English Longitudinal Study On Ageing Research Articles

Cataract surgery utilization in Parkinson's disease: the english longitudinal survey on ageing.

Older adults with Alzheimer's disease are less likely to be offered cataract surgery than the general population, but these disparities have not been examined in the context of other neurodegenerative disorders such as Parkinson's disease (PD). Using data from the English Longitudinal Study on Ageing (ELSA), an ongoing, longitudinal population-based survey of older adults in England, we examined the relationship between PD and cataract surgery among adults 50 and older. We used logistic regression to measure the association between PD and history of cataract surgery at baseline. In longitudinal analyses of subjects with no history of cataract surgery at time of enrollment, we used semiparametric, discrete-time proportional hazards models to model the incidence of cataract surgery as a function of PD and other time-dependent covariates. Models were adjusted for demographic variables, self-reported comorbidities, and measures of daily activity limitation. We included data from 19,241 eligible ELSA respondents, of whom 231 (1.2%) reported a diagnosis of PD. PD was positively associated with a history of self-reported cataract surgery at baseline (OR 3.66, 95% CI: 2.55-5.26), but this did not remain significant after adjusting for confounders (OR 1.22, 95% CI: 0.75-1.98). Among subjects with no history of cataract surgery at baseline, PD was also not associated with incident cataract surgery (adjusted HR 1.32, 95% CI: 0.86-2.02). Unlike Alzheimer's disease, people with PD were no less likely to receive cataract surgery compared to those without PD.

SENSE OF PURPOSE IN LIFE AND ALLOSTATIC BURDEN IN TWO LONGITUDINAL COHORTS

Abstract Sense of purpose in life has been linked with better physical health, longevity, and reduced risk for disability and dementia, but the mechanisms linking purposefulness with diverse health outcomes is unclear. Chronic activation and dysregulation of neural, immune, and other bodily systems, known as allostatic load, may contribute to these underlying mechanisms. Specifically, sense of purpose may promote better physiological regulation in response to stressors and health challenges, leading to lower allostatic burden and disease risk over time. Data from the nationally representative US Health and Retirement Study (HRS) and English Longitudinal Study on Ageing (ELSA) (Total N=5846; Mean Age=67.24, SD=10.68, 59.08% female) were used to examine associations between sense of purpose and repeated assessments of allostatic load across 8 and 12 years of follow-up. Allostatic load scores were constructed from 12 blood-based and anthropometric biomarkers of cardiovascular, metabolic, immune, and lung function, with higher scores representing higher allostatic burden. Population-weighted multilevel models revealed that sense of purpose in life was associated with lower overall levels of allostatic load in HRS (b = -0.22, 95% CI: -0.27,-0.17) and in ELSA (b = -0.19, 95% CI: -0.35,-0.03). Sense of purpose in life did not predict rate of change in allostatic load in either sample. Associations with sense of purpose were highest among cardiovascular and immune biomarkers, suggesting that preservation of these bodily systems may underlie associations between purposefulness and reduced risk for chronic health conditions. Discussion will focus on biological and behavioral pathways connecting sense of purpose in life and health.

P05-12 Objectively measured physical activity, chronic illness and health service utilisation - a latent class analysis of activity behaviours in older adults

BackgroundPhysical activity contributes to the prevention of chronic illness as well as promotion of physical and mental health, but most adults remain inactive. Chronic illness affects mainly middle aged and older adults, and very little objectively measured data on physical activity behaviours and associated health outcomes of this population is published. The aims of this study are to: 1. Objectively measure physical behaviour outcomes of adults participating in the Move for Life study; 2. Develop distinct activity profiles based on six behaviour variables; 3. Investigate whether health outcomes differ across the activity profiles.MethodsParticipants were Irish adults aged 50 years and older. Using the activPAL, objectively measured data were collected on average daily: light intensity physical activity (hours); moderate to vigorous intensity physical activity (minutes); step count; time in bed (hours); standing time (hours); and waking sedentary time (hours). Data were obtained on chronic illness and health service utilisation. Validated questionnaires were used to collect data on wellbeing, loneliness and social isolation. Hierarchical cluster analysis using squared Euclidian distance was used to cluster behaviours based on similarity, using SPSS version 26. Regression models explored associations between health outcomes and activity profiles, adjusted for age and sex.ResultsData from 485 participants were analysed, and four activity profiles were identified: sedentary (n = 50, 10.3% of total), low active (n = 295, 60.8%), moderate active (111, 22.9%) and higher active (n = 29, 6%). We will present the differences across the activity profiles for chronic illnesses, multi-morbidity, health service utilisation and validated health tools, comparing to data from the Irish Longitudinal Study on Ageing (TILDA) and the English Longitudinal Study on Ageing (ELSA).ConclusionsThe use of physical activity behaviour clusters may identify people with multi-morbidity and higher utilisation of health services. These findings could be factored into the development of future targeted physical activity interventions.

