Based on three sets of cross-sectional data from the HUNT studies conducted over the 20-year period from 1984 – 86 to 2006 – 08, this study shows that there has been a positive development in the level of functioning and subjective health of elderly people. This applies to both sexes and all age groups. The prevalence of self-reported diseases varied through the period, with no clear tendencies. There was a reduction in the use of home-help services, but a strong increase in the use of general practitioner services over the period.
A strength of this study lies in its large number of participants, which enables us to stratify by sex and five-year age groups. Because of the falling participation rate in the oldest age groups some reservations need to be made, however, especially when it comes to the very oldest participants. On the other hand, Danish studies of this age group have shown the same trends indicated by our material (18). The measurements have been undertaken according to the same model in all three studies. Moreover, the HUNT data are relevant for the rest of Norway, since Nord-Trøndelag county is to some extent representative of the country as whole, despite having no large city (21).
Those who participated in the HUNT studies needed to be sufficiently healthy to fill in a questionnaire and go to a field station for a clinical examination. Participation was therefore low for the county's least healthy inhabitants; this applies to all three studies. The declining participation rate nevertheless represents a challenge, since it has previously been shown that those who failed to attend HUNT3 had a somewhat less healthy lifestyle and somewhat poorer health than those who did attend (26). Some of the registered improvements in health condition shown by our data may thus be an effect of increasing selection.
It has been shown, however, that there was a considerable increase in overweight and obesity also among the older participants (27). Furthermore, it has been shown that the number of people who have never taken antihypertensive drugs has fallen, and that blood pressure has been reduced both among these and among those who do take such drugs (28).
The registered increase in physical activity is in line with results from Swedish studies, where an increased level of activity was found in all age groups. Our data are based on self-reporting, and there is reason to assume that for lifestyle factors in particular, people tend to report their own habits as more favourable than they truly are. Since we have analysed two cross-sections of the same population (HUNT1 and HUNT3), we can nevertheless highlight the changes over time. Evaluation studies have shown, however, that the HUNT questions tend to capture vigorous physical activity particularly well, while lighter activity is not recorded with equal reliability (25).
Improvement in ADL functioning is one of our main findings. The participants in HUNT3 reported a great degree of self-reliance, and compared to figures from Sweden (10), the HUNT participants had better ADL function scores. In Danish studies of the very elderly there was a clear positive development (29), and several other studies conducted before 2000 have come to the same conclusion (13, 15). A British study shows improvement in functioning from 1998 to 2008 (15).
In our material we found no clear tendencies in the development of self-reported disease. For both sexes, more coronary disease was reported in HUNT2 than in both HUNT1 and HUNT3. A Dutch study found less coronary disease, asthma and stroke, but a higher prevalence of diabetes in the period 1987 – 2001 (30), and Wolf and collaborators found a delayed onset of disease in elderly people in the period 1982 – 94 (31).
There was a marked decrease in the use of home-help services from HUNT1 to HUNT3, which is consistent with other findings from Norway (32). This is most likely due to the fact that home nursing was free of charge to the inhabitants in 1998, whereas the patient charges for home help were gradually increased in the 1990s (33). The increased use of general practitioner services is consistent with figures from Statistics Norway (34). The increase in the use of outpatient specialist health services in the period from HUNT2 to HUNT3 is consistent with findings made by Sintef (35).
The objective of this study was to investigate whether elderly people had experienced any gains in health and ADL functioning over the 20-year period from HUNT1 (1984 – 86) to HUNT3 (2006 – 08). Despite some weaknesses in the material, the data indicate that the older inhabitants of Nord-Trøndelag county were in better health and had better ADL functions at the time of HUNT3 than previously.
If elderly people feel that they have good functional capacity and fairly good health despite having multiple diagnoses, this could serve as a moderating factor when the grey tsunami arrives.
Our data will soon be ten years old, and social gradients in the development have not been investigated. Recent American studies indicate that health development remains unchanged for more disadvantaged social groups, but improves for the wealthier (36), and Krokstad and collaborators have shown that health prospects have a clear social gradient (37).