1. Old, Sick and Alone ? Living arrangements, health and well-being among older people in England BSPS Annual Conference University of St Andrews 12 th September 2007 Harriet Young and Emily Grundy London School of Hygiene and Tropical Medicine

2. Research to date Those living with spouse are the most healthy Those living with spouse are the most healthy Contradictory evidence for those not living with spouse: more healthy living with other relatives or living alone ? Contradictory evidence for those not living with spouse: more healthy living with other relatives or living alone ? Lund (2000), Grundy (1989),Lund (2000), Grundy (1989), Michael (2001), Gustavson (2004)Michael (2001), Gustavson (2004) Selection effects Selection effects Effects may vary according to cultural, socio- economic context and presence of social ties Effects may vary according to cultural, socio- economic context and presence of social ties

3. Research Objectives  1 & 2: Analyse associations between living arrangements and health and well- being among older people Cross-sectional Cross-sectional Longitudinal Longitudinal  3: Examine whether having social ties influences the association between living arrangements and health and well-being.

4. Dataset: English Longitudinal Study of Ageing (ELSA)  Two waves of data in 2002 and 2004  Cross-sectional dataset of population aged 60+ in Wave One – 7146 people  Longitudinal dataset of population aged 60+ in Wave One and present at Wave Two – 5443 people

5. Variables  Outcome variables Self-rated health Self-rated health Psychological morbidity – CES-D depression scale Psychological morbidity – CES-D depression scale  Explanatory variable Living arrangements: Living arrangements: spouse only,spouse only, spouse and other,spouse and other, Children or others only,Children or others only, AloneAlone

6. Co-variates GenderGender AgeAge SmokingSmoking WealthWealth Housing tenure,Housing tenure, Contact with relatives, contact with friends, membership of social organisations,Contact with relatives, contact with friends, membership of social organisations, Limitations of Activities of Daily Living, chronic health conditionsLimitations of Activities of Daily Living, chronic health conditions

7. Cross sectional analysis  Associations between living arrangements and…. Self-rated health (binary variable: poor & fair cc excellent, very good & good health): logistic regression Self-rated health (binary variable: poor & fair cc excellent, very good & good health): logistic regression CES-Depression score (8 point scale: 0-2 compared with 3+): logistic regression CES-Depression score (8 point scale: 0-2 compared with 3+): logistic regression

8. This model controlled for gender, age, smoking, wealth, housing tenure, contact with relatives, contact with friends, membership of social organisations

9. This model controlled for gender, age, smoking, wealth, housing tenure, contact with relatives, contact with friends, membership of social organisations and self-rated health status

10.  Gender differences in these findings  Other factors associated with self-rated health and CES-D score

11. Longitudinal analysis  Association of living arrangements in 2002 with change in health and well-being 2002-2004 Self-rated health: deteriorated cc didn’t deteriorate, Logistic regression Self-rated health: deteriorated cc didn’t deteriorate, Logistic regression CES-D: well-well cc well-depressed well-depressed cc depressed-depressed, logistic regression CES-D: well-well cc well-depressed well-depressed cc depressed-depressed, logistic regression  Drop those who changed living arrangement 2002 to 2004 (7.5%)

12. This model controlled for gender, age, smoking, wealth, housing tenure, contact with relatives, contact with friends, membership of social organisations, ADL limitations in 2002, and presence of health conditions in 2002

13. Cross-tabulation of living arrangements and change in depression score 2002-2004, people aged 60+. ELSA 2002-2004 Percent (%) Well 2002 Well 2004 Well 2002 Depr 2004 Depr 2002 Well 2004 Depr 2002 Depr 2004 Total Spouse only 73989100 Spouse plus others 69111010100 Living alone 53131321100 With non- spouse others 57121417100 TOTAL67(3158)10(502)10(502)13(621)100

14. Adjusted odds ratios from logistic regression of living arrangements on change in depression 2002-2004, for those well in 2002 and for those depressed in 2002, people aged 60+. ELSA Well 2002 Well 2004 Well 2002 Depr 2004 Depr 2002 Well 2004 Depr 2002 Depr 2004 Spouse only 1 0.76 * 10.75 Spouse plus others 10.9910.83 Living alone (ref group) 1111 With non- spouse others 10.8810.83 These models controlled for gender, age, smoking, wealth, housing tenure, contact with relatives, contact with friends, membership of social organisations, presence of health conditions in 2002, presence of health conditions in 2004 * p<0.05

15. Interaction with social ties  Cross-sectional analysis  Two interaction terms: Contact with relatives Contact with relatives Contact with friends Contact with friends More than once per week, less than once per week, no relatives / friends, missing More than once per week, less than once per week, no relatives / friends, missing

16. Odds ratios from logistic regression of interaction of contact with friends on the association between living arrangements and self-rated health for the unmarried compared with living alone, people aged 60+. ELSA 2002 Interaction term Odds ratio for those seeing friends more than once per week Odds ratio for those seeing friends less than once per wk With others cc alone 0.48 * 1.250.63 This model controlled for gender, age, smoking, wealth, housing tenure, contact with friends, membership of social organisations. * p<0.05

17. Odds ratios from logistic regression of interaction of contact with relatives on the association between living arrangements and CES-Depression score for the unmarried compared with living alone, people aged 60+. ELSA 2002 Interaction term Odds ratio seeing relatives more than once per week Odds ratio seeing relatives less than once per wk With others cc alone 1.94 * 0.45 *** 0.94 This model controlled for gender, age, smoking, wealth, housing tenure, contact with friends, membership of social organisations, self-rated health. * p<0.05 ***p<0.001

18. Limitations  Small numbers in the sample limited ability to draw firm conclusions  Limited longitudinal analysis  Missing individuals between round 1 and 2  No information on length of time in living arrangement.  Missing data: social ties variables, and these individuals had high proportions with depression.

19. Conclusions  Clear association between living alone and higher levels of depression and loneliness (ELSA)  Among women, better self-rated health if alone than with a spouse.  Possible influence of social ties

20. The End Thank you Harriet.Young@lshtm.ac.uk Emily.Grundy@lshtm.ac.uk