Quality of life at older ages in ELSA

Quality of life at older ages in ELSA Gopalakrishnan Netuveli , David Blane, Zoe Hildon Imperial College London, Scott M Montgomery Karolinska Institutet, Stockholm; Örebro University Hospital, Sweden. Richard D Wiggins City University, London

Abstract

Objectives: To investigate whether long-standing illnesses, social context and

current socio-economic circumstances predict quality of life.

Design: Secondary analysis of wave 1 of the English Longitudinal Study of Ageing.

Missing data were imputed and multiple regression analyses conducted.

Setting: England, 2002

Participants: Nationally representative sample of Non-institutionalised adults living

in England (N= 11234, 54.5% females, age 65.1 ± 10.2 years).

Main outcome measure: Quality of life as measured by CASP-19, a 19 item Likert-

scaled index.

Results: The quality of life was reduced by poor perceived financial situation (β -

0.173), limiting long-standing illness (β -0.115), limitations in mobility (β -0.126),

difficulties with everyday activities (β -0.141) and depression (β -0.152). The quality

of life was enhanced by trusting relationships with family (β 0.118) and friends (β

0.087), frequent contacts with friends (β 0.087), living in good neighbourhoods (β

0.110) and having two cars (β 0.078). The regression models explained 44% variation

in CASP-19 scores. There were slight differences between age groups and between

men and women.

Conclusions: Efforts to improve quality of life in early old age need to address

financial hardships, functionally limiting disease, lack of at least one trusting

relationship and inability to move out of a disfavoured neighbourhood. There is the

potential for improved quality of life in early old age (the Third Age) if these factors

are controlled.

Imperial CollegeLondon

Quality of life at older ages in ELSA

Image source: Pat Thane, Old Age in English History: Past Experiences, Present Issues. Oxford: Oxford University Press, 2000

Gopalakrishnan NetuveliDavid BlaneZoe Hildon

Scott M MontgomeryRichard D Wiggins

LundSeptember 28, 2005


Lund, 28 September, 2005

Third agePercentage distribution of British population in the three stages

0% 20% 40% 60% 80% 100%

1850s

1900s

1950s

1990s

First ageSecond ageThird age

Data from Midwinter, 2005

maximise quality of life and postpone the onset of physical dependency



CASP-19

• Based on needs satisfaction theory• Independent from factors that

influence QoL• Increasing popularity: HRS, SHARE,

Whitehall II, HAPIEE, ELSA, BHPSPredictors of CASP-19 in Boyd-Orr cohort:

quality and the density of the social networks, recent loss, inadequate pension provision and living in a poor or deprived neighbourhood


Lund, 28 September, 2005 CASP-19 questionnaireControl, Autonomy, Self-realisation, Pleasure

1. My age prevents me from doing the things I would like to 2. I feel that what happens to me is out of my control 3. I feel free to plan for the future 4. I feel left out of things5. I can do the things that I want to do 6. Family responsibilities prevent me from doing what I want to do 7. I feel that I can please myself with what I do8. My health stops me from doing things I want to do 9. Shortage of money stops me from doing things I want to do10. I look forward to each day 11. feel that my life has meaning 12. I enjoy the things that I do 13. I enjoy being in the company of others 14.On balance, I look back on my life with a sense of happiness15. I feel full of energy these days16. I choose to do things that I have never done before 17. I feel satisfied with the way my life has turned out 18. I feel that life is full of opportunities 19. I feel that the future looks good for me



Objective

To explore the predictors of CASP-19 in the English Longitudinal Study of Ageing (Wave 1)



ELSA Wave 1 Data

EnglishLongitudinal Study of Ageing

200212100

HSE 19985194

HSE 19992268

HSE 20014638

Age >49?11392

Direct respondent?

11234

Complete cases?

