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Research Highlights

Older Americans have better cognitive health, worse overall health than English Peers

Older Americans have better cognitive health but worse overall health than their counterparts in England, two recent studies show. According to researchers, these health gaps could be due to differences in the prevalence of cardiovascular disease, depression, and other health factors, as well as differences in education, wealth, and access to health care.

Older adults in the United States performed significantly better than their English counterparts on standard tests of cognitive function, shows a study published in BMC Geriatrics. The study—the first comparison of cognitive function in representative samples of older adults in the United States and England—looked at data on 8,299 Americans and 5,276 Britons, drawn from the 2002 waves of the NIA-funded Health and Retirement Study and the English Longitudinal Study of Ageing. All participants were non-Hispanic whites ages 65 and older.

Overall, the difference in cognitive performance on tests of word recall and orientation was striking. On average, an 85-year-old American performed as well as a 75-year-old Briton. The U.S. advantage was greatest for people ages 85 and older, the age group on both sides of the Atlantic with the lowest scores on a 24-point cognitive scale.

The difference in cognitive health could be due to several factors, the researchers write. Older adults in the United States are generally wealthier and better educated than those in England. They also reported lower levels of depressive symptoms. Higher levels of wealth and education and lower levels of depression have been associated with reduced risk of cognitive decline.

In addition, the Americans had better cognitive health despite a higher prevalence of cardiovascular risk factors and disease—traits associated in some studies with poorer cognition. This result may be explained by the fact that the Americans were more likely than the British to take antihypertensive medications, which previous studies have suggested may help prevent cognitive decline.

Another study, supported in part by the NIA and published in the American Journal of Public Health, found that older Americans had worse health than English and European seniors at all income levels, even though U.S. per-capita medical spending is two to three times higher than in Europe. Researchers compared the overall health status of non-Hispanic white adults ages 50 to 74 in the United States, England, and 10 European countries.

Drawing on 2004 data from the Health and Retirement Study, the English Longitudinal Study of Ageing, and the Survey of Health, Ageing, and Retirement in Europe, the researchers found that Americans had the highest prevalence of chronic conditions and physical-function limitations. For example, 18 percent of Americans had heart disease, compared with 12 percent of Britons and 11 percent of Europeans. Poor Americans experienced the greatest health disadvantages compared with their overseas peers, but even well-off Americans reported health comparable to that of poorer Europeans.

No single factor accounted for these disparities, the researchers note. Differences in behavioral risk factors such as smoking, obesity, physical activity, and alcohol consumption played a role, as did the prevalence of chronic disease, survival rates, and different health care systems. For instance, “the American medical system might be more focused on ameliorating the consequences of disease, with relatively less attention given to prevention,” the authors write.

Together, the two studies point to the need for further international research that compares and explains the demographic, social, and health factors that account for differences in health status between older populations in different countries. These studies might help identify factors that could help improve the cognitive and physical health of growing elderly populations worldwide.


Langa, K.M., et al. Cognitive health among older adults in the United States and England. BMC Geriatrics. 2009 June 25. 9:23.

Avendano, M., et al. Health disadvantage of U.S. adults aged 50 to 74 years: a comparison of the health of rich and poor Americans with that of Europeans. Am J Public Health. 2009. 99(3):540–8.

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