Ageing

OBJECTIVE: To test whether the number of reports of enjoyment of life over a four year period is quantitatively associated with all cause mortality, and with death from cardiovascular disease and from other causes. DESIGN AND SETTING: Longitudinal observational population study using the English Longitudinal Study of Ageing (ELSA), a nationally representative sample of older men and women living in England. PARTICIPANTS: 9365 men and women aged 50 years or older (mean 63, standard deviation 9.3) at recruitment. MAIN OUTCOME MEASURES: Time to death, based on mortality between the third phase of data collection (wave 3 in 2006) and March 2013 (up to seven years). RESULTS: Subjective wellbeing with measures of enjoyment of life were assessed in 2002 (wave 1), 2004 (wave 2), and 2006 (wave 3). 2264 (24%) respondents reported no enjoyment of life on any assessment, with 1833 (20%) reporting high enjoyment on one report of high enjoyment of life, 2063 (22%) on two reports, and 3205 (34%) on all three occasions. 1310 deaths were recorded during follow-up. Mortality was inversely associated with the number of occasions on which participants reported high enjoyment of life. Compared with the no high enjoyment group, the hazard ratio for all cause mortality was 0.83 (95% confidence interval 0.70 to 0.99) for two reports of enjoyment of life, and 0.76 (0.64 to 0.89) for three reports, after adjustment for demographic factors, baseline health, mobility impairment, and depressive symptoms. The same association was observed after deaths occurring within two years of the third enjoyment measure were excluded (0.90 (0.85 to 0.95) for every additional report of enjoyment), and in the complete case analysis (0.90 (0.83 to 0.96)). CONCLUSIONS: This is an observational study, so causal conclusions cannot be drawn. Nonetheless, the results add a new dimension to understanding the significance of subjective wellbeing for health outcomes by documenting the importance of sustained wellbeing over time.

In China, the employment rate among middle-aged and older urban residents is exceptionally low. This paper investigates potential explanations of this low level of employment in urban China.

Relationship between employment histories and frailty trajectories in later life: evidence from the English Longitudinal Study of Ageing

Wealth and Disability in Later Life: The English Longitudinal Study of Ageing (ELSA)

This paper examines health status differences between England and the United States, with an emphasis on the implications of any health disparities for health care cost differences between the two countries.

We use data from the Medicare Current Beneficiary Survey (MCBS) to document the medical spending of Americans aged 65 and older.

In 2012/2013 the English Longitudinal Study of Ageing (ELSA) included a comprehensive Sexual Relationships and Activities Questionnaire (SRA-Q). A total of 7,079 men and women mainly aged 50 to >90, primarily heterosexual and in a coupled relationship, completed the SRA-Q, answering a series of questions about their attitudes to sexual relationships, their own sexual activities, problems and concerns with sexual functioning, and quality of intimate relationships. The questions aimed to gain insights into the ways in which sexual relations and activities related to health, wellbeing and other lifestyle factors change as people grow older. The primary mode of data collection was a tick box response to a series of questions. However, at the end of the questionnaire an open comment box was provided, which asked respondents whether there was anything else that they would like to say; 1,084 respondents provided additional information and these comments created a unique qualitative data-set. The analysis of the data then illustrated how people's health, relationships, experiences and perceptions of ageing, along with sexual satisfaction, impact on sexual relationships and activities.

The old age provisions of the Medicaid program were designed to insure retirees against medical expenses. We estimate a structural model of savings and medical spending and use it to compute the distribution of lifetime Medicaid transfers and Medicaid valuations across currently single retirees.

BACKGROUND: The main aim of this study was to quantify and compare 6-year mortality risk attributable to smoking, hypertension and diabetes among English and Brazilian older adults. This study represents a rare opportunity to approach the subject in two different social and economic contexts.

Health Literacy and Moderate to Vigorous Physical Activity During Aging, 2004-2013.

