1. Prosperity, good health and drinking in later life Clare Holdsworth Keele University

2. Alcohol consumption, life course transitions and health in later life Research Team: Keele UniversityUniversity College of London Clare Holdsworth, PINicola Shelton Marina MendonçaHynek Pikhart Martin FrisherCesar de Oliveira

3. Key Questions Who is most at risk of heavy/hazardous drinking in later life? How does this correspond to health risks? What does this infer about the causality between drinking and health in later life?

4. Focus on drinking in later life

5. Data & Methodology ELSA W0 (HSE): Baseline for alcohol variables English Longitudinal Study of Ageing (ELSA): Practice-informed modeling approach in collaboration with Beth Johnson Foundation Cross-sectional analysis: Association between alcohol consumption and socio-demographic and health variables Longitudinal analysis: Drinking behaviours over 10 year period (quantity and frequency); link between drinking behaviours and health: Growth curve model and multilevel ordered logistic model 199819992001 W6 2012/13 W4 2008/9 W5 2010/11 W3 2006/7 W2 2004/5 W1 2002/3

6. TPercentage distribution of drinking profiles by gender, wave 0. Drinking Variables Drinking Profiles % Respondents wave 0 Drinking Status Quantity of Alcohol Frequency of drinking MenWomen Non-drinkerNon-Drinker714 Drinker Below Recommended Limits (Men ≤21 units; Women≤ 14 units) Occasional (≤ 4 days) Low Risk: Occasional Drinker 5464 Daily (≥ 5days) Low Risk: Daily Drinker 128 Above Recommended Limits (Men > 21 units Women > 14 unit) Occasional (≤ 4 days) Focal Drinker73 Daily (≥ 5days) Heavy Drinker2011 Number of cases = 11205

7. Percentage distribution of drinking frequency waves 0 and 5 Number of cases = 4780

8. Average weekly units by wave and gender wave 0 and wave 5 Mean (n – number of drinkers in each wave) Wave 0Wave 5 Men 18.9 (n=1678) 13.5 (n=1332) Women9.3 (n=1582) 6.7 (n=1241)

9. Self Rated Health Repeat for Depressive Symptoms, partnership status and employment Health Variables Wave 0Wave 5 Good healthGood Health (58%) Good HealthPoor/Fair Health (16%) Poor/Fair HealthPoor/Fair Health (13%) Poor/Fair HealthGood Health (11%)

10. Pauline: In partnership, Retired, Good health, Some qualifications, Non-smoker, Average Wealth Pearl: Not in partnership, Retired, Not in good health, No qualifications, Non-smoker, Lowest wealth group Doreen: In partnership, Working, Good health, University degree, Former smoker, Highest wealth group Dorothy: During 10 year period: Loses partner, retires & health deteriorates A level qualifications Non-smoker, Above average wealth Age 60Age 70Age 80Age 90Age 50Age 60 Age 70 3.953.50 (11%)3.432.92 (15%)11.9210.18 (15%)5.844.54(22%) Paul: In partnership, Retired, Good health, Some qualifications, Non- smoker, Average Wealth Peter: Not in partnership, Retired Not in good health No qualifications Non-smoker Lowest wealth group Duncan: During 10 year period: Gets married Working, Good health, University degree, Former smoker, Highest wealth group Derek: During 10 year period: Loses partner, retires & health deteriorates A level qualifications Non-smoker Above average wealth Age 65Age 75Age 80Age 90Age 50Age 60 Age 70 6.755.76 (15%)7.476.04 (19%)33.8028.0 (17%)7.766.81 (12%) Average weekly units consumed for synthetic profiles of older people

11. Who is drinking more at start of the study? Younger older adults Highest wealth group Highest educated Current/former regular smoker Men out of a partnership Women in employment

12. Changes in drinking quantity over time Steeper reduction in drinking quantity: – Older adults in deteriorating health – Women in retirement – Women whose partnership ends

13. Transitions in self-rated health*wave coeff.p-val. Wave 0 Continual good health 0.00 Health deteriorates -0.11 0.52 Continual poor health -0.99<0.01 Health improves -0.93<0.01 Wave 4 Continual good health 0.00 Health deteriorates -0.81<0.01 Continual poor health -1.81<0.01 Health improves -1.20<0.01 Wave 5 Continual good health 0.00 Health deteriorates -0.81<0.01 Continual poor health -1.99<0.01 Health improves -1.31<0.01 Full model: Age wave 0, gender, wealth, education, employment & marital status, BMI, smoking Model Drinking Frequency over Time

14. Transitions in self-rated health*wave coeff.p-val. Continual good health Wave 0 0.00 Wave 4 -0.90<0.01 Wave 5 <0.01 Health deteriorates between waves 0 and 5 Wave 0 0.00 Wave 4 -1.60<0.01 Wave 5 -1.89<0.01 Continual poor health Wave 0 0.00 Wave 4 -1.72<0.01 Wave 5 -1.99<0.01 Health improves between waves 0 and 5 Wave 0 0.00 Wave 4 -1.16<0.01 Wave 5 -1.37<0.01

15. Transitions in depressive symptoms*wave coeff.p-val. Wave 0 No depression 0.00 Becomes at risk of depression -0.08 0.67 Continual depression -0.140.56 Depression improves -0.340.09 Wave 4 No depression 0.00 Becomes at risk of depression -0.72<0.01 Continual depression -1.27<0.01 Depression improves -0.82<0.01 Wave 5 No depression 0.00 Becomes at risk of depression -0.72<0.01 Continual depression -1.02<0.01 Depression improves -0.600.02

16. Who is drinking more frequently at start of study? Younger older adults Highest wealth group with increase in frequency with wealth More educated Current/former regular smoker Healthy BMI In good health/no depressive symptoms

17. Changes in drinking frequency over time Drinking frequency declines over time regardless of health status But it is intensified for those in continual poor health and for those whose health deteriorates (self rated health and depression).

18. What does the study tell us? Evidence for the relationship between indicators of well-being in later life and frequency and quantity of drinking – more evident for drinking frequency. Clear evidence that drinking responds to health, which suggests that the causal relationship between health and drinking is complex. Need to consider the significance of partnership for older men’s drinking.

19. What should be done? What are the health problems associated with drinking in later life? Policies to enhance well-being in later life may lead to more frequent drinking among older adults (and more alcohol consumption). Changes in drinking frequency are gradual, advice on responsible drinking could reflect this.

20. More information c.m.holdsworth@keele.ac.uk Holdsworth, C., Frisher, M., Mendonca, M., de Oliveira, C., Pikhart, H., Shelton, N. (2015) Life course transitions, gender and drinking in later life, Ageing and Society. DOI: DOI: http://dx.doi.org/10.1017/S0144686X15001178. Published online 26 th Oct 2015. Frisher, M., Mendonca, M., Shelton, N., Pikhart, H., de Oliveira, C., Holdsworth, C. (2015) Is alcohol consumption in older adults associated with poor self-rated health? Cross-sectional and longitudinal analyses from the English Longitudinal Study of Ageing. BMC Public Health, vol. 15, Article ARTN 703 Holdsworth, C., Mendonca, M., Pikhart, H., Frisher, M., de Oliveira, C. and Shelton, N. (forthcoming) Is regular drinking in later life an indicator of good health? Evidence from the English Longitudinal Study of Ageing Journal of Epidemiology and Community Health