Content

The purpose of the Household Demographics module is to keep up-to-date the information on demographics, family structure and relations.

Topics covered are:

• For all current household members: sex, date of birth/age, and relationships between them; also whether in paid employment;
• Household exits: identify people who had left the household, why they had done so (including death) and when;
• At each wave any new entrants are added to the household information (including date joined);
• Children Grid: collect details of children (including step, foster and adopted) that live outside the household (include names, sex, date of birth/ age and relationship of child to other household members);

This module is also used to identify which individuals are eligible for main ELSA interview, whether any interviews need to be done by proxy, and the appropriate member(s) to supply financial information

The Individual Demographics Module updates more detailed demographic information about each ELSA member. Information collected at previous waves (including HSE) is checked to see if still accurate and any changes recorded.

The details are:

• Age last birthday
• Sex
• Legal marital status
• Number of living grandchildren or great grandchildren (children covered in Household Demographics module)
• Number of living siblings
• Natural parents: if alive, current age; if dead, year of death, age at death and cause thereof; for all, the age left education
• Identifies who was the respondent's main carer during childhood and that person's main occupation when the respondent was aged 14 years. This historic information is only collected once from an ELSA member.

This section is also used to identify relationship of proxy informant to respondent, where applicable.

The Health module concerns the respondent's state of health, functional limitations, and certain behavioural aspects of their daily life that are likely to influence health. In Wave 2 the nurse visit covers the biomedical aspects of health. ELSA has a particularly strong contribution in cardiovascular disease and physical function performance.

The main subsections are:

• Subjective measures including self-reported general health, longstanding illness and limiting longstanding illness.
• Perceptions of presence of problems with eyesight, hearing or walking, awareness of any diagnosed eye disease and, if appropriate, reasons for difficulty in walking. In Wave 3 three questions about dental health were added (these will be asked alternate waves).
• Chronic diseases and psychiatric problems ever diagnosed by a doctor (as recalled by respondent). The first time a person takes part they are asked whether these conditions have ever been diagnosed and, if they have, they are asked their age when the diagnosis was first made. In subsequent waves, they are reminded of the diseases previously reported, given an opportunity to dispute this, and (where appropriate) asked if the condition continues. The continuing participants are then asked to report new diagnoses since the previous interview and to specify when they were told.
• For most of the diseases, there is a single question in each wave about receiving medication or other treatment but not details as to the exact medication or form of treatment. Ten forms of cardiovascular disease or its precursors are recorded: high blood pressure, high cholesterol (added Wave 2), angina, myocardial infarction, heart failure, irregular heart rhythm, heart murmur, diabetes, stroke and other heart disease. For some of these conditions related to cardiovascular disease (CVD) further details are collected of symptoms experienced recently. The other chronic physical illnesses covered are: chronic lung diseases; asthma, arthritis and osteoporosis, cancers and Parkinson's disease. In case the term cancer was not capturing all cases of leukaemia or lymphoma, a question was added in wave 3 asking about blood=related disorders and identifying whether these were leukaemia or lymphoma. The psychiatric conditions include depression, dementia and cognitive impairment.
• Falls, fractures sustained as a result of falls, and joint replacements.
• Symptoms pain, dizziness, respiratory symptoms, and urinary incontinence (see Self-completion and Psychosocial sections for data on symptoms of mental health). In wave 4 questions about sleep disturbance were added. Some of the symptoms questions are asked every 4 years instead of every 2 years.
• Disability and functioning including avoidance of activities, ability to do activities of daily living (ADL) and instrumental activities of daily living (IADLs), use of mobility aids. Receipt of formal and informal care in connection with these ADLs and IADLs.

Health behaviours encompass current tobacco and alcohol consumption, fruit and vegetable consumption, and self-report of level of physical activity. Wave 1 only covered frequency of drinking and perception of change in consumption since the Health Survey for England interview (which collected detailed consumption). In Wave 2 the emphasis changed to consumption in the previous week and questions were moved from the main questionnaire to the self-completion; data from Waves 2 and 3 give detailed consumption for the heaviest drinking day in the previous week; in Wave 4 questions are changed to ask for total consumption in the previous 7 days by type of alcohol. Fruit and vegetable consumption was introduced into the self-completion section in Wave 3.

The self-reported mobility questions are complemented by a timed walking speed test for people aged 60 years and over at the time of the interview.