Abstract OBJECTIVE: To provide an example of a new methodology for using multiple characteristics in the study of population aging and to assess its usefulness. METHOD: Using the English Longitudinal Study of Aging (ELSA), we investigate three characteristics of each person 60 to 85 years old, by level of education, hand-grip strength in 2004 (measured in kilos), chair rise speed in 2004 (measured in rises per minute), and whether the person survived from 2004 to 2012. Because the three characteristics are measured in different units, we convert them into a common metric, called alpha-ages. RESULTS: We find that the average of the alpha-age differentials in the measures of upper body and lower body strength predicts educational differentials in subsequent survival better than either physical measure alone. DISCUSSION: This result demonstrates the benefit of combining characteristics, using alpha-ages to convert incommensurate observations into a common metric.

Research to date suggests that physical activity (PA) is associated with distinct aspects of sleep, but studies have predominantly focused on sleep quality, been carried out in younger adults, and have not accounted for many covariates. Of particular interest is also the reported relationship between physical activity and depression in older adults and as such, their associations with sleep duration. Here we examine the cross-sectional relation between physical activity and sleep duration in a community-dwelling sample of 5265 older adults from the English Longitudinal Study of Ageing. We analysed the data using multiple regression, with physical activity as a categorical exposure and sleep duration a continuous outcome, as well as testing the interaction between physical activity and depressive symptoms, which was significant (p < 0.001). We therefore stratified our analyses by depressive symptomatology. Our main finding was that, in the group with elevated depressive symptoms only, physical activity was positively associated with sleep duration in models adjusted for all covariates (age, sex, wealth, ethnicity, smoking, alcohol consumption, BMI, long-standing illness) across low [B (mean difference in sleep duration) = 25.22 min, 95% CI = (3.72; 46.72)], moderate [B = 27.92 min, 95% CI = (6.59; 49.26)] and high [B = 31.65 min, 95% CI = (7.36; 55.94)] PA groups, in comparison to the sedentary group. However, we observed no relation between physical activity and sleep duration in respondents who reported no depressive symptoms, irrespective of physical activity level (p > 0.05). Our findings suggest that a potentially effective way of improving sleep in older adults with depressive symptoms is via physical activity interventions.

Hearing loss is a major cause of disability: in people over 70 years of age in the UK around two-thirds report some form of hearing loss. The social and health consequences of hearing impairment are as considerable as the economic implications for care. There is strong evidence that several age-related chronic conditions, particularly cardiovascular disease (CVD), have their origins in early life and a shared aetiology between hearing impairment and CVD has been advanced in adults. Physical stature (height) captures exposure to early life psychosocial stress, adversity, somatic illness, and nutrition, and reveals an inverse relationship with CVD but studies on hearing impairment are very scarce. We related measured height (mean measure at wave 4 [2008] and 6 [2012]) to performance on an objective hearing examination at wave 7 (2014). In an analytical sample of 4,398 there were 1,682 cases (38%) of hearing impairment. We found evidence of an inverse relationship between height and later hearing impairment, such that taller study members experienced a lower risk. The odds ratio (95% confidence interval) for the increase of 5cm in height in a fully adjusted model was 0.92 (0.87, 0.98). While low height per se is of course not a risk factor for hearing impairment, it is more likely that one or more of the characteristics that it proxies – early life diet, illness, social adversity, cognition – has a role. Future research should therefore attempt to relate these individual, prospectively gathered indicators in childhood populations to hearing impairment in later life.

