Presentation on theme: "English Longitudinal Study of Ageing (ELSA)"— Presentation transcript:
1English Longitudinal Study of Ageing (ELSA) Natasha WoodPresentation is split into two parts.I am going to give a brief background to ELSA then Mai Stafford from UCL is going to present some of the findings from the study.
2A study of people aged 50+ and their partners BackgroundA study of people aged 50+ and their partnersMulti-disciplinary - health, economic and social circumstancesLongitudinal - change over timeComparative - USA (HRS) and Europe (SHARE)Funding - National Institute on Aging (US) & UK Government DepartmentsELSA is a multi-disciplinary cover a wide range of topics.ELSA aims to measure outcomes across all aspects of people’s lives as they age beyond 50 and provide data that can shed light on the cause and consequences of these outcomes.ELSA aims to answer the following questions:What explains who has good health in later life and who does not?When do people retire and how do they plan for their retirement?Do people have enough savings to provide for their older age?How do changes in memory and concentration affect well being?What is the relationship between all the factors involved in ageing?Also collect objective physical measurements through a nurse visit.2
3Dept of Epidemiology and Public Health, UCL Research TeamDept of Epidemiology and Public Health, UCLNational Centre for Social ResearchInstitute for Fiscal StudiesUniversities of Manchester, East Anglia and CambridgeThis is the research team.
4History of ELSA Wave 1 2002/3 Wave 2 Nurse visit 2004/5 Wave 3 Original sampleinterviewed inHSE 1998/1999/2001Age 50+ on 1 Mar 2002Wave 112,0992002/3Wave 29,432Nurse visit7,6662004/5Refreshment sampleHSE 2001/02/03/04Age on 1 Mar 2006Wave 39,771Life-history7,8552006/7Refreshment samplefrom HSE 2006Age on 1 Mar 20082008/9Wave 411,050Nurse visit8,641ELSA Wave 1 began in 2002, the original sample was taken from the Health Survey for England (HSE) – we call the HSE Wave 0 – those aged 50 and above on 1 March Wave 1 consisted of just a main interviewELSA Wave 2 took place in 2004, at this wave there was a core interview and a nurse visit.ELSA Wave 3 was carried out in 2006 and consisted of a core interview. As our sample ages it is no longer representative of those aged So the sample was refreshed by the HSE sample at this wave.ELSA Wave 4 took place in 2008, there was a core interview and a nurse visit. The mainstage sample was refreshed by the HSE 2006 sample at this wave for those aged 50 – 74 years – replenish the sample.Wave 5 began in June 2010 and finished last month. We carried out a financial risk taking module with a sub-sample of respondents aged which will talk more about in a moment.Wave 6 will commence in April 2012, we are just preparing for this now. Wave 6 will include a nurse visit. We will also refresh the sample this year from HSE 2009 and 2010 for people aged years.Wave 5Approx 10,274Risk moduleApprox 1,0652010/11Refreshment samplefrom HSE 2009/10Age on 1 Mar 2012Wave 6Nurse visit2012/134
5Main Interview Content Household and individual demographicsHealthSocial participationWork and pensionsIncome and assetsHousing and consumptionCognitive function (assessments)ExpectationsEffort and reward (of voluntary work and caring)Psychosocial healthTimed walk (for those 60+)Self-completionThese are the sections of the main ELSA interview. Interview is roughly 80 mins for 1 resp 120 mins for two.Health – questions on whether diagnosed with particular health conditions, quality of care, help around the house, experience pain, smoking,Social participation – questions on transport – private and personal, a couple of questions on how they feel about their local area.Cognitive function – respondents carry out a number of activities to measure their short and long term memory, prospective memory (remembering to remember), verbal fluency, mental speed and visual scanning, numeracy and literacy.Expectations – expectations for the future – what degree of certainty they have about future events occurring e.g. living to a certain age, their future health, receiving an inheritancePsycho social health – views on life e.g. how often during the last week they were happy, depressed, lonelyTimed walk – ask those aged 60 and above to walk 8ft (244cm) twice.Self-completion – includes questions on quality of life, social participation, life satisfaction, well-being, personality, social networks, religion, discrimination, diet and alcohol consumption.
6Blood sample (fasting where possible) Height (standing, sitting) Nurse Visit ContentBlood pressureGrip strengthBlood sample (fasting where possible)Height (standing, sitting)WeightWaist and hip measurementLung functionBalanceLeg riseChair raiseSaliva sample (after visit)This is the content of the nurse visit. Each nurse interview takes an hour.Balance testsSaliva sample – measuring cortisol.
