Old, Sick and Alone ?Old, Sick and Alone ?Living arrangements, health and Living arrangements, health and well-being among older people in well-being among older people in

EnglandEngland

BSPS Annual ConferenceBSPS Annual ConferenceUniversity of St Andrews University of St Andrews

1212thth September 2007 September 2007

Harriet Young and Emily GrundyHarriet Young and Emily GrundyLondon School of Hygiene and Tropical MedicineLondon School of Hygiene and Tropical Medicine

Research to dateResearch to date

Those living with spouse are the most healthyThose living with spouse are the most healthy

Contradictory evidence for those not living Contradictory evidence for those not living with spouse: more healthy living with other with spouse: more healthy living with other relatives or living alone ? relatives or living alone ? • Lund (2000), Grundy (1989), Lund (2000), Grundy (1989), • Michael (2001), Gustavson (2004)Michael (2001), Gustavson (2004)

Selection effectsSelection effects

Effects may vary according to cultural, socio-Effects may vary according to cultural, socio-economic context and presence of social tieseconomic context and presence of social ties

Research ObjectivesResearch Objectives

1 & 2: Analyse associations between 1 & 2: Analyse associations between living arrangements and health and well-living arrangements and health and well-being among older people being among older people

Cross-sectionalCross-sectional LongitudinalLongitudinal

3: Examine whether having social ties 3: Examine whether having social ties influences the association between living influences the association between living arrangements and health and well-being. arrangements and health and well-being.

Dataset: English Longitudinal Study Dataset: English Longitudinal Study of Ageing (ELSA)of Ageing (ELSA)

Two waves of data in 2002 and 2004Two waves of data in 2002 and 2004

Cross-sectional dataset of population aged Cross-sectional dataset of population aged 60+ in Wave One – 7146 people60+ in Wave One – 7146 people

Longitudinal dataset of population aged Longitudinal dataset of population aged 60+ in Wave One and present at Wave 60+ in Wave One and present at Wave Two – 5443 peopleTwo – 5443 people

VariablesVariables

Outcome variablesOutcome variables Self-rated health Self-rated health Psychological morbidity – CES-D depression Psychological morbidity – CES-D depression

scalescale

Explanatory variableExplanatory variable Living arrangements: Living arrangements:

• spouse only, spouse only, • spouse and other,spouse and other,• Children or others only,Children or others only,• Alone Alone

Co-variatesCo-variates

• Gender Gender

• AgeAge

• SmokingSmoking

• Wealth Wealth

• Housing tenure, Housing tenure,

• Contact with relatives, contact with friends, Contact with relatives, contact with friends, membership of social organisations, membership of social organisations,

• Limitations of Activities of Daily Living, chronic Limitations of Activities of Daily Living, chronic health conditions health conditions

Cross sectional analysis Cross sectional analysis

Associations between living arrangements Associations between living arrangements and….and…. Self-rated health (binary variable: poor & fair Self-rated health (binary variable: poor & fair

cc excellent, very good & good health): cc excellent, very good & good health): logistic regressionlogistic regression

CES-Depression score (8 point scale: 0-2 CES-Depression score (8 point scale: 0-2 compared with 3+): compared with 3+): logistic regressionlogistic regression

This model controlled for gender, age, smoking, wealth, housing tenure, contact with This model controlled for gender, age, smoking, wealth, housing tenure, contact with relatives, contact with friends, membership of social organisationsrelatives, contact with friends, membership of social organisations

Odds ratio from logistic regression of living arrangements on self-rated health, compared to those living alone,

people aged 60+ , ELSA 2002

0.6

0.8

1

1.2

1.4

1.6

1.8

spouse only spouse and others others only

Living arrangement

Od

ds

ra

tio

This model controlled for gender, age, smoking, wealth, housing tenure, contact with This model controlled for gender, age, smoking, wealth, housing tenure, contact with relatives, contact with friends, membership of social organisations and self-rated relatives, contact with friends, membership of social organisations and self-rated health statushealth status

Odds ratio from logistic regression of living arrangements on CES-D depression score, compared to those living alone,

people aged 60+, ELSA 2002 *

0.2

0.4

0.6

0.8

1

1.2

spouse only spouse and others others only

living arrangements

Od

ds

ra

tio

Gender differences in these findingsGender differences in these findings

Other factors associated with self-rated Other factors associated with self-rated health and CES-D scorehealth and CES-D score

Longitudinal analysisLongitudinal analysis

Association of living arrangements in 2002 with Association of living arrangements in 2002 with change in health and well-being 2002-2004change in health and well-being 2002-2004 Self-rated health: deteriorated cc didn’t deteriorate, Self-rated health: deteriorated cc didn’t deteriorate,

Logistic regressionLogistic regression CES-D: well-well cc well-depressed CES-D: well-well cc well-depressed

well-depressed cc depressed-depressed, well-depressed cc depressed-depressed, logistic regressionlogistic regression

Drop those who changed living arrangement Drop those who changed living arrangement 2002 to 2004 (7.5%) 2002 to 2004 (7.5%)

Odds ratio from logistic regression of living arrangements on change in self-rated health status, compared to those living

alone, people aged 60+ , ELSA 2002 - 2004

0.6

0.8

1

1.2

1.4

1.6

1.8

spouse only spouse and others others only

Living arrangement

Od

ds

ra

tio

This model controlled for gender, age, smoking, wealth, housing tenure, contact with This model controlled for gender, age, smoking, wealth, housing tenure, contact with relatives, contact with friends, membership of social organisations, ADL limitations in relatives, contact with friends, membership of social organisations, ADL limitations in 2002, and presence of health conditions in 20022002, and presence of health conditions in 2002

Cross-tabulation of living arrangements and change in Cross-tabulation of living arrangements and change in depression score 2002-2004, people aged 60+. depression score 2002-2004, people aged 60+.