Depressive disorders are a leading cause of disability in older age. Although the role of psychosocial and behavioural predictors has been well examined, little is known about the biological origins of depression. Findings from animal studies have implicated insulin-like growth factor 1 (IGF-1) in the aetiology of this disorder. A total of 6017 older adults (mean age of 65.7 years; 55% women) from the English Longitudinal Study of Ageing provided serum levels of IGF-1 (mean=15.9 nmol l(-1), s.d. 5.7) during a nurse visit in 2008. Depression symptoms were assessed in the same year and again in 2012 using the eight-item Center for Epidemiologic Studies Depression Scale. Self-reports of a physician-diagnosis of depression were also collected at both time points. In separate analyses for men and women, the results from both the cross-sectional and longitudinal analyses revealed a 'U'-shaped pattern of association, such that lower and higher levels of IGF-1 were associated with a slightly elevated risk of depression, whereas the lowest risk was seen around the median levels. Thus, in men, with the lowest quintile of IGF-1 as the referent, the age-adjusted odds ratios (95% confidence interval) of developing depression symptoms after 4 years of follow-up, for increasing quintiles of IGF-1, were: 0.51 (0.28-0.91), 0.50 (0.27-0.92), 0.63 (0.35-1.15) and 0.63 (0.35-1.13) (P-value for quadratic association 0.002). Some attenuation of these effects was apparent after adjustment for co-morbidity, socioeconomic status and health behaviours. In conclusion, in the present study of older adults, there was some evidence that moderate levels of IGF-1 levels conferred a reduced risk of depression.

•Longitudinal associations of body mass, inflammation, and cognition are explored. •Body mass predicted change in systemic inflammation levels (CRP) over 4 years. •C-reactive protein predicted participants’ rates of cognitive decline over 6 years. •Inflammation statistically mediated the association of body mass and cognition among aging adults. •The results support inflammatory models of neurodegeneration among aging adults.

In this paper we document significantly steeper declines in nondurable expenditures in the UK compared to the US, in spite of income paths being similar. We explore several possible causes, including different employment paths, housing ownership and expenses, levels and paths of health status, number of household members, and out-of -pocket medical expenditures. Among all the potential explanations considered, we find that those to do with healthcare—differences in levels and age paths in medical expenses—can fully account for the steeper declines in nondurable consumption in the UK compared to the US.

Abstract BACKGROUND AND OBJECTIVE: The fall risk assessment tool (FRAT-up) is a tool for predicting falls in community-dwelling older people based on a meta-analysis of fall risk factors. Based on the fall risk factor profile, this tool calculates the individual risk of falling over the next year. The objective of this study is to evaluate the performance of FRAT-up in predicting future falls in multiple cohorts. METHODS: Information about fall risk factors in 4 European cohorts of older people [Activity and Function in the Elderly (ActiFE), Germany; English Longitudinal Study of Aging (ELSA), England; Invecchiare nel Chianti (InCHIANTI), Italy; Irish Longitudinal Study on Aging (TILDA), Ireland] was used to calculate the FRAT-up risk score in individual participants. Information about falls that occurred after the assessment of the risk factors was collected from subsequent longitudinal follow-ups. We compared the performance of FRAT-up against those of other prediction models specifically fitted in each cohort by calculation of the area under the receiver operating characteristic curve (AUC). RESULTS: The AUC attained by FRAT-up is 0.562 [95% confidence interval (CI) 0.530-0.594] for ActiFE, 0.699 (95% CI 0.680-0.718) for ELSA, 0.636 (95% CI 0.594-0.681) for InCHIANTI, and 0.685 (95% CI 0.660-0.709) for TILDA. Mean FRAT-up AUC as estimated from meta-analysis is 0.646 (95% CI 0.584-0.708), with substantial heterogeneity between studies. In each cohort, FRAT-up discriminant ability is surpassed, at most, by the cohort-specific risk model fitted on that same cohort. CONCLUSIONS: We conclude that FRAT-up is a valid approach to estimate risk of falls in populations of community-dwelling older people. However, further studies should be performed to better understand the reasons for the observed heterogeneity across studies and to refine a tool that performs homogeneously with higher accuracy measures across different populations.

Our findings suggest the C-reactive protein-depression association is symptom-specific and modified by antidepressant treatment.

BACKGROUND: Parenting style is associated with offspring health, but whether it is associated with offspring mortality at older ages remains unknown.