social connections and wellbeing in later life
TRANSCRIPT
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Social Connections and Wellbeing
in Later Life
19th February 2015
#socialconnections
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Welcome
Paul CannAge-UK Oxfordshire
#socialconnections
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Welcome
Professor Andrew SteptoeUniversity College London
#socialconnections
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Dr Aparna ShankarUniversity College London
#socialconnections
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Aparna Shankar, Snorri Bjorn Rafnsson & Andrew Steptoe
Department of Epidemiology & Public Health, UCL
Loneliness, social isolation and well-being over 6 years
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Background
• Increasing move towards placing national wellbeing at the centre of policy-making (Stiglitz et al., 2009)
• Substantial differences in wellbeing across countries, particularly at older ages
• Given the increasing proportion of older adults, understanding factors affecting wellbeing among older adults is important
Wealthy English speaking countries Eastern Europe and FSUDeaton, 2010
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Social connections
• Different dimensions of social relationships may be particularly relevant for wellbeing in older adults
• The relationship between social connections and wellbeing maybe complex in older age
(adapted from Victor &Yang, 2011)
0
2
4
6
8
10
12
14
< 25 25-34 35-44 45-54 55-64 65-74 >= 75
%
Age in years
Male Always lonely
Female Always lonely
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• Objective measure
• Relates to aspects of social network and diversity, frequency of contact participation in social activities, social engagement
• Measured using one of these dimensions or by an index
• Subjective measure
• Relates to (dis)satisfaction with existing relationships
• Measured using standard questionnaires
Social isolation
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The English Longitudinal Study of Ageing (ELSA)
• Nationally representative panel study of individuals aged 50 years and over
• Started in 2002, with 11391 core sample members
• Participants are contacted every 2 years and complete an interview in person
• We now have 10 years worth of data (Waves 1 – 6) and data are currently being collected for wave 7
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What do we ask participants?
• The interview covers a range of topics including household demographics, health, financial circumstances and cognitive function
• Participants also complete a questionnaire assessing wellbeing, social relationships, use of computers/the internet and how they spend their time
• Every other wave also includes a nurse visit with measures of physical performance and blood sampling
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Social isolation in ELSA
• There are many ways of conceptualising social isolation
• We used a combined index with 1 point given for each of the following:
-- living alone
-- contacting family less than a month
-- contacting friends less than once a month
-- contacting children less than once a month
-- not participating in any social/community activities
• We classified people into 3 groups: low isolation, intermediate isolation and high isolation. This was measured only at the start of the study
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Loneliness in ELSA• Again, many different measures are available
• We used the short form of the Revised UCLA scale
• We classified people as being lonely or not lonely. This was measured only at the start of the study
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Wellbeing in ELSA We consider 2 main measures of wellbeing here
• Life satisfaction, which is an evaluation of life in general
• Enjoyment of life or how happy individuals feel at this point in time
Wellbeing was measured a 4 time points over a 6-year period (2004 – 2010)
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Wellbeing over the 6 years
8
9
10
11
2002 2004 2006 2008 2010 2012
Enjo
yme
nt
of
life
Years
17
18
19
20
21
22
23
24
2002 2004 2006 2008 2010 2012Li
fe s
atis
fact
ion
Years
• Levels of wellbeing were generally high in participants
• Although there were some decreases initially, wellbeing increased with time
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How does isolation affect wellbeing?
8
9
10
11
2002 2004 2006 2008 2010 2012
Enjo
yme
nt
of
life
Years
18
19
20
21
22
23
24
2002 2004 2006 2008 2010 2012
Life
sat
isfa
ctio
n
Years
• Individuals with low and intermediate levels of isolation had higher levels of wellbeing that those in the high isolation group; they also showed expected increases with time
• The low isolation group showed sustained decreases in enjoyment of life and only small increases in life satisfaction with time
Low isolation Intermediate isolation
High isolation
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How does loneliness affect wellbeing?
8
9
10
11
2003 2004 2005 2006 2007 2008 2009 2010 2011
Enjo
yme
nt
of
life
Years
18
19
20
21
22
23
24
2002 2004 2006 2008 2010 2012Li
fe s
atis
fact
ion
Years
• The low loneliness group showed consistently higher levels of wellbeing when compared with the high loneliness group
Not lonely Lonely
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Summary of findings
• Individuals with who were less lonely had consistently higher levels of wellbeing when compared with those who were more lonely
• High levels of isolation were associated with sustained decreases in enjoyment of life over the 6-year period
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Acknowledgements
This study was supported by the Economic and Social Research Council Secondary Data Analysis Initiative [Grant number ES/K003178/1].
