The English Longitudinal Study of Ageing (ELSA) including some information

1. The English Longitudinal Study of Ageing (ELSA) including some information on the Whitehall Studies

2. The Presenter • Professor Anthea Tinker, member of the Advisory Committee of ELSA since it started • Participant in 3 longitudinal studies including the Whitehall II study • PI for research on the Retention of Participants in Longitudinal Studies

3. The ELSA team • The research is a collaborative one between Epidemiology, University College London, the Institute for Fiscal Studies and the National Centre for Social Research (NatCen) with additional contributions from the University of Manchester. • Presentation on behalf of the team: PIs Professor Sir Michael Marmot, Professor James Banks, Professor James Nazroo and with particular thanks to Professor Andrew Steptoe and Dr PanosDemakakos

4. 1. ELSA Funders • National Institute on Aging (USA) • UK Government departments (co-ordinated by the Office for National Statistics) - Department of Health - Department for Work and Pensions - Department for Transport - Department for Environment, Food and Rural Affairs - Department for Communities and Local Government - Her Majesty’s Inland Revenue and Customs

5. 2. The objectives 1. To collect longitudinal data on health, disability, economic circumstances, social participation and networks, and well-being from a representative sample of the English population aged 50 and over

6. 2. The objectives (ctd) 2. To explore the dynamic relationships between health and functioning, social participation and economic position and well-being as people plan for, and move into, retirement

7. 3. The sample – successive waves

8. Original sample interviewed in HSE 1998/1999/2001 (Age 50+ on 1 Mar 2002) Wave 1 12,099 2002/3 Nurse visit 7,666 Wave 2 9,432 2004/5 New cohort sample HSE 2001/02/03/04 (Age 50-52 on 1 Mar 2006) Life-history 7,855 Wave 3 9,771 2006/7 Refreshment sample from HSE 2006 (Age 50-74 on 1 Mar 2008) Wave 4 11,050 2008/9 Nurse visit 8,643 Risk module 1,063 Wave 5 10,326 (approx) 2010/11

9. 4. Data collection Interviewer visit: • CAPI (computer assisted personal interview) • Self completion • Measurements – e.g. timed walk Nurse visit (waves 2 and 4) • Measurements (e.g. blood pressure) • Measures of functioning (e.g. grip strength, balance) • Blood sample (e.g. testing for blood sugar)

10. 4. Data collection (also used) • NHS Central Registry (mortality) • National Insurance contributions • Benefits including state pensions and tax credits • Tax records, savings, private pensions

11. 5. Measures used • Demographic data and household composition • Employment • Income, wealth and pensions • Physical health (symptoms and diagnosed disease) • Mental health (depression, anxiety, diagnosed disease) • Physical function (objective and self report) • DNA (through the ELSA DNA repository)

12. 5. Measures used (ctd) • Cognitive function (objective and self reported) • Social engagement (social participation, volunteering, caring) • Social support, social capital, loneliness • Cultural engagement • Expectations • Quality of life/well-being • End of life interview with a relative, friend or carer of the deceased respondent

13. 5. Measures used – additional measures at some waves • Life history interviews • Vignettes on general health and work disability • Salivary cortisol • Perceptions of ageing • Religion • Experience of discrimination

14. 5. Measures used – additional measures at even waves Nurse assessment: • Anthropometric measures • Grip strength, balance, chair rise • Lung function • Blood pressure • Blood measures (lipids, haemoglobin, ferritin, blood sugar, glycated haemoglobin,(HbA1c), fibrinogen, C- reactive protein)

15. 6. Major findings on health • Note that the inclusion of biomarkers has added to the understanding of the biology of ageing and a clear social gradient can be seen. Those in the less wealthy quartiles had lower HDL cholesterol (this is associated with increased risk of coronary heart disease), low IGF-1 and low DHEAS. High levels of the latter are associated with improved health and well-being and better cognitive function

16. 6. Major findings on health (ctd) Over successive waves: • Increases in weight and waist indicating obesity • Increases in sedentary behaviour

17. Wealth and impaired activities of daily living

18. 6. Major findings on health (ctd) • Clear social gradients in health with less wealthy participants having higher levels of limitations in ADL/IADL, higher rates of elevated depressive symptoms, more hypertension and diabetes, lower levels of physical activity, and poorer diet (measured using consumption of fruit and vegetables). However the proportion of more wealthy participants drank more than the recommended limits of alcohol.

