19th February 2015 - ILC-UK and UCL

1. Social Connections and Wellbeing
in Later Life
19th February 2015
#socialconnections

2. Welcome
Paul Cann
Age-UK Oxfordshire
#socialconnections

3. Welcome
Professor Andrew Steptoe
University College London
#socialconnections

4. Dr Aparna Shankar
University College London
#socialconnections

5. Aparna Shankar, Snorri Bjorn Rafnsson & Andrew Steptoe
Department of Epidemiology & Public Health, UCL
Loneliness, social isolation and well-being
over 6 years

6. 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 FSU
Deaton, 2010

7. 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

8. • 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

9. 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

10. 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

11. 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

12. 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

13. 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)

14. Wellbeing over the 6 years
8
9
10
11
2002 2004 2006 2008 2010 2012
Enjoymentoflife
Years
17
18
19
20
21
22
23
24
2002 2004 2006 2008 2010 2012
Lifesatisfaction
Years
• Levels of wellbeing were generally high in participants
• Although there were some decreases initially, wellbeing increased with
time

15. How does isolation affect wellbeing?
8
9
10
11
2002 2004 2006 2008 2010 2012
Enjoymentoflife
Years
18
19
20
21
22
23
24
2002 2004 2006 2008 2010 2012
Lifesatisfaction
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

16. How does loneliness affect wellbeing?
8
9
10
11
2003 2004 2005 2006 2007 2008 2009 2010 2011
Enjoymentoflife
Years
18
19
20
21
22
23
24
2002 2004 2006 2008 2010 2012
Lifesatisfaction
Years
• The low loneliness group showed consistently higher levels of wellbeing
when compared with the high loneliness group
Not lonely Lonely

17. 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

18. Acknowledgements
This study was supported by the Economic and Social Research Council
Secondary Data Analysis Initiative [Grant number ES/K003178/1].

19. Thank you!

20. Dr Snorri Rafnsson
University College London
#socialconnections

21. 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

22. 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

23. Aim of study
To investigate the relationship between
specific social network characteristics
and future wellbeing levels among
older men and women participating in
the ELSA study

24. 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”.

25. Quality of life at baseline and 6 years later by
social network diversity
Baseline
Follow-
up

26. Quality of life at baseline and 6 years later by
social network size
Baseline
Follow-
up

27. Quality of life at baseline and 6 years later by
social network contact frequency
Baseline
Follow-
up

28. 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

29. Social networks and subjective
wellbeing over 6 years: The ELSA Study
Contact information:
Dr. Snorri Bjorn Rafnsson
Department of Epidemiology and Public
Health, University College London
Email: s.rafnsson@ucl.ac.uk

31. 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%

32. Social network
characteristics
Life satisfaction Quality of life
Network diversity
-Lowest
-Middle
-Highest
Baseline
20.1
20.4
21.9
Follow-up
19.9
19.8
21.4
Baseline
41.4
42.7
44.1
Follow-up
38.8
40.0
41.9
Network size
-Lowest
-Middle
-Highest
19.8
21.9
22.7
19.6
21.3
22.0
41.4
44.2
45.3
39.2
41.9
43.0
Contact frequency
-Lowest
-Middle
-Highest
20.1
21.7
22.5
19.8
21.1
21.9
42.2
44.1
44.9
39.7
41.7
42.8
All linear trends statistically significant with p-values ranging from <0.05 to P<0.001

33. Social network
characteristics
Life satisfaction Quality of life
B 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, 0.77
0.26, 1.54
Ref.
0.46
0.98*
-
-0.24, 1.15
0.19, 1.77
Contact frequency
-Lowest
-Middle
-Highest
Ref.
0.59
0.82*
-
-0.00, 1.17
0.14, 1.50
Ref.
1.19**
1.18**
-
0.47, 1.19
0.35, 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

34. 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

35. 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

36. 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

37. Questions on informal caregiving in ELSA
Asked question: ‘Did you do any of the following activities last month (i.e.
cared for someone)?’
Yes MissingNo
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

38. 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?