8120

Age <50708

Proxy158

Missing values3114

QOL,Neighbourhoo


Lund, 28 September, 2005Explanatory variables used

• Socio-demographic: age, sex• Socio-economic: education, income, car

ownership, perceived financial situation• Social relationships: living alone, caring

for someone, volunteering, retired, looking after home, unemployed, trusting relationships with family, with friends, frequency of contacts with family, with friends, close relationships, neighbourhood

• Health: longstanding illness, limitations due to illness, limitations to mobility, limitations with ADL/IADL, lack of support with limitations, depression



ResultsDistribution of CASP-19 in ELSA



CASP-19 scores in different socio-demographic groups

Variables Number CASP-19 scores (95%CI)

All 9300 42.5 (42.3 to 42.7)Age 50-64 5104 43.0 (42.8 to 43.3)

65-74 2602 42.9 (42.6 to 43.2)75+ 1594 40.0 (39.5 to 40.4)

Sex Female 4975 42.7 (42.5 to 42.9)Male 4325 42.2 (42 to 42.5)

Education Some 5695 43.7 (43.5 to 43.9)No qualification 3599 40.5 (40.2 to 40.8)



CASP-19 scores according to social class

44.4

43.2

40.8

39

40

41

42

43

44

45

Managerial Intermediate Routine

NS-SEC

CA

SP-1

9



CASP-19 scores according to income quintiles



Predictors of CASP-19

Variables Regression coefficients (95%CI)Socio-demographic variablesAge : age 0.679 (0.449 to 0.909)

age2 -0.005 (-0.007 to -0.003)Sex: male -1.047 (-1.405 to -0.689)Socio-economic variablesEducational qualification: none -0.482 (-0.813 to -0.151)Income distribution: top 40% 0.69 (0.359 to 1.021)Cars: one 0.838 (0.393 to 1.282)

two or more 1.477 (0.957 to 1.997)Perceived financial situation: poor -3.183 (-3.516 to -2.849)


Lund, 28 September, 2005Predictors of CASP-19 contd…

Variables Regression coefficients (95%CI)

Social relationshipsLiving alone: yes 0.335 (-0.011 to 0.682)NS

Caring for somebody: yes -1.282 (-1.784 to -0.78)Volunteer work: yes 0.787 (0.373 to 1.2)Retired: yes 0.377 (-0.089 to 0.843)NS

Looking after home: yes -0.729 (-1.338 to -0.121)Unemployed or unable to work: yes -1.225 (-1.953 to -0.498)Trusting relationships: children and family 0.122 (0.096 to 0.147)

friends 0.161 (0.116 to 0.207)Frequency of contacts: children and family -0.051 (-0.088 to -0.013)

friends 0.168 (0.106 to 0.23)Number of close relationships 0.077 (0.053 to 0.101)Neighbourhood characteristics 0.147 (0.122 to 0.171)



Predictors of CASP-19 contd…

Variables Regression coefficients (95%CI)

HealthLongstanding illness -0.579 (-0.933 to -0.225)Functional limitation due to illness

-2.126 (-2.584 to -1.669)

Mobility -0.442 (-0.558 to -0.327)ADL/IADL -0.755 (-0.917 to -0.592)Lack of help with limitations -0.779 (-1.106 to -0.452)Depression -2.631 (-2.936 to -2.326)Constant 13.139 (5.548 to 20.73)

R2 = 0.44


Lund, 28 September, 2005ELSA: Standardised beta coefficients,

mutually adjusted

-0.115

-0.267

-0.152

0.110

0.118

0.087

0.078

-0.173

CASP-19QOL

Functional limitations

due to illness

Poor. Perceived financial situation

Limitations in everyday

activities

Psychological depression

Neighbourhoodcharacteristics

Trustingrelationshipswith childrenand family

Trustingrelationshipswith friends

Ownership of 2 or moremotor cars



Age curve: point estimates of CASP-19 scores after controlling for everything else



Policy implicationsQuality of life at older ages could potentially be high and policies should be directed towards the development of this potential. Such policies would include those increasing confidence in their financial future in older people, those fostering trust in social networks and neighbourhoods, and those reducing the impact of functional limitations.Policies should also take cognisance of

increasing proportion of women in older age groups and the importance of their role in informal care has on their quality of life.



Thank you

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Quality of life at older ages in ELSA