In Wave 2 the health section included questions about quality of care, based on indicators developed in the USA for assessing the care of vulnerable elders (ACOVE). Questions on quality of care were applied to incident cases with respect to cataracts, high blood pressure, angina, heart attack, diabetes, stroke, high cholesterol, osteoarthritis and psychiatric problems. There were also questions for those who experienced falls or balance problems and for those who reported symptoms of the following types: hearing difficulty, joint pain combined with osteoarthritis, chest pain, incontinence, depression. Finally some questions were asked about advice and help given to stop smoking. In Waves 3 and 4, the quality of care questions are restricted to a few high priority conditions.

In Wave 2 and Wave 4, the core members of ELSA were offered a nurse visit to obtain objective biological information and measures of physical functioning.

Measures previously assessed at HSE contact for 1998 and 2001 and repeated in Wave 2 are: blood pressure, lung function, anthropometric measures (height, weight, waist, hip), haemoglobin and ferritin, inflammatory markers of C-reactive protein and fibrinogen, lipids, fasting lipids, fasting glucose, and glycated haemoglobin.

Physical functioning is assessed using balance tests, timed chair stands, and grip strength. There are two separately funded components. The first involves measures of stress in the form of cortisol from saliva samples taken over one day and accompanied by a diary. The second involved extraction of DNA for a genetic repository. In Wave 2, all members taking part in the nurse visit were asked for these extra measures; in wave 4, newly recruited members are asked plus a subsample of ongoing members.

Written consent is sought for taking a blood sample, for the extraction of DNA, and for reporting back selected results to GPs.

Levels of social integration and exclusion are covered in a number of questions spread over the Social Participation, Effort and Reward, and Self-completion modules. Participation in education and voluntary activities is also briefly covered in the Work and Pensions module.

In Wave 1 the Social Participation module covered caring responsibilities, various social and cultural activities, and membership of organizations. Respondents are asked whether they would like to participate in activities more often. It also covered transport options available as this may be a barrier to participation. Questions on access to key facilities were in the self-completion questionnaire.

Since Wave 2 the Social Participation module has been mainly confined to transport questions. In Wave 3 the transport section was expanded to consider some forms of transport other than own car and public transport.

In Wave 2 the questions on caring (other than in a professional capacity) and on voluntary work were enhanced by asking about motivations for caring and voluntary work. These questions were placed in the newly-created Effort and Reward module because people were also asked whether they felt they were being appreciated for their efforts in caring or voluntary work and were satisified with the gain therefrom. These were added to enable testing of the hypothesis that an imbalance between effort and reward leads to stress and hence to ill health. In Wave 4 the Effort and Reward section has been expanded yet further to ask people to specify the forms of voluntary work that they do and also, for those whose caring absorbs more than 20 hours a week, to ask about use of respite care.

Since Wave 2 questions on other social and cultural activities and on organizational membership have been in the self-completion module. Also see the self-completion module for information on social networks.

The Work and Pensions module collects from each member of the ELSA sample employment details, job characteristics, earnings, occupational pension contributions or receipts, and retirement decisions. It includes information about job search, training and voluntary activities if relevant. One use of the job details is to assign National Statistics Socioeconomic Classification to individuals. The information on pensions is detailed in order to collect sufficient information to establish individual pension contributions and pension rights for those not currently drawing pensions and to determine how these will change with employment or retirement decisions. For those wishing to study pension rights in detail, separate data sets at pension-scheme level have been produced. Medical insurance provision is also covered.

In addition to those areas covered in wave 1, the Work and Pensions module from wave 2 onwards also covers:

• Why sample members left/started work or changed job and the ways in which their jobs have/could be changed to make it easier for them to continue working - this includes facilities for those who report that a health problem or disability limits the range of paid work that they can do;
• Expectations of future income from state pensions and from private pensions.

In wave 3 there were questions on the receipt of pension forecast statements and, from wave 3 onwards, women under 60 were asked about their awareness of changes to the state pension.

In the Income and Assets module, those identified as providers of financial information, are asked about their individual and joint income, assets and debts. Summary information on the income and assets of other household members is collected where appropriate. This section of the interview is modelled fairly closely on the Health and Retirement Survey, with the use of unfolding brackets to minimise non-response.

