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  • John Anderson, My Jo*
  • John Anderson, my jo, John,
  • When we were first aquent:
  • Your locks were like the raven,
  • Your bonie brow was brent.
  • But now your brow is beld, John,
  • Your locks are like the snaw;
  • But blessings on your frosty pow,
  • John Anderson, my jo.
  • John Anderson, my jo,
  • We clamb the hill thegither;
  • And mony a cantie day, John,
  • We've had wi' ane anither;
  • Now we maun totter down, John,
  • And hand in hand we'll go,
  • And sleep thegither at the foot,
  • John Anderson, my jo.
  •     Robert Burns, 1789


Do you recall this poem above from your high school English literature course? I certainly do, for its romantic depiction of a couple's idealized journey together through this life and perhaps beyond. Little did I dream at the time that the central theme of this chapter would define a paradox that would provide a focus throughout my career in gerontology and geriatric medicine: women outlive men even as they experience greater levels of morbidity, health care utilization, and functional impairment throughout their lives.

A visit to almost any long-term care facility will prompt an obvious question from even the most casual observer: “Where are the men?” This chapter attempts to answer this intriguing question on the basis of both practical and theoretical considerations and extrapolate its conclusions and speculations to considerations of the health and social care of the elderly in this century of an unprecedented “age wave” in America and the world at large.

The principal questions addressed in this chapter include:

  • What is the magnitude of the sex differential in longevity in the United States?
  • How universal is this differential among different populations? Among ethnic groups in the United States? Among different nations, especially by degree of socioeconomic development?
  • Has this differential always existed? If not, when did it emerge? And why?
  • Are there genetic determinants of this differential? Are these mediated by sex hormones? How do these change across the life cycle?
  • What are the extragenital consequences of the sex differential in sex hormone physiology at various stages in the life cycle? What are these consequences, notably in the:

    • Nervous system?
    • Endocrine/metabolic system?
    • Immune system?
    • Cardiovascular system?
  • What are the social, psychological, and behavioral implications of these differentials at various stages in the life cycle?
  • What are the age-specific mortality rates of men and women (commonly expressed as the ratio between the two)—both all-cause and cause-specific?
  • What are the age-specific morbidity rates in men and women—both all-cause (especially as expressed in functional status) and cause-specific?
  • How do these differentials affect the lives of older persons, with specific implications for the duration and quality of life for elderly men and women? For the prevalence and duration of widowhood? For the health—physical, psychological, social, functional, and financial—and social and living circumstances of elderly widows and widowers?
  • Are these trends changing? If so, how and ...

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