39. Quality of life at baseline and 2 years later by
type of caregiving transition - WOMEN
Baseline
Follow-
up

40. Depression at baseline and 2 years later by
type of caregiving transition - WOMEN
Baseline
Follow-
up

41. 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”.

42. Emotional wellbeing of older caregivers:
Findings from the ELSA study
Contact information:
Dr. Snorri Bjorn Rafnsson
Department of Epidemiology and Public
Health, University College London
Email: s.rafnsson@ucl.ac.uk

44. 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

45. ELSA C1CM sample at Wave 2
Characteristics Study sample (n=8780)
Age, % (n)
50-59
60-69
70-79
80+
29.6% (2597)
32.7% (2874)
24.9% (2188)
12.8% (1121)
Sex, % women (n) 55.0% (4831)
Provided informal care last week, % (n)
Yes
No
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)

46. Carers versus non-carers at Wave 2
Characteristics 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

47. SWB by type of care relationship at Wave 2
Caregiving type
N
Life Satisfaction
Mean (SD)
CES-D
Mean (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%

48. Characteristics†
N
Life Satisfaction
Mean (SD)
CES-D
Mean (SD)
CES-D
% ≥4
Number of persons
Non-carer
1 person
>1 person
7826
713
231
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 hours
20-49 hours
50-167 hours
168 hours
7826
488
167
55
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 person
Non-carer
Yes
No
7826
404
539
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

49. SWB and subjective appraisal of caregiving
at Wave 2
Characteristics†
N
Life Satisfaction
Mean (SD)
CES-D
Mean (SD)
CES-D
% ≥4
Why provides care?
Non-carer
Obliged/is needed
Other reasons
7826
652
301
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-carer
Agrees
Disagrees
7826
1115
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-carer
Agrees
Disagrees
7826
1069
138
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

50. 2-year changes in SWB by type of
caregiving transition
Characteristics†
N
W2 Life
Satisfaction
Mean (SD)
W3 Life
Satisfaction
Mean (SD)
Age & sex
adjusted
B (SE)
Age, sex & LS
W2 adjusted
B (SE)
Carer at Wave 2
Yes
No
801
7478
20.7 (6.3)
21.2 (6.2)
-
-
-
-
-
-
Carer at Wave 3
Yes
No
600
6213
-
-
19.8 (6.9)
20.0 (6.3)
-
-
-
-
Wave 2 to Wave 3
transitions
Consistent non-carer
Entry to caregiving
Exit from caregiving
Consistent carer
5657
310
373
258
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

51. WOMEN
Baseline characteristics
No
caregiving
Caregiving
entry
Long term
caregiving
Caregiving
exit
Age
50-59 (ref.)
70-79
77.9%
85.3%***
6.5%
4.3%*
7.0%
4.1%**
8.7%
6.2%*
Marital status
Not married (ref.)
Married
91.0%
78.9%***
2.5%
6.5%***
2.3%
6.5%***
4.1%
8.2%***
Education
No qualification (ref.)
Degree
87.0%
81.8%*
3.6%
7.0%***
3.8%
5.2%
5.5%
7.5%*
Work participation
Not working (ref.)
Working
85.3%
80.0%***
4.2%
6.5%**
4.8%
4.5%
5.7%
9.0%**
Wealth
Lowest quintile (ref.)
Highest quintile
85.5%
81.3%*
4.9%
5.2%
4.3%
5.1%
5.2%
8.4%*
Longstanding illness
No (ref.)
Yes
82.9%
85.7%*
4.8%
4.8%
5.2%
4.0%
7.1%
5.5%

52. 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

53. Panel Responses
Chris Sherwood, Relate
Andy Kaye, Independent Age
Laura Alcock-Ferguson, Campaign to End
Loneliness
Emily Holzhausen, Carers UK
#socialconnections

54. Open Discussion
Chaired by Paul Cann
Age-UK Oxfordshire
#socialconