English Longitudinal Study Of Ageing Wave Research Articles

MENTAL HEALTH AND WELLBEING ACROSS THE COVID-19 PANDEMIC AMONG OLDER PEOPLE IN ENGLAND

Abstract Numerous studies have identified declines in mental health and psychosocial wellbeing over the course of the COVID-19 pandemic across the world and in different age groups, including older people. A key question for researchers, health practitioners, and policymakers alike is whether the influence of the pandemic on these outcomes is temporary or more long-lasting. The lived experience of the pandemic, such as lockdowns, likely played a role in shaping mental health and wellbeing, but recovery is not always immediate following the removal of such negative stimuli. Our recent work using the English Longitudinal Study of Ageing (ELSA) identified that depression, anxiety, and quality of life demonstrated statistically significant worsening trajectories between ELSA Wave 9 (2018/19) and through two assessments during the pandemic, i.e. June/July and Nov/Dec 2020. Because depression and anxiety are also common neuropsychiatric symptoms among people with dementia or mild cognitive impairment, we also examined differences according to cognitive function, finding a convergence among cognitive function groups in the risk for poor mental health through the pandemic. This paper expands on this work to incorporate ELSA Wave 10, the first survey assessment after the easing of key pandemic-related restrictions and health crisis measures, to assess how older people are faring since the acute phase of the pandemic in terms of mental health and wellbeing. It highlights key subgroup dynamics, including cognitive function group, that are associated with patterns of recovery in mental health and wellbeing to pre-pandemic levels and those linked to more long-lasting adverse experiences.

Personality traits and loneliness among older people in the UK: Cross-sectional and longitudinal analysis from the English Longitudinal Study of Ageing

Little research has analysed the relationship between personality traits and loneliness, considering polygenic risk scores (PGSs), social isolation, socioeconomic, and health factors. We used data from 4,892 older adults 52 years and older from the English Longitudinal Study of Ageing (ELSA). ELSA wave 5 (2010/2011) was our baseline, and wave 6 (2012/2013) to wave 9 (2018/2019) was the loneliness follow-up. Polygenic risk scores for loneliness were derived from genome-wide association studies. We conducted multiple linear regression and multilevel LMMs to analyse the cross-sectional and longitudinal relationship between personality traits and loneliness. Extroversion (Coef. = -.375; 95% CI:−.447 to .302), Neuroticism (Coef. = .557; 95% CI: .485–.629), Agreeableness (Coef. = −.188: 95% CI: −.273 to .103), Conscientiousness (Coef. = −.183; 95% CI: −.271 to .095), and Openness to Experience (Coef. = −.170; 95% CI: −.236 to .103) were associated with loneliness at baseline. Over eight years of follow-up, loneliness levels decreased on average. Only Extroversion was associated with the loneliness rate of decline (Coef. = .012; 95% CI: .002–.022) after potential confounders had been considered. An important task of health and social services is to identify older adults at risk of physical, mental, and cognitive health issues. The success of public health and clinical interventions to reduce loneliness could be informed by a consideration of personality profiles.

Educational level as a cause of type 2 diabetes mellitus: Caution from triangulation of observational and genetic evidence.

We obtained observational evidence from the English Longitudinal Study of Ageing (ELSA). Self-reporting educational attainment was categorised as high (post-secondary and higher), middle (secondary), and low (below secondary or no academic qualifications) in 6,786 community-dwelling individuals aged ≥ 50years without diabetes at ELSA wave 2, who were followed until wave 8 for the first diabetes diagnosis. Additionally, we performed two-sample Mendelian randomisation (MR) using an inverse-variance weighted (IVW), MR-Egger, weighted median (WM), and weighted mode-based estimate (WMBE) method. Steiger filtering was further applied to exclude single-nucleotide polymorphisms (SNPs) that were correlated with an outcome (T2DM) stronger than exposure (education attainment). We observed 598 new diabetes cases after 10.4years of follow-up. The adjusted hazard ratios (95% CI) of T2DM were 1.20 (0.97-1.49) and 1.58 (1.28-1.96) in the middle- and low-education groups, respectively, compared to the high-education group. Low education was also associated with increased glycated haemoglobin levels. Psychosocial resources, occupation, and health behaviours fully explained these inverse associations. In the MR analysis of 210 SNPs (R2 = 0.0161), the odds ratio of having T2DM per standard deviation-decreasing years (4.2years) of schooling was 1.33 (1.01-1.75; IVW), 1.23 (0.37-4.17; MR-Egger), 1.56 (1.09-2.27; WM), and 2.94 (0.98-9.09; WMBE). However, applying Steiger filtering attenuated most MR results towards the null. Our inconsistent findings between cohort and genetic evidence did not support the causality between education and T2DM.