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Thank you!
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Dr Snorri RafnssonUniversity College London
#socialconnections
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Social networks and subjective wellbeing over 6 years: The ELSA Study
Dr. Snorri Bjorn Rafnsson, Dr. Aparna Shankar &
Professor Andrew Steptoe
Department of Epidemiology and Public Health, University College London
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Background
• There is growing interest in subjective wellbeing outcomes and their determinants in ageing populations
• Good social connections are consistently related to better health and wellbeing among older adults
• There is limited longitudinal research examining different dimensions of social networks and their influence on wellbeing in later life
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Aim of study
To investigate the relationship between specific social network characteristicsand future wellbeing levels among older men and women participating in the ELSA study
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Data on social networks and subjective wellbeing in ELSA
• Social network dimensions (at ELSA Wave 2 = baseline)
1. Diversity: reflects the presence of children, other family or friends
2. Size: reflects number of relations with children, other family or friends
3. Contact frequency: reflects frequency of contact with children, other family or friends
• Subjective wellbeing domains (at baseline & 6-years later)
1. Life satisfaction: “An individual’s judgement of his satisfaction with life according to his chosen criteria”.
2. Quality of life: “Individual’s functioning in life as well as realisation of one’s potential”.
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Quality of life at baseline and 6 years later bysocial network diversity
Baseline
Follow-up
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Quality of life at baseline and 6 years later bysocial network size
Baseline
Follow-up
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Quality of life at baseline and 6 years later bysocial network contact frequency
Baseline
Follow-up
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Summary of findings & conclusions
– Social network size and contact frequency were positively and independently related to future levels of subjective wellbeing in later life
– Having multiple social ties may provide a larger pool from which to obtain assistance with various tasks or problems i.e. social support
– The role of close relationships and frequent contact in later life may be important for sustaining wellbeing levels as people grow older
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Social networks and subjective wellbeing over 6 years: The ELSA Study
Contact information:Dr. Snorri Bjorn RafnssonDepartment of Epidemiology and Public Health, University College London Email: [email protected]
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Baseline variables Sample (n=4116)
Age 63.1 (7.1)
Females 55.2%
SWLS scale score (0-30) 21.0 (6.2)
CASP19 scale score (0-57) 41.5 (8.7)
Network diversity (0-3)-Lowest (0-1)-Middle (=2)-Highest (=3)
2.2%20.0%77.8%
Network size (0-30)-Lowest (<5)-Middle (5-8)-Highest (>8)
27.7%43.1%29.2%
Contact frequency (0-18)-Lowest (<6)-Middle (6-9)-Highest (>9)
26.6%42.5%31.0%
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Social network characteristics
Life satisfaction Quality of life
Network diversity-Lowest-Middle-Highest
Baseline20.120.421.9
Follow-up19.919.821.4
Baseline41.442.744.1
Follow-up38.840.041.9
Network size-Lowest-Middle-Highest
19.821.922.7
19.621.322.0
41.444.245.3
39.241.943.0
Contact frequency-Lowest-Middle-Highest
20.121.722.5
19.821.121.9
42.244.144.9
39.741.742.8
All linear trends statistically significant with p-values ranging from <0.05 to P<0.001
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Social network characteristics
Life satisfaction Quality of lifeB 95% CI B 95% CI
Network diversity-Lowest-Middle-Highest
Ref.-1.29-1.04
--2.97, 0.39-2.72, 0.64
Ref.-1.22-0.95
--3.29, 0.85-3.01, 1.12
Network size-Lowest-Middle-Highest
Ref.0.20
0.90**
--0.36, 0.770.26, 1.54
Ref.0.46
0.98*
--0.24, 1.150.19, 1.77
Contact frequency-Lowest-Middle-Highest
Ref.0.59
0.82*
--0.00, 1.170.14, 1.50
Ref.1.19**1.18**
-0.47, 1.190.35, 2.01
Adjusted for baseline age, sex, either SWLS or CASP19 score, relationship status, education, work participation, wealth and longstanding limiting illness. *P<0.05; **P<0.01
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Emotional wellbeing of older caregivers: Findings from the ELSA study
Dr. Snorri Bjorn Rafnsson, Dr. Aparna Shankar &
Professor Andrew Steptoe
Department of Epidemiology & Public Health, University College London
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Background
• Almost 1.2 million people aged 65 or older in England provided informal care in 2011; Approximately 56% of older carers were female
• Caregiving often involves diverse responsibilities and can be a stressful experience
• Associations between poor psychological and physical health and being an informal caregiver are well established
• Informal caregiving has been described as “a career” but there is limited longitudinal research investigating specific caregiving role transitions and their impact on wellbeing
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Main study objectives
To determine the longitudinal relationships between major (excl. grandparenting) caregiving transitions and positive and negative emotional wellbeing among older men and women participating in the ELSA study
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Questions on informal caregiving in ELSA
Asked question: ‘Did you do any of the following activities last month (i.e. cared for someone)?’
