slightly with care intensity. However for women, although there is a clear difference between the 1 to 19 hours category and the other hours spent caring, there is very little difference between the 20 to 49 hours and 50+ hours categories. For example, for those women aged 85 and over, 16% of those providing 1 to 19 hours of unpaid care considered that they had bad or very bad health, compared to 22% providing 20-49 hours of unpaid care and 24% providing 50+ hours of unpaid care. This may be a true gender difference in the relationship between care intensity and general health, or may be confounded by gender differences in self-perceived health and subjective definitions of caring activities.

The information from the 2011 Census cannot determine whether the relationship between care intensity and poor health is causal. For men and women aged 75 and over providing 50+ hours of unpaid care a week instead of 20 to 49 hours does not appear to greatly increase the likelihood of having bad or very bad health. This might be because those in bad or very bad health are not fit enough to provide a high intensity of unpaid care. Alternatively, it may be that the majority of people in the 20 to 49 hours care giving category are mainly providing 40 to 49 hours which is not so different to providing 50+ hours. An alternative is that it could be that a threshold on the impact of providing unpaid care on health is reached on a lower number of hours in the 75 to 84 and 85+ age groups than in the 65 to 74 age group.

Notes for Provision of unpaid care

1. Further details on definitions can be found in the 2011 Census Glossary of Terms, (October 2013), Office for National Statistics

2. 'Full story: The gender gap in unpaid care provision: is there an impact on health and economic position?' (May 2013), Office for National Statistics

3. Widowed in this context only refers to heterosexual married couples

4. 'Full story: The gender gap in unpaid care provision: is there an impact on health and economic position?' (May 2013), Office for National Statistics

This report has looked at the characteristics of the “oldest old” – those aged 85 or over on Census Day 2011. It has compared them to people aged 65-84 in 2011 and to those who were in the 85 and over age group on Census Day 2001. It has shown that they are different to those aged 65-74 and 75-84, for example in their marital status, perceived general health and the amount of unpaid care that they provide.

The people who made up the population aged 85 and over in 2011 had many characteristics in common and were in many ways more homogeneous than other age groups, for example within England & Wales they had the highest percentages of White British ethnicity and of Christians of any age group of the population. However, there is also diversity within the “oldest old”. Since 2001 they have become slightly more ethnically and religiously diverse, a smaller proportion are widowed and more people aged 85 and over are in very good, good or fair general health.

Other characteristics of the “oldest old” should also be considered when building up a full picture of this generation. Information on their educational qualifications, social class, country of birth and nationality, to name but a few, were also collected by the 2011 Census and await investigation in future analyses.