Disability

BACKGROUND: Frail older adults are heavy users of health and social care. In order to reduce the costs associated with frailty in older age groups, safe and cost-effective strategies are required that will reduce the incidence and severity of frailty.

Personality and risk of frailty: the English Longitudinal Study of Ageing

Physical inactivity in relation to self-rated eyesight: cross-sectional analysis from the English Longitudinal Study of Ageing.

he consequences of self-reported vision change in later-life: evidence from the English Longitudinal Study of Ageing

This report explores the relationship between disability and poverty among the older population. It emphasises the additional living costs that disabled people face, and the importance of taking disability costs into account when making poverty assessments in the older population. The report considers alternative directions of reform for the system of public support for older people with disabilities, and casts doubt on some of the suggestions that have been made for improving the targeting of public support for older disabled people.

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.

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.

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.

BACKGROUND: Frailty is a state of increased vulnerability to poor resolution of homeostasis after a stressor event, which increases the risk of adverse outcomes including falls, disability and death. The underlying pathophysiological pathways of frailty are not known but the hypothalamic-pituitary-adrenal axis and heightened chronic systemic inflammation appear to be major contributors.

Abstract We examined the association between lifecourse socioeconomic status (SES) and the risk of type 2 diabetes at older ages, ascertaining the extent to which adult lifestyle factors and systemic inflammation explain this relationship. Data were drawn from the English Longitudinal Study of Ageing (ELSA) which, established in 2002, is a representative cohort study of ≥50-year olds individuals living in England. SES indicators were paternal social class, participants' education, participants' wealth, and a lifecourse socioeconomic index. Inflammatory markers (C-reactive protein and fibrinogen) and lifestyle factors were measured repeatedly; diabetes incidence (new cases) was monitored over 7.5 years of follow-up. Of the 6218 individuals free from diabetes at baseline (44% women, mean aged 66 years), 423 developed diabetes during follow-up. Relative to the most advantaged people, those in the lowest lifecourse SES group experienced more than double the risk of diabetes (hazard ratio 2.59; 95% Confidence Interval (CI) = 1.81-3.71). Lifestyle factors explained 52% (95%CI:30-85) and inflammatory markers 22% (95%CI:13-37) of this gradient. Similar results were apparent with the separate SES indicators. In a general population sample, socioeconomic inequalities in the risk of type 2 diabetes extend to older ages and appear to partially originate from socioeconomic variations in modifiable factors which include lifestyle and inflammation.

BACKGROUND: Previous research suggests that greater well-being may protect against onset of chronic disease. However, it is unclear whether this association is similar across different types of disease. METHOD: We used Cox proportional hazards regression to examine the prospective relationship between well-being (measured using the CASP-19 quality of life questionnaire) and incidence of arthritis, cancer, stroke, diabetes, myocardial infarction, and chronic lung disease over 8 years. The sample consisted of 8182 participants 50 years or older from the English Longitudinal Study of Ageing. RESULTS: After adjustments for established risk factors, a standard deviation increase in CASP-19 score was associated with a decrease in arthritis risk (hazard ratio [HR] = 0.89, 95% confidence interval [CI] = 0.83-0.96) and, in those younger than 65 years, a decrease in diabetes risk (HR = 0.82, 95% CI = 0.70-0.95) and chronic lung disease risk (HR = 0.80, 95% CI = 0.66-0.97). Higher CASP-19 scores were associated with reduced risk for stroke and myocardial infarction; however, these associations were no longer significant after adjustments for established risk factors. No association was observed for cancer incidence. An age interaction was observed for diabetes, myocardial infarction, and chronic lung disease, with a stronger association between CASP-19 score and disease incidence at younger ages. CONCLUSIONS: The extent of association between well-being and incident disease risk is not consistent across different chronic diseases. Future studies should examine the cause of this variation.

The UK has enacted a number of reforms to the structure of disability benefits, including the introduction of Incapacity Benefit in 1995 and the replacement of Incapacity Benefit with Employment and Support Allowance from 2008. The authors bring together administrative and survey data over the period and highlight key differences in receipt of disability benefits by age, sex and health.

This report summary is drawn from IFS research that was carried out as part of a programme of work examining the outlook for poverty and living standards in older age.

The UK has enacted a number of reforms to the structure of disability benefits, including the introduction of Incapacity Benefit in 1995 and the replacement of Incapacity Benefit with Employment and Support Allowance from 2008. The authors bring together administrative and survey data over the period and highlight key differences in receipt of disability benefits by age, sex and health.

In this report, we distinguish between factors affecting mainly the demand for older workers and those affecting mainly the supply of older workers. However, in practice, it is very difficult to disentangle the effects of the two.

In this briefing note we use data from the Labour Force Survey (LFS) and the English Longitudinal Study of Ageing (ELSA) to describe patterns of employment and self-employment among people aged between 50 and 74 in England in 2012–13.