Associations of discontinuation of care: A longitudinal analysis of the English Longitudinal Study of Ageing?

Informal carers play a vital part to ensuring that individuals in need of care, due to illness or disability, continue to experience a good quality of life. Care provision has been studied extensively, however, little is known about the associations of discontinuing care. This knowledge is important not only to ensure that informal carers are supported, even after caring episode, but also to ensure the care-recipients are not left without support. By conducting longitudinal analysis of the English Longitudinal Study of Ageing (ELSA), this paper uniquely starts to unveil the associations of discontinuing the caring role and the patterns of care provision prior to discontinuing. A multivariable binary regression analysis was conducted of the ELSA waves 7 (2015) to 8 (2017), total sample size of N=6,687. 10.5% (n=701) respondents were identified as discontinued carers. The dependent variable was care provided in wave 7 but not in wave 8 (a discontinued carer), compared to providing care in both waves (a continuing carer). Socio-demographic, such as age, gender, marital status, economic activity and health acted and caring patterns, such as intensity and relationship with care-recipient, acted as independent variables. Results showed nearly 30% of discontinued carers had provided care to a spouse. Nearly a quarter of continuing carers had transitioned between care-recipients, which raises the question of a potential 'Serial Carer Trajectory'. The regression analysis noted that being divorced or widowed increased the odds of discontinuing care. Providing 20-49hr of care per week was associated with lower odds of discontinuing the role. This paper suggests that policymakers should take a holistic approach to policies to support carers through all stages of their caring journey, including after discontinuing the caring role. This could ensure carers settle into life post-caring and continue to feel valued and recognised.

Comparison of Self-reported Measures of Hearing With an Objective Audiometric Measure in Adults in the English Longitudinal Study of Ageing

An effective and sustainable hearing loss (HL) screening strategy for the early detection of and intervention for HL in older adults is needed. To examine the concordance of self-reported measures of hearing difficulty with objective hearing data and the factors associated with the potential discordances among these measures across different population subgroups of a representative sample of people 50 years and older in England. This study was a cross-sectional analysis of wave 7 of the English Longitudinal Study of Ageing (ELSA), a large, population-based, prospective cohort study that provides a unique resource for exploring issues associated with aging in England in the 21st century. The full analytic cohort was composed of 9666 individuals participating in the ELSA wave 7, which collected information from June 1, 2014, to May 31, 2015. This study further analyzed a sample of 8529 adults 50 to 89 years of age who had an assessment of their hearing by self-reported measures, and consented to assessment by a qualified nurse via a hearing screening device, and did not have an ear infection or a cochlear implant. Bivariate analyses were performed from July 1 to December 30, 2018, and multivariate analysis from January 1 to June 30, 2019. Multiple logistic regression models examined factors associated with misclassification of hearing difficulties across several categories among those with objectively identified HL. The study examined whether age, marital status, retirement status, indicators of socioeconomic position, and lifestyle factors (such as body mass index, physical activity, and tobacco and alcohol consumption) were associated with the concordance between self-reported hearing problems and manual audiometry among older adults. Self-reported hearing measures, including hearing in background noise, compared with objective audiometric assessments. A total of 9666 study participants (5368 female [55.5%]; mean [SD] age, 67.4 [14.4] years) provided responses regarding their hearing difficulties, hearing in noise, quality of care in hearing, and hearing aid recommendation in ELSA wave 7. Within the cohort, 684 individuals (30.2%) with objectively measured HL greater than 35 dB HL at 3.0 kHz went undetected by the self-report measure, whereas the new constructed categories for moderate and moderately severe or severe HL resulted in 9.3% increased sensitivity. Factors associated with misreporting hearing difficulties (while they had objectively measured HL >35 dB HL at 3.0 kHz, in the better-hearing ear) were as follows: female sex (odds ratio [OR], 1.97; 95% CI, 1.18-3.28), no educational qualifications (OR, 1.37; 95% CI, 1.26-2.55), routine or manual occupation (OR, 1.43; 95% CI, 1.28-2.61), tobacco consumption (OR, 1.14; 95% CI, 1.08-1.90), alcohol intake above the low-risk-level guidelines (OR, 1.13; 95% CI, 1.11-2.34), and lack of moderate physical activity (OR, 1.25; 95% CI, 1.03-1.42). Age was largely associated with misreporting of moderately severe to severe HL; the odds were 5.75 (95% CI, 1.17-8.13) higher for those 65 to 74 years of age and 7.08 (95% CI, 1.41-9.30) higher for those 75 to 89 years of age to not report their hearing difficulties compared with those 50 to 64 years of age. In addition, socioeconomic indicators, such as educational level (OR, 1.95; 95% CI, 1.63-6.01) and occupation (OR, 2.07; 95% CI, 1.78-5.40), along with lifestyle factors, such as smoking (OR, 1.46; 95% CI, 1.25-2.48) and alcohol intake above the low-risk-level guidelines (OR, 1.86; 95% CI, 1.67-5.12), were factors associated with misreporting moderately severe or severe HL. The use of a screening measure for audiometric testing and a self-report measure is essential for accurately identifying older people with HL. The results of this study should be considered by HL researchers who analyze self-reported hearing data as a surrogate measurement of audiometric hearing to identify bias in their observed analytic research results.