7Life History Interview Follow up interview at Wave 3Asks about childhood and important life eventsAim to enhance our understanding of how early life and events throughout life impact upon circumstances of older peopleCalendar technique to enhance recallGoing back to people who agreed to do the LHI at end of their Wave 3 interview (varied gap - weeks to many months)The interview asks about birth up until the present day - quite a long periodAsk about childhood and any important life eventsAim of the life history interview is to understand how the life course can impact upon the circumstances of older people.We used an event history calendar to enhance recall. Record events on a calendar7
8Relationship with parents as a child Other important life events Topics coveredChildren & fertilityPartnersWhere livedWork historyHealthRelationship with parents as a childOther important life eventsChildren - natural, adopt, foster, miscarriages, abortions, still birthsPartners - cohabiting and non-cohab (social networks)Accommodation - addresses for 6 months or more,- more detail about where lived when 10 (who lived with, no. of bedrooms, facilities, no. of books)Work - jobs for 6 months or more, changes in employer, pt or ft, salaries, activities between jobs, whether left because of ill healthHealth - injuries,- childhood health (missed school, hospitalisation, list of conditions and when, impact on current life)- adult health (conditions lasting for more than 1 yr, age, long term effects)- smoking history- gynaecology (age periods started, hysterectomy, ovaries removed, menopause, HRT)Parents - separation from mother, divorce- care and protectionOther - experience of difficult life events (e.g. physical attack, abuse, bereaved)- open ended questions - 3 aspects of life especially important, and how affected them8
9Life history was a follow up interview to Wave 3. Life history interview asked about the respondents’ lives prior to joining ELSA – from early childhood to the date they joined ELSA. We know very little about respondent’s lives before they joined ELSA and early life events impact on circumstances in later life.Respondents trying to recall information from a long time period we developed a life grid – to aid recall.5 domains of respondent’s lives we asked about:Children - natural, adopt, foster, miscarriages, abortions, still birthsPartners - cohabiting and non-cohab (social networks)Accommodation - addresses for 6 months or more,Work - jobs for 6 months or more, changes in employer, pt or ft, salaries, activities between jobs, whether left because of ill healthHealth - injuries, childhood health (missed school, hospitalisation, list of conditions and when, impact on current life)- adult health (conditions lasting for more than 1 yr, age, long term effects)This is a screen shot of the life history interviewTop is the question.Then the life grid – 5 topics down the sideYears along the top and underneath that the age of the respondent during that yearFull shaded square shows that date moved into that accommodation etc.Shaded square in the children line is when this respondent had their children.At the bottom are the important events in that year and personal events in that year – help respondent remember what they were doing that year.Found that both the respondents and the interviewers enjoyed the life history interview.
10Plans for Wave 6 Social care Fluid intelligence We are now preparing for Wave 6 which will commence in April 2012.We are adding a number of new topics at this wave.Questions on social care – which have been developed by a collaboration of NatCen, Personal Social Services Research Unit at Universities of Kent, LSE and Manchester. Now been introduced on HSE. We will be introducing a shortened module.Fluid intelligence or fluid reasoning is the capacity to think logically and solve problems in new situations, and is essential for many forms of problem solving. It is relevant to how people negotiate life, and shows age-related declines.
11Fluid Intelligence Example BLANKWhat number belongs in the blank?Correct answer is 15, as there are four between 8 and 12 and then 3 between 12 and 15 and 2 between 15 and 17.
12Plans for Wave 6 Social care Fluid intelligence Sexual functioning We are going to be including a self-completion on sexual functioning, or we are calling it sexual relationships and activities.Sexual function and satisfaction are related to health and wellbeing. Alongside increasing life expectancy, evidence suggests an increasing proportion of people remain sexually active in later life, with current opinion increasingly viewing waning sexuality associated with ageing as a pathological outcome requiring medical and lifestyle interventions.There is very limited data to address questions relating to sexual function and satisfaction in later life and its determinants and consequences. Collecting relevant data from the ELSA cohort, would permit important and novel examination of this topic, particularly as repeat measures in subsequent waves would allow a separation of age and cohort effects and an examination of causal direction.We have developed male and female self-completion questionnaire.
13Plans for Wave 6Social careFluid intelligenceSexual functioningNurse visit, biomarkers
14Wave 6 biomarkers Wave 2 Wave 4 Wave 6 Anthropometric Grip, balance, chair rise, tandem stand, leg raiseBlood pressure, lung functionLipids, triglycerides, HbA1c, glucoseC-reactive protein, fibrinogenC-reactive protein, fibrinogen, white cell countHaemoglobin, ferritinDNA(DNA)IGF-1, DHEAS?IGF-1, Vitamin DApolipoprotein EAnthropometric – height, weight, waist, hipVery few changes from wave 4.