Comparing loneliness in England and the United States, 2014-2016: Differential item functioning and risk factor prevalence and impact.

The purpose of this study is to compare mean levels of loneliness, and correlates of loneliness, among older adults in the U.S. and England. Comparisons are conducted after attending to comparability of the loneliness measure between countries based on tests for discriminatory capacity and differential item functioning of the 3-item UCLA Loneliness Scale. Cross-sectional data from the 2015–16 wave of the National Social Life, Health and Aging Project (NSHAP) and the 2014–2015 wave of the English Longitudinal Study on Ageing (ELSA) were analyzed using graded item response models and multiple indicators and multiple causes (MIMIC) models. Risk factors included demographic variables, health characteristics, and social characteristics that were harmonized across surveys. Because of differences in the racial-ethnic composition of the U.S. and England, analyses were limited to white respondents (N = 2624 in NSHAP; N = 6639 in ELSA). Only respondents born 1925–1965 were included in analyses. Discriminatory capacity was evident in each item being able to distinguish a lonely from a nonlonely individual. Differential item functioning (DIF) was evident in country differences in the likelihood of endorsing the “lack companionship” item at a given level of trait loneliness, and in DIF among marital status, education, and gender subgroups that were comparable across countries. Overall loneliness levels are equivalent in England and the U.S. Risk factor impact did not differ between countries, but differences in risk factor prevalence between countries combined to produce a net result of slightly lower mean levels of loneliness in older adults in England than in the U.S. after risk factor adjustment. The fact that the impact of risk factors were similar across countries suggests that evidence of successful interventions in one country could be leveraged to accelerate development of effective interventions in the other.

223 Prevalence of Depression Among People with Diabetes; Comparative Analysis of Older Adults Across Three Health Systems Using Nationally Representative Data

Abstract Background The co-occurrence of depression and diabetes is an emerging global challenge but any association is influenced by variations in prevalence, study design and measure used. We compared depression prevalence in older adults with and without diabetes across three health systems using a validated measure to examine the causal association between diabetes and depression. Methods We used data of adults aged over 49 years, from three nationally representative ageing datasets; The Irish Longitudinal Study on Ageing (TILDA), the English Longitudinal Study on Ageing (ELSA) and the Health and Retirement Study (HRS). Data were collected during 2009–2011 (TILDA), and 2010 (ELSA, HRS). The 8-item CESD scale categorised depression using recommended cut-off scores of < 3 for ELSA and HRS and < 8 for TILDA. Self-reported individual, environmental, behavioural risk, and health system exposure variables were selected a-priori using literature and a directed acyclic graph. Prevalence was presented as a percentage with corresponding 95% confidence intervals. Binomial logistic regression examined the odds of depression by diabetes status. Data were analysed in Stata v15 using the ‘svy’ function. Results Diabetes prevalence (Ireland;8%[(95%CI:7.5–8.6), England;11%(95%CI:10.6–12.0) and USA;19%[(95%CI:18.8-20.1);p<0.001]) and depression prevalence (Ireland;10%(95%CI:9.0–10.6), England;16%(95%CI:15.3-16.9), USA;14%[(95%CI:13.5-14.7);p<0.001] varied across countries. Depression was consistently higher among people with versus without diabetes (Ireland;14%(95%CI:10.9-16.6)vs.9%(95%CI:8.7–10.3),p=0.001], England;25%(95%CI:21.7-27.7)vs.15%[(95%CI:14.2-15.9),p≤0.001] and USA;19%(95%CI:16.9-20.0)vs.13%[(95%CI:12.4-13.8);p≤0.001]. The odds of depression were significantly higher in people with versus without diabetes (Ireland;OR=1.5(95%CI:1.2-1.9);p=0.001, England;OR=1.8(95%CI:1.5–2.2);p<0.000, USA;OR=1.5(95%1.3-1.7);p<0.000), but only remained significant in the English sample after adjustment; (Ireland;OR=1.2(0.8-1.6);p=0.356, England;OR=1.3(1.0–1.6);p=0.045, USA;OR=1.0(0.9-1.1);p=0.898). Conclusion Among older adults in different health systems, depression was consistently higher among people with versus without diabetes. The findings support incorporation of holistic approaches to diabetes management across health systems.

