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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
Imperial CollegeLondon
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
Imperial CollegeLondon
Lund, 28 September, 2005
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
Imperial CollegeLondon
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
Imperial CollegeLondon
Lund, 28 September, 2005
Objective
To explore the predictors of CASP-19 in the English Longitudinal Study of Ageing (Wave 1)
Imperial CollegeLondon
Lund, 28 September, 2005
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
Imperial CollegeLondon
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
Imperial CollegeLondon
Lund, 28 September, 2005
ResultsDistribution of CASP-19 in ELSA
Imperial CollegeLondon
Lund, 28 September, 2005
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)
Imperial CollegeLondon
Lund, 28 September, 2005
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
Imperial CollegeLondon
Lund, 28 September, 2005
CASP-19 scores according to income quintiles
Imperial CollegeLondon
Lund, 28 September, 2005
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)
Imperial CollegeLondon
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)
Imperial CollegeLondon
Lund, 28 September, 2005
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
Imperial CollegeLondon
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
Imperial CollegeLondon
Lund, 28 September, 2005
Age curve: point estimates of CASP-19 scores after controlling for everything else
Imperial CollegeLondon
Lund, 28 September, 2005
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.
Imperial CollegeLondon
Lund, 28 September, 2005
Thank you
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