Higher risk of dementia in English older individuals who are overweight or obese.

BackgroundSeveral risk factors contribute to dementia, but the role of obesity remains unclear. This study investigated whether increased body weight or central obesity were associated with a higher risk of developing dementia in a representative sample of older English adults.MethodsWe studied 6582 participants from the English Longitudinal Study of Ageing (ELSA) who were aged ≥50 years and were dementia-free at baseline, that being either wave 1 (2002–2003) for study members who started at wave 1, or at either wave 2 (2004–2005) or 4 (2008–2009) for those who began the study as refreshment samples. Body mass index (BMI) was measured at baseline and categorized into normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2) and obese (≥30 kg/m2). Central obesity was defined as a waist circumference (WC) >88 cm for women and >102 cm for men. Cumulative incidence of dementia was ascertained based on physician-diagnosed dementia, an overall score >3.38 on the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and Hospital Episodes Statistics (HES) data at every ELSA wave from baseline until wave 8 (2016–2017). Cox proportional hazards models were used to assess the association between baseline BMI levels or abdominal obesity in relation to dementia incidence during the mean follow-up period of 11 years.ResultsFrom the overall sample, 6.9% (n = 453) of participants developed dementia during the follow-up period of maximum 15 years (2002–2017). Compared with participants with normal weight, those who were obese at baseline had an elevated risk of dementia incidence [hazard ratio (HR) = 1.34, 95% confidence interval (CI) 1.07–1.61] independent of sex, baseline age, apolipoprotein E-ε4 (APOE-ε4), education, physical activity, smoking and marital status. The relationship was slightly accentuated after additionally controlling for hypertension and diabetes (HR = 1.31, 95% CI 1.03–1.59). Women with central obesity had a 39% greater risk of dementia compared with non-central obese women (HR = 1.39, 95% CI 1.12–1.66). When compared with a normal BMI and WC group, the obese and high WC group had 28% (HR = 1.28, 95% CI 1.03–1.53) higher risk of dementia.ConclusionsOur results suggest that having an increased body weight or abdominal obesity are associated with increased dementia incidence. These findings have significant implications for dementia prevention and overall public health.

Urinary incontinence and sexual health in a population sample of older people.