GENDERED LATE CAREERS IN THE UNITED STATES AND THE UNITED KINGDOM: A SEQUENCE ANALYSIS

Numerous policy reforms in the 21 century have tried to extend working lives without paying enough attention to the gendered nature of late careers. Combining a life-course approach with sequence analysis techniques, this study empirically explores how gendered are late careers in the United States and the United Kingdom. Drawing on data for the last decade from the Health and Retirement Study (HRS) and the English Longitudinal Study on Ageing (ELSA), we identify multiple types of labor force sequences. Preliminary results suggest that labor force sequences five years before and after the legal retirement age are more unstable and diverse for women in the United Kingdom. In contrast, labor force sequences for males are similarly stable and homogenous in both countries. We discuss the policy implications of these results for the financial security and health of both females and males in old age.

Older Adults’ Experiences of Sexual Difficulties: Qualitative Findings From the English Longitudinal Study on Ageing (ELSA)

There is a growing body of evidence demonstrating that sexual activity is important to the quality of life of older adults, and that it can be influenced by physical, psychological, and social factors. However, older adults’ experiences of sexual difficulties remain relatively unexplored. This article draws on qualitative data collected as part of the English Longitudinal Study of Ageing (ELSA). Participants answered a Sexual Relationships and Activities Questionnaire (SRA-Q), which included an open comment box for further details, 1,084 (1/7) of which were completed. These data were analyzed using Template Analysis, and findings on the experiences of sexual difficulties are presented in this article. Sexual difficulties were contextualized within the couple relationship and could be detrimental to the relationship, particularly if the partner would not seek professional help. Participants reported that sexual difficulties could also have a negative impact on psychological well-being, described mainly as frustration, depression, and sadness. For some participants the supportive nature of their relationship buffered these impacts. Few had sought professional help; those who had reported helpful and unhelpful experiences. These findings add to the limited evidence base and have implications for health care in the context of global aging and a growing recognition of older adults’ sexual rights.

Data Resource Profile: Cross-national and cross-study sociodemographic and health-related harmonized domains from SAGE plus ELSA, HRS and SHARE (SAGE+, Wave 1).

Four longitudinal studies were included in this rigorous harmonization process: the Study on global AGEing and adult health (SAGE); English Longitudinal Study on Ageing (ELSA); US Health and Retirement Study (HRS); and Survey of Health, Ageing and Retirement in Europe (SHARE). An ex-post harmonized process was applied to nine health-related thematic domains (socio-demographic and economic, health states, overall self-report of health and mental state, health examinations, physical and mental performance tests, risk factors, chronic conditions, social network and subjective well-being) for data from the 2004 wave of each study. Large samples of adults aged 50 years and older were available from each study: SAGE, n = 18 886; ELSA, n = 9181; HRS, n = 19 303; and SHARE, n = 29 917. The microdata, along with further details about the harmonization process and all metadata, are available through the World Health Organization (WHO) data archive at [http://apps.who.int/healthinfo/systems/surveydata/index.php/catalog]. Further information and enquiries can be made to [sagesurvey@who.int] or the corresponding author. The data resource will continue to be updated with data across additional waves of these surveys and new waves.

Social Inequality and Visual Impairment in Older People

Visual impairment is the leading cause of age-related disability, but the social patterning of loss of vision in older people has received little attention. This study's objective was to assess the association between social position and onset of visual impairment, to empirically evidence health inequalities in later life. Visual impairment was measured in 2 ways: self-reporting fair vision or worse (moderate) and self-reporting poor vision or blindness (severe). Correspondingly, 2 samples were drawn from the English Longitudinal Study on Ageing (ELSA). First, 7,483 respondents who had good vision or better at Wave 1; second, 8,487 respondents who had fair vision or better at Wave 1. Survival techniques were used. Cox proportional hazards models showed wealth and subjective social status (SSS) were significant risk factors associated with the onset of visual impairment. The risk of onset of moderate visual impairment was significantly higher for the lowest and second lowest wealth quintiles, whereas the risk of onset of severe visual impairment was significantly higher for the lowest, second, and even middle wealth quintiles, compared with the highest wealth quintile. Independently, lower SSS was associated with increased risk of onset of visual impairment (both measures), particularly so for those placing themselves on the lowest rungs of the social ladder. The high costs of visual impairment are disproportionately felt by the worst off elderly. Both low wealth and low SSS significantly increase the risk of onset of visual impairment.