Yes Missing No
Asked question: ‘Did you look after someone in the past week (including your partner or other people in your household)?’
By ‘look after’ we mean active provision of care
Yes No Missing
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Emotional wellbeing
1. Life satisfaction: Assessed using the Satisfaction with Life Scale (SWLS). Based on adding 5 individual scale items such as: If I could live my life over, I would change almost nothing
2. Quality of life: Determined using CASP-19 which taps four domains: “Control”, “autonomy”, “pleasure” and “self-realisation”. Example: I feel free to plan for the future
3. Depression symptoms: Assessed with the 8-item Center for Epidemiologic Studies Depression scale (CES-D). Example: How much of the time during the past week did you feel depressed?
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Quality of life at baseline and 2 years later bytype of caregiving transition - WOMEN
Baseline
Follow-up
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Depression at baseline and 2 years later bytype of caregiving transition - WOMEN
BaselineFollow-
up
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Summary of findings & conclusions
• Among older women, long-term caregiving may steadily erode quality of life and increase feelings such as not being in control of one’s life
• Cessation of caregiving responsibilities may also be associated with emotional distress around the time carers leave this role
• These findings highlight the importance of supporting carers during different stages of their caregiving “career”.
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Emotional wellbeing of older caregivers: Findings from the ELSA study
Contact information:Dr. Snorri Bjorn RafnssonDepartment of Epidemiology and Public Health, University College London Email: [email protected]
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Methods
• ELSA Study sample
– 3007 men and 3564 women aged 50 years and older
• Data collection
– Baseline in 2004/5 (Wave 2) and 2-year follow-up in 2006/7 (Wave 3)
• Informal caregiving
– Respondents asked at each time about whether they actively provided informal care
– Participants taking care of grandchildren were excluded from the analysis (n=224)
– Caregiving transitions: (1) No caregiving; (2) Entry into caregiving; (3) Exit from caregiving; (4) Consistent caregiving
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ELSA C1CM sample at Wave 2Characteristics Study sample (n=8780)
Age, % (n)50-5960-6970-7980+
29.6% (2597)32.7% (2874)24.9% (2188)12.8% (1121)
Sex, % women (n) 55.0% (4831)
Provided informal care last week, % (n)YesNo
11.2% (954)88.8% (7548)
Life satisfaction (0-30), mean (SD) 21.2 (6.2)
Depression symptoms (0-8)Mean (SD)CES-D score ≥4, % (n)
1.5 (2.0)15.6% (1353)
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Carers versus non-carers at Wave 2Characteristics Carers (n=954)† Non-carers (n=7548)
Age, %
50-59 37.5% 28.2%
60-69 35.4% 32.1%
70-79 22.6% 25.5%
80+ 4.4% 14.2%
Sex, %
Men 32.5% 47.0%
Women 67.5% 53.0%
†Includes all types of caregiving
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SWB by type of care relationship at Wave 2
Caregiving typeN
Life SatisfactionMean (SD)
CES-DMean (SD)
CES-D% ≥4
Non-carer 7826 21.3 (6.2) 1.5 (2.0) 15.9%
Grandparenting 138 22.5 (5.4) 0.8 (1.1) 2.2%
Spouse/partner 315 20.2 (6.5) 1.8 (2.0) 16.2%
Child 72 19.1 (7.5) 2.0 (2.1) 19.4%
Parent/parent-in-law
252 21.1 (5.8) 1.4 (1.9) 12.7%
Other relative/ friend/ neighbour
166 21.6 (6.2) 1.5 (1.8) 12.7%
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Characteristics†N