ObjectivesTo investigate the association between self‐reported urinary incontinence (UI) and sexual health in a representative sample of older people.Subjects and MethodsParticipants were community‐dwelling women and men aged 50–90+ years from the English Longitudinal Study of Ageing (ELSA) who reported any sexual activity in the last year. The prevalence of UI was assessed both cross‐sectionally (ELSA Wave 6; 2012) and retrospectively over the preceding 8 years (ELSA Waves 2–6; 2004–2012). Sexual activities, difficulties and concerns were assessed using a validated Sexual Relationships and Activities Questionnaire. The association between UI and sexual health outcomes was examined using weighted logistic regressions, with adjustments made for demographic, health, and lifestyle factors.ResultsAt Wave 6, 391 (20.0%) women and 141 (6.9%) men reported ‘any UI’ in the last 12 months. Compared to those without UI, women with UI reported declines in sexual activity and arousal over the last year, and increased concern about their frequency of sexual activity and ability to become sexually aroused. Men with ‘any UI’ reported declines in sexual desire, increased erectile and orgasm difficulties, and were more concerned about these sexual functions compared to men without UI. Differences in the patterns of association with sexual health were seen, dependent upon whether UI was reported as sporadic or persistent, and also with respect to the duration of retrospectively reported UI.ConclusionSelf‐reported UI was associated with impairment in sexual health in women and men, and mainly linked to recent declines in sexual activity and function along with elevated sexual concerns. Our findings highlight that the sexual health of older people should be considered when managing UI.

Agreement Between 35 Published Frailty Scores in the General Population.

In elderly populations, frailty is associated with higher mortality risk. Although many frailty scores (FS) have been proposed, no single score is considered the gold standard. We aimed to evaluate the agreement between a wide range of FS in the English Longitudinal Study of Ageing (ELSA). Through a literature search, we identified 35 FS that could be calculated in ELSA wave 2 (2004–2005). We examined agreement between each frailty score and the mean of 35 FS, using a modified Bland-Altman model and Cohen's kappa (κ). Missing data were imputed. Data from 5,377 participants (ages ≥60 years) were analyzed (44.7% men, 55.3% women). FS showed widely differing degrees of agreement with the mean of all scores and between each pair of scores. Frailty classification also showed a very wide range of agreement (Cohen's κ = 0.10–0.83). Agreement was highest among “accumulation of deficits”-type FS, while accuracy was highest for multidimensional FS. There is marked heterogeneity in the degree to which various FS estimate frailty and in the identification of particular individuals as frail. Different FS are based on different concepts of frailty, and most pairs cannot be assumed to be interchangeable. Research results based on different FS cannot be compared or pooled.

Advanced analytical methodologies for measuring healthy ageing and its determinants, using factor analysis and machine learning techniques: the ATHLOS project

A most challenging task for scientists that are involved in the study of ageing is the development of a measure to quantify health status across populations and over time. In the present study, a Bayesian multilevel Item Response Theory approach is used to create a health score that can be compared across different waves in a longitudinal study, using anchor items and items that vary across waves. The same approach can be applied to compare health scores across different longitudinal studies, using items that vary across studies. Data from the English Longitudinal Study of Ageing (ELSA) are employed. Mixed-effects multilevel regression and Machine Learning methods were used to identify relationships between socio-demographics and the health score created. The metric of health was created for 17,886 subjects (54.6% of women) participating in at least one of the first six ELSA waves and correlated well with already known conditions that affect health. Future efforts will implement this approach in a harmonised data set comprising several longitudinal studies of ageing. This will enable valid comparisons between clinical and community dwelling populations and help to generate norms that could be useful in day-to-day clinical practice.

Let's talk about sex – what do older men and women say about their sexual relations and sexual activities? A qualitative analysis of ELSA Wave 6 data

ABSTRACTIn 2012/2013 the English Longitudinal Study of Ageing (ELSA) included a comprehensive Sexual Relationships and Activities Questionnaire (SRA-Q). A total of 7,079 men and women mainly aged 50 to >90, primarily heterosexual and in a coupled relationship, completed the SRA-Q, answering a series of questions about their attitudes to sexual relationships, their own sexual activities, problems and concerns with sexual functioning, and quality of intimate relationships. The questions aimed to gain insights into the ways in which sexual relations and activities related to health, wellbeing and other lifestyle factors change as people grow older. The primary mode of data collection was a tick box response to a series of questions. However, at the end of the questionnaire an open comment box was provided, which asked respondents whether there was anything else that they would like to say; 1,084 respondents provided additional information and these comments created a unique qualitative data-set. The analysis of the data then illustrated how people's health, relationships, experiences and perceptions of ageing, along with sexual satisfaction, impact on sexual relationships and activities.