Topics covered are:

• Sources of income: state pension, private pension, annuity income, health and disability benefits, non means-tested benefits, intra-family transfers, income from savings or assets whether in the form of interest or dividends, rent. Salary and some aspects of occupational pension are covered in the Work and Pensions section.
• Assets including value of money accounts, stocks and shares, TESSAs, ISAs, Premium Bonds, life insurance, value of real assets such as property*, inheritance, or works of art.
• Information on debts from credit cards, purchase order agreements, formal and informal loans. These are offset against assets.
• Organisation of family finances.

* Value of main home is collected in the housing module.

In the Housing module the financial respondent is asked to provide details of current tenure of main home, housing type and quality, house value and mortgage liabilities.

Topics covered are:

• Financial commitments: identifying the person that rents/buys accommodation, details of rent payments, mortgage arrangements and any loans or other financial measures taken to pay for the accommodation.
• Housing type and quality such as whether facilities and services included in rent, number of rooms, adjustments done to the accommodation/ special features.
• Ownership of durables such as telephone, deep freeze or computer and on access to private vehicles. From Wave 2 onwards, respondents are also asked about purchase of durables.
• Expenditure on food. From wave 2 onwards, the consumption questions were extended to cover clothes and fuel expenditure. In addition, in waves 2 and 4, respondents were asked about spending on transfers to charity. Details of gifts - especially the nature of intended recipients - were added in wave 4.
• Subjective perceptions of housing such as difficulties with paying the rent or mortgage, and problems with the housing such as noise, dirt or decay.

The cognitive functioning module covers memory, language and executive function. Dimensions of cognitive function included in all waves were: meta-memory; orientation in time; prospective memory; word list learning; verbal fluency; and visual search. In wave 1 basic arithmetic ability was assessed and in wave 2 literacy was assessed. Arithmetic ability is being retested in Wave 4.

The Psychosocial Health module covers psychological health and perceptions of old age. There are other items of psychosocial risk factors in the self-completion part of the questionnaire. A core part of this module measures depression using the CES-D scale. In Wave 2 this was supplemented by some quality of care questions. In Waves 1 and 3 there were also questions on the respondents' perceptions of the ages at which old age starts and middle age finishes. In wave 4 some questions on perceptions of age one feels and would like to be were moved into this section from the self completion section.

An Expectations module is included to see whether perceptions of what the future holds foreshadow the reality - and to compare sub-groups to see if such attitudes might be on the pathway to health and income differences between them.

Questions cover:

• expectations of living beyond a specified age;
• working beyond a specified age;
• being limited in work by health;
• financial situation;
• receipt of inheritance;
• leaving bequest;
• change in value of home;
• moving out of current home (wave 2 only);
• moving into a nursing home (wave 2 only).

The respondent's financial planning horizon was also measured in waves 1 and 2.

The main self-completion questionnaire contains instruments that are standardly collected in this way to safeguard privacy or because they are straightforward to collect. Core items are the CASP quality of life questionnaire, views of relationships with family and friends, and perceived social status. The self-completion form was expanded in wave 2 to include items previously administered by interviewer (mainly participation in activities). Instruments to measure demand - control balance, effort and reward and the Diener Life Satisifaction Scale have been included from wave 2 onwards. Items that will appear in some waves but not others are the GHQ12, accessibility of key facilities, and questions about the neighbourhood that provide a measure of social capital, and questions about perceptions of positive and negative aspects of ageing. In Wave 4 there are new questions on altruism, sense of community, and television watching (for sedentary activity and cultural interest).

Details of the previous week's alcohol consumption are also requested although the details have changed over waves. In Wave 3 questions on fruit and vegetable consumption were added.

Supplementary self-completion questionnaires can be added for subsamples of participants at specific waves. For example, in Wave 2, a small subsample received the Ryff questionnaire on well-being. In Wave 3 subsamples were asked to complete questionnaires with vignettes; these give an 'external' assessment of thresholds people apply when assessing health and work disability. This information is then used to see whether differences in self-reports between groups are partly the consequence of differences in thresholds.

Miscellaneous information that does not easily fit elsewhere is collected in the Final Questions Module. Classificatory information on ethnic group, country of birth, education is collected. Importantly this section seeks consent from respondents to collect a range of further information from them and about them. Also to facilitate future contact, respondents are asked to name a third party who can act as contact should the respondent move and also to nominate someone who could be their proxy, should they become unable to answer for themselves.