Life SatisfactionMean (SD)
CES-DMean (SD)
CES-D% ≥4
Number of personsNon-carer 1 person>1 person
7826713231
21.3 (6.2)20.9 (6.1)21.0 (6.5)
1.5 (2.0)1.6 (1.9)1.3 (1.8)
15.9%13.6%10.8%
Hours of care (week)Non-carer<20 hours20-49 hours50-167 hours168 hours
782648816755
218
21.3 (6.2)21.8 (5.5)20.9 (6.8)20.2 (6.5)19.1 (6.9)
1.5 (2.0)1.3 (1.8)1.4 (1.8)1.7 (1.8)2.0 (2.1)
15.9%10.2%12.0%14.5%19.7%
Lives with personNon-carerYesNo
7826404539
21.3 (6.2)19.8 (6.7)21.7 (5.8)
1.5 (2.0)1.8 (2.0)1.3 (1.7)
15.9%16.3%10.4%
SWB and level of care at Wave 2
†Includes all types of caregiving
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SWB and subjective appraisal of caregiving at Wave 2
Characteristics†N
Life SatisfactionMean (SD)
CES-DMean (SD)
CES-D% ≥4
Why provides care?Non-carerObliged/is neededOther reasons
7826652301
21.3 (6.2)20.8 (6.1)21.4 (6.2)
1.5 (2.0)1.5 (1.9)1.4 (1.8)
15.9%13.3%12.0%
Has gained from caring for others?Non-carerAgreesDisagrees
78261115
78
21.3 (6.2)21.3 (6.0)18.8 (7.6)
1.5 (2.0)1.4 (1.8)1.7 (2.2)
15.9%11.9%15.4%
Feels appreciated for caring for others?Non-carerAgreesDisagrees
78261069138
21.3 (6.2)21.3 (6.0)19.3 (6.7)
1.5 (2.0)1.3 (1.7)2.2 (2.3)
15.9%10.6%25.4%
†Includes all types of caregiving
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2-year changes in SWB by type of caregiving transition
Characteristics†N
W2 Life SatisfactionMean (SD)
W3 Life SatisfactionMean (SD)
Age & sex adjusted
B (SE)
Age, sex & LS W2 adjusted
B (SE)
Carer at Wave 2YesNo
8017478
20.7 (6.3)21.2 (6.2)
--
--
--
Carer at Wave 3YesNo
6006213
--
19.8 (6.9)20.0 (6.3)
--
--
Wave 2 to Wave 3 transitionsConsistent non-carerEntry to caregivingExit from caregivingConsistent carer
5657310373258
21.3 (6.1)21.2 (6.4)20.7 (5.9)20.6 (6.9)
20.0 (6.4)20.4 (6.6)19.8 (6.4)18.9 (7.3)
Ref.0.34 (0.41)-0.09 (0.38)
-0.92 (0.44)*
Ref.0.28 (0.29)0.25 (0.27)-0.42 (0.31)
†Excludes participants caring for grandchildren at Wave 2 or Wave 3*P<0.05
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WOMENBaseline characteristics
No caregiving
Caregivingentry
Long term caregiving
Caregivingexit
Age50-59 (ref.)70-79
77.9%85.3%***
6.5%4.3%*
7.0%4.1%**
8.7%6.2%*
Marital statusNot married (ref.)Married
91.0%78.9%***
2.5%6.5%***
2.3%6.5%***
4.1%8.2%***
EducationNo qualification (ref.)Degree
87.0%81.8%*
3.6%7.0%***
3.8%5.2%
5.5%7.5%*
Work participationNot working (ref.)Working
85.3%80.0%***
4.2%6.5%**
4.8%4.5%
5.7%9.0%**
WealthLowest quintile (ref.)Highest quintile
85.5%81.3%*
4.9%5.2%
4.3%5.1%
5.2%8.4%*
Longstanding illnessNo (ref.)Yes
82.9%85.7%*
4.8%4.8%
5.2%4.0%
7.1%5.5%
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WOMEN -Caregiving transitions
Quality of life Depression
B 95% CI OR 95% CI
-No Caregiving
-Caregiving entry
-Long term caregiving
-Caregiving exit
Ref.
-0.16
-1.21*
0.08
-
-1.17, 0.84
-2.20, -0.22
-0.79, 0.95
1.0
0.86
1.21
1.54*
-
0.53, 1.42
0.21, 1.89
1.05, 2.26
Multiple linear regression models adjusting for baseline age, Quality of Life or depression, marital status, education, work participation, wealth and longstanding limiting illness.
*P<0.05
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Panel Responses
Chris Sherwood, Relate
Andy Kaye, Independent Age
Laura Alcock-Ferguson, Campaign to End
Loneliness
Emily Holzhausen, Carers UK
#socialconnections
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Open Discussion
Chaired by Paul CannAge-UK Oxfordshire
#socialconnections
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Social Connections and Wellbeing
in Later Life
19th February 2015
#socialconnections