ELSA 2002-2004ELSA 2002-2004

Percent (%)Percent (%)

Well 2002Well 2002

Well 2004Well 2004

Well 2002Well 2002

Depr 2004Depr 2004

Depr 2002Depr 2002

Well 2004Well 2004

Depr 2002Depr 2002

Depr 2004Depr 2004

TotalTotal

Spouse onlySpouse only 7373 99 88 99 100100

Spouse plus Spouse plus othersothers

6969 1111 1010 1010 100100

Living alone Living alone 5353 1313 1313 2121 100100

With non-With non-spouse othersspouse others

5757 1212 1414 1717 100100

TOTALTOTAL 6767

(3158)(3158)

1010

(502)(502)

1010

(502)(502)

1313

(621)(621)

100100

Adjusted odds ratios from logistic regression of living Adjusted odds ratios from logistic regression of living arrangements on change in depression 2002-2004, for arrangements on change in depression 2002-2004, for those well in 2002 and for those depressed in 2002, those well in 2002 and for those depressed in 2002,

people aged 60+. ELSApeople aged 60+. ELSA

Well 2002Well 2002

Well 2004Well 2004

Well 2002Well 2002

Depr 2004Depr 2004

Depr 2002Depr 2002

Well 2004Well 2004

Depr 2002Depr 2002

Depr 2004Depr 2004

Spouse onlySpouse only 11 0.76 *0.76 * 11 0.750.75

Spouse plus Spouse plus othersothers

11 0.990.99 11 0.830.83

Living alone Living alone

(ref group)(ref group)11 11 11 11

With non-With non-spouse othersspouse others

11 0.880.88 11 0.830.83

These models controlled for gender, age, smoking, wealth, housing tenure, contact These models controlled for gender, age, smoking, wealth, housing tenure, contact with relatives, contact with friends, membership of social organisations, presence of with relatives, contact with friends, membership of social organisations, presence of health conditions in 2002, presence of health conditions in 2004health conditions in 2002, presence of health conditions in 2004

* p<0.05

Interaction with social tiesInteraction with social ties

Cross-sectional analysisCross-sectional analysis Two interaction terms:Two interaction terms:

Contact with relatives Contact with relatives Contact with friendsContact with friends

More than once per week, less than once per More than once per week, less than once per week, no relatives / friends, missingweek, no relatives / friends, missing

Odds ratios from logistic regression of interaction of Odds ratios from logistic regression of interaction of contact with friendscontact with friends on the association between living on the association between living arrangements and arrangements and self-rated healthself-rated health for the unmarried for the unmarried

compared with living alone, people aged 60+. ELSA 2002compared with living alone, people aged 60+. ELSA 2002

Interaction termInteraction term Odds ratio for Odds ratio for those seeing those seeing friends more friends more than once per than once per weekweek

Odds ratio for Odds ratio for those seeing those seeing friends less than friends less than once per wkonce per wk

With others cc With others cc alonealone

0.48 *0.48 * 1.251.25 0.630.63

This model controlled for gender, age, smoking, wealth, housing tenure, contact with This model controlled for gender, age, smoking, wealth, housing tenure, contact with friends, membership of social organisations.friends, membership of social organisations.

* p<0.05

Odds ratios from logistic regression of interaction of Odds ratios from logistic regression of interaction of contact with relativescontact with relatives on the association between living on the association between living

arrangements and arrangements and CES-Depression scoreCES-Depression score for the for the unmarried compared with living alone, unmarried compared with living alone,

people aged 60+. ELSA 2002people aged 60+. ELSA 2002

Interaction termInteraction term Odds ratio Odds ratio seeing relatives seeing relatives more than once more than once per weekper week

Odds ratio Odds ratio seeing relatives seeing relatives less than once less than once per wkper wk

With others cc With others cc alonealone

1.94 *1.94 * 0.45 *** 0.45 *** 0.940.94

This model controlled for gender, age, smoking, wealth, housing tenure, contact with This model controlled for gender, age, smoking, wealth, housing tenure, contact with friends, membership of social organisations, self-rated health.friends, membership of social organisations, self-rated health.

* p<0.05 ***p<0.001

LimitationsLimitations

Small numbers in the sample limited ability Small numbers in the sample limited ability to draw firm conclusionsto draw firm conclusions

Limited longitudinal analysisLimited longitudinal analysis Missing individuals between round 1 and 2 Missing individuals between round 1 and 2 No information on length of time in living No information on length of time in living

arrangement. arrangement. Missing data: social ties variables, and Missing data: social ties variables, and

these individuals had high proportions with these individuals had high proportions with depression. depression.

ConclusionsConclusions

Clear association between living alone and Clear association between living alone and higher levels of depression and loneliness higher levels of depression and loneliness (ELSA)(ELSA)

Among women, better self-rated health if Among women, better self-rated health if alone than with a spouse. alone than with a spouse.

Possible influence of social tiesPossible influence of social ties

The EndThe End

Thank youThank you

Harriet.Young@lshtm.ac.ukHarriet.Young@lshtm.ac.uk

Emily.Grundy@lshtm.ac.ukEmily.Grundy@lshtm.ac.uk