A103 Who has a bus pass, and is it good for their health? ID: 133

Abstract Background The older person’s bus pass, introduced in 2006, enables people aged over the state retirement age to travel free on local buses across the UK. Uptake averaged at 75% in 2008-2010 (National Travel Survey data). Existing research suggests that, of those eligible, women, older people, less advantaged people, those who live in London and those who have cars are more likely to hold a bus pass (Coronini-Cronberg et al., 2012). There are also suggestions that older people with bus passes may be more physically active (Coronini-Cronberg et al., 2012) and less likely to be obese (Webb et al., 2011). This paper will investigate who has a bus pass and whether having a bus pass predicts public transport use and adiposity. Methods Data were drawn from wave 6 of the English Longitudinal Study of Ageing (ELSA), a nationally representative survey of people aged 50 years and older, and their partners, living in England conducted in 2012 and 2013 (N=10,601). The analytic sample was restricted to those we knew were eligible for a bus pass at ELSA wave 6 interview (N=6870). Holders and non-holders of bus passes were described according to their age, sex, socioeconomic circumstances, car and public transport use, physical activity and adiposity, and multivariable logistic regression was used to determine the predictors of holding a bus pass. Associations between holding a bus pass and public transport use and adiposity were investigated using, respectively, multivariable logistic regression and multivariable linear regression. Models were run separately for men and women where sex interactions were observed. Results Initial models suggest that i) women, retired people and those in the middle of the wealth distribution are most likely to hold a bus pass ii) people who hold bus passes use public transport more often, and iii) women, but not men, who hold a bus pass have lower levels of adiposity, as measured by BMI and waist circumference, than their peers. Conclusions These findings suggest that older people who have a bus pass may be more physically active and healthier than those who don’t, supporting the growing evidence that there is a public health justification for maintaining the older person’s bus pass.

Sexual Health and Well-being Among Older Men and Women in England: Findings from the English Longitudinal Study of Ageing.

We describe levels of sexual activity, problems with sexual functioning, and concerns about sexual health among older adults in the English Longitudinal Study of Ageing (ELSA), and associations with age, health, and partnership factors. Specifically, a total of 6,201 core ELSA participants (56% women) aged 50 to >90 completed a comprehensive Sexual Relationships and Activities questionnaire (SRA-Q) included in ELSA Wave 6 (2012/13). The prevalence of reporting any sexual activity in the last year declined with age, with women less likely than men at all ages to report being sexually active. Poorer health was associated with lower levels of sexual activity and a higher prevalence of problems with sexual functioning, particularly among men. Difficulties most frequently reported by sexually active women related to becoming sexually aroused (32%) and achieving orgasm (27%), while for men it was erectile function (39%). Sexual health concerns most commonly reported by women related to their level of sexual desire (11%) and frequency of sexual activities (8%). Among men it was level of sexual desire (15%) and erectile difficulties (14%). While the likelihood of reporting sexual health concerns tended to decrease with age in women, the opposite was seen in men. Poor sexual functioning and disagreements with a partner about initiating and/or feeling obligated to have sex were associated with greater concerns about and dissatisfaction with overall sex life. Levels of sexual activity decline with increasing age, although a sizable minority of men and women remain sexually active until the eighth and ninth decades of life. Problems with sexual functioning were relatively common, but overall levels of sexual health concerns were much lower. Sexually active men reported higher levels of concern with their sexual health and sexual dissatisfaction than women at all ages. Older peoples' sexual health should be managed, not just in the context of their age, gender, and general health, but also within their existing sexual relationship.

Financial Crisis Wealth Losses and Responses among Older Households in England*

AbstractPrices of real and financial assets fell substantially in the UK during 2008–09. The fourth wave of the English Longitudinal Study of Ageing (ELSA) was in the field throughout this ‘financial crisis’. We use these data, and earlier ELSA waves, to document the effect of the crisis on those aged 50 and over in England, importantly taking into account that a significant proportion of the wealth of these households is held in forms such as state pensions that will not be directly affected by movements in asset prices. We find that the median fall in wealth among individuals was 8 per cent of total household gross wealth with, on average, richer individuals having experienced a larger decline. We find some evidence that those who experienced greater wealth shocks were more likely to reduce their expected chance of leaving a large bequest and to reduce their spending on certain ‘semi‐luxury’ items such as clothing and food consumed out of the home.