19. Wealth and depression

20. 6. Major findings on health (ctd): Sleep • Sleep deprivation and problems with sleep have considerable economic ramifications. Disturbed sleep is also linked to several health conditions and poorer quality of life. Information on sleep was collected in ELSA for the first time in Wave 4 • Women had worse sleep patterns • The more wealthy reported better sleep patterns than those less wealthy

21. 6. Major findings on health (ctd): well-being • In ELSA measured by depression, life satisfaction, quality of life and loneliness. • Depressive symptoms and loneliness rose with age • Women aged 75+ and older had particularly poor well-being with high rates of depression, low life satisfaction, poor quality of life and high ratings of loneliness • Those who were limited in their activities had poorer well-being on all 4 indicators irrespective of age

22. 6. Major findings on health (ctd): well-being - Wealth is associated with all aspects of well-being - Levels of well-being were positively associated with the number of close personal relationships

23. 7. Conclusion • A well funded study which has produced significant findings in its own right and given other researchers access to the data

24. In the public domain • Wave 1 2002-3; report Marmot et al 2003 • Wave 2 2004-5; report Banks et al 2006 • Wave 3 2006-7; report Banks et al 2008 • Wave 4 2008-9; report Banks et al 2010 • www.ifs.org.uk/elsa • http://www.esds.ac.uk/longitudinal/access/elsa/l5050.asp

25. 8. Whitehall I and Whitehall II (with thanks to Professor Michael Marmot and Professor Mika Kivimaki) • Whitehall I 1967 study of 18,000 male civil servants aged 20 - 64 • Whitehall II 1985 – continuing. Study of 10,308 civil servants aged 35 – 55 in London (one third were women). Original aim to investigate social and occupational influences on health and illness but has become a study of healthy ageing

26. Whitehall II – key findings • Steep gradient in health outcomes – the less control and status the more likely to have poor health and die early • Those in the lowest employment grades most likely to have many of the risk factors for coronary heart disease. • Social gradient in health (Professor Marmot subsequently chaired the WHO Commission on Social Determinants of Health) • Ageing is not characterised by universal decline

27. ELSA and Whitehall II • Similar sizes (ELSA 12,000 and numbers refreshed) Whitehall II 10,308) • ELSA from the Health Survey for England which was representative and Whitehall II only from civil servants • Both used medical screening, blood samples, measures of mental health, physical and cognitive functioning. Whitehall II also used validated disease

28. 9. The future: funding • Lack of research funds generally in the UK and specially for expensive studies such as longitudinal studies

29. 9. The future – problems of attrition In ELSA • A decline in response rates: • Wave 2 (eligible in W2 and respondent in W1) = 82% • Wave 3 (eligible in W2 and W3 and respondent in W1) = 73% • Wave 4 (eligible in W2, W3 and W4 and respondent in W1) = 74%

30. 9. The future – problems of attrition In Whitehall II response rate of 73%. Research on those who had dropped out compared with those who had remained showed that they had a lower occupational social grade, were older, female, unmarried at baseline, engaged in fewer social activities, rented their home, were less educated

31. 8. The future – problems of attrition: ways to overcome this in ELSA • Telephone interview with refusers (from W3) • Proxy interviews with refusers from W3 • Increased incentive from £10 to £20 (W5) • ‘Expert’ ELSA interviewers • Finding out why people take part • Self completion before interview • Give respondents more info before interview and about the study • Improve tracing of movers • Changed how respondents are asked to update

32. 8. The future – problems of attrition: ways to overcome this in Whitehall II • Newsletters with FAQs • Reminders • Home visits • Pay travel • Response to suggestions about facilities and refreshments