15Nurse visit, biomarkers Multiple drug use (polypharmacy) Plans for Wave 6Social careFluid intelligenceSexual functioningNurse visit, biomarkersMultiple drug use (polypharmacy)The use of multiple drugs in older people is an important and poorly understood health care issue, with both risks and benefits for health and independent functioning. Potentially inappropriate prescribing is common, with up to one third of all older people in the UK receiving a potentially harmful drug prescription (De Wilde et al, 2007). These high levels of potentially inappropriate prescribing are likely to lead to adverse drug reactions, a major cause of avoidable hospital admissions. Data on prescribed drugs will complement existing ELSA information on diagnosed conditions and quality of care, by linking information on diagnosis and receipt of indicated care for conditions such as coronary heart disease, hypertension, diabetes mellitus, osteoarthritis, and depression to prescriptions received. Combining these data with existing ELSA data will enable important insights into the factors that identify successful use of prescribed drugs in older people, such as socio-economic status and cognitive ability, building on existing research that has found potentially inappropriate prescribing increased with age and deprivation (Carey et al, 2008).The information on prescriptions will be collected during the nurse visit in wave 6 of ELSA.
16FindingsI am now going to talk through some findings from ELSA.
17Disease outcomes at older ages in the US & England Health and Retirement Study is ELSA’s sister study in the US. Results from HRS and ELSA are directly comparable.A paper written by colleagues at the IFS compared health of older American with older English and found that all types of disease were more prevalent in older Americans than older English.This finding was used by Michael Moore in his film Sicko which investigates healthcare in the US.“In a study of older Americans and Brits, the Brits had less of almost every major disease. Even the poorest Brit can expect to live longer than the richest American.”Source: Banks et al. (May, 2006) Disease and Disadvantage in the United States and in England; JAMA, Vol 295, No.17
18Childhood disease in the US & England A life history health module was introduced on the HRS in The module was broadly comparable to the ELSA health life history module.Using the data collected in the ELSA Life History Interview and a similar life history module in the HRS we can explore how childhood health and circumstances relate to outcomes in late life in both the US and England.What we see here is that the relative prevalence of self-reported childhood diseases was very similar across the two countries. However, in general, prevalence of childhood health conditions can be seen to be higher in the US than in the England. This is similar pattern to that seen in later life.Source: Banks et al. (May 2011) Childhood health and differences in late-life health outcomes between England and the United States, NBER Working Paper and forthcoming in Wise et al (ed), Investigations into the Economics of Ageing, NBER 2001118
19Unemployment before 50 & quality of life SHARE – European carried out a similar life history interview as ELSALooked at period of unemployment before the age of 50 and what impact this had on quality of life in later life for men and women. Unemployment was classified as a period of 6 months or more.Quality of life was measured using CASP 19 – measure of quality of life used on many studies.ELSA – is down as Anglo-Saxon (not Angle Saxon).In Scandinavian, Bismarckian and Anglo-Saxon countries (men only) people experiencing a period of unemployment before 50 generally report lower quality of life in later life. Results remain stable if wealth and age are considered in the multivariate analyses. However, no significant results are found for Southern and Eastern countries, probably countries were non-institutional factors, such as family are a more important role of welfare.Source: Wahrendorf,M.; Blane D. & J. Siegrist19
20Wave 4 Report FindingsA quarter of households experienced at least a 10% increase in the share of their income devoted to basics. Spending on domestic fuel rose by more than a thirdThe poorest fifth are more sedentary, heavier and least likely to eat five portions of fruit and vegetables than the wealthiest fifth –trend has been increasing over timeHalf of those aged 50 to 74 provide some form of help to friends and neighbours, with more than 1 in 10 actively providing care for someone - partner or parentIncreasing reports of feeling lonely and less happy with lifeWe published the Wave 4 report late last year. Here are some findings from the report.Source: Financial circumstances, health and well-being of the older population in England; The 2008 English Longitudinal Study Of Ageing (Wave 4)
22ELSA data in the archive FileWave 0Wave 1Wave 2Wave 3Wave 4Core DataNurse DataN/AIndex File UpdatesTBALife History DataRyff Self Completion DataTelephone Interview (with non -responders) DataEnd of Life Interview DataFinancial Derived VariablesPension Wealth Derived VariablesPension GridMortgage DataMortgage GridTechnical ReportN/A5Go through tableWave 3 was archived late last year.Wave 4 main interview was interviewed late last yearIndex file updates – W3 index file now available soon. The index file contains all the respondents who were ever selected for ELSA including those that have died or have consistently refused. It contains reference information such as whether they had an interview at certain waves and whether they are still alive or not.Life history data – was archived earlier this yearTelephone interview data for Wave 3 will be ready later on this yearEnd of life interview data – Waves 2 and 3 will be archived in autumn of this year22
23Data and associated documentation: http://www.esds.ac.uk/longitudinal/ Further informationELSA website:Data and associated documentation:Contact me:ELSA website – reports and journal articles, documentationELSA data housed at uk data archiveCan contact me at this address.