Older people: Inequalities 

After World War II mortality rates in Scotland fell, as in most other European countries, reflecting a population-level improvement in health. However, reductions in age-standardised mortality rates have begun to falter in recent years. Figure 1 shows the fall in mortality rates in both males and females from 1991 to approximately 2012. In more recent years the plateauing in the improvement in mortality rates is clearly seen. A plateauing in the mortality rates reflects a plateauing in the improvements in population-level health.

Figure 1: Age-standardised rolling four-quarterly mortality rates for men and women in Scotland, with segmented regression models fitted, 1990–2018.

Legend: Square and circles represent observed mortality rates for males and females, respectively. Solid and doted lines are predicted rates. See source for more details. Source: Fenton L et al 2019.

This faltering in mortality rates in Scotland is largely driven by little or no improvements in mortality rates in those living in more deprived areas compared to much larger improvements in mortality rates in those living in more affluence areas (Fenton L et al 2019). 

There has been a widening in socioeconomic inequalities in recent years, this has affected all age groups. Inequalities tend to accrue and get reinforced across a person’s life. Health inequalities in old age often reflect accumulated disadvantage, due to factors such as one’s location, gender and socio-economic status, and can further be influenced by social changes, such as isolation and loss of loved ones (Health Inequalities in Old Age. United Nations Department of Economic and Social Affairs (UNDESA) programme on ageing (social.un.org/ageing)).