Commentary:Would your health be better if you lived in England or in the USA?

Commentary:Would your health be better if you lived in England or in the USA?

Equal access, (Un)equal uptake: a longitudinal study of cataract surgery uptake in older people in England.

BackgroundUptake of cataract removal is a function of the effectiveness of the healthcare delivery services: services that are inaccessible, inappropriate, or unaffordable will not be utilised by (sub)populations, who consequently live with untreated cataracts. The aim of the study was to identify the relationship between individual wealth inequalities and uptake of cataract surgery in England, having controlled for the effects of potentially confounding variables.MethodsThe final sample comprised of 2091 respondents from the English Longitudinal Study on Ageing (ELSA) who were diagnosed with cataracts prior to or during the study, aged 50 and over at wave 1, who had not undergone cataract surgery prior to the first survey observation, and had also provided a response in the second wave of the study. The uptake of cataract surgery was measured using the question, have you ever had cataract surgery? Data from waves 1-5 were used to identify those having received treatment during the 8-year observation window of ELSA. Survival analysis techniques were used.ResultsHaving controlled for the effects of potentially confounding variables, wealth did not make a statistically significant contribution to the overall fit of the Cox proportional hazard model nor were individual parameters statistically significant. Thus, respondents’ socioeconomic position was not found to be a significant predictor in the uptake of cataract surgery in the UK. Receiving a recommendation from a medical professional was a key driving factors in the uptake of cataract surgery.ConclusionsStudy findings suggest that uptake of cataract surgery among over 50s with a cataracts diagnosis in England do not discriminate on the grounds of individuals’ material social position (wealth).

Adapting data collection methods in the Australian Life Histories and Health Survey: a retrospective life course study

ObjectiveIdeally, life course data are collected prospectively through an ongoing longitudinal study. We report adaptive multimethod fieldwork procedures that gathered life history data by mail survey and telephone interview, comparable...

European and global approaches to survey ageing populations and perspectives for joint approaches to measure age-related health outcomes

European and global approaches to survey ageing populations and perspectives for joint approaches to measure age-related health outcomes

Rekha interviews Baroness Sally Greengross

Baroness Sally Greengross Baroness Sally Greengross is an influential figure in nutritional and ageing policy through her involvement in parliamentary and advisory groups. She has been a crossbench (independent) member of the House of Lords since 2000 and chairs four All-Party Parliamentary Groups: Dementia, Corporate Social Responsibility, Intergenerational Futures and Continence Care. She is the Vice Chair of the All-Party Parliamentary Group on Ageing and Older People, and is Treasurer of the All-Party Parliamentary Group on Equalities. Sally is Chief Executive of the International Longevity Centre—UK, Co-President of the ILC Global Alliance and in December 2006, and she was announced as a Commissioner for the Equality and Human Rights Commission. Baroness Greengross is Chair of the Advisory Groups for the English Longitudinal Study on Ageing (ELSA) and the New Dynamics of Ageing (NDA). She is President of the Pensions Policy Institute and Honorary Vice President of the Royal Society for the Promotion of Health and a Global Ambassador to Help Age International. She holds honorary doctorates from seven UK universities and is an Honorary Fellow of the Institute and Faculty of Actuaries. In this interview, Baroness Sally Greengross describes how current research is shaping public policy and identifies the areas that we need to think about in practice.

The differential impact of subjective and objective aspects of social engagement on cardiovascular risk factors

BackgroundThis article provides new insights into the impact of social engagement on CVD risk factors in older adults. We hypothesized that objective (social participation, social ties and marital status) and subjective (emotional support) aspects of social engagement are independently associated with objective measures of cardiovascular risk.MethodsData from the English Longitudinal Study on Ageing (ELSA) were analyzed. The effects of social participation, social ties, marital status, and emotional support on hypertension, obesity, high sensitivity C-reactive protein, and fibrinogen were estimated by logistic regression controlling for age, sex, education, physical function, depression, cardiovascular disease, other chronic diseases, physical activity, and smoking.ResultsSocial participation is a consistent predictor of low risk for four risk factors, even after controlling for a wide range of covariates. Being married is associated with lower risk for hypertension. Social ties and emotional support are not significantly associated with any of the cardiovascular risk factors.ConclusionOur analysis suggests that participation in social activities has a stronger association with CV risk factors than marital status, social ties or emotional support. Different forms of social engagement may therefore have different implications for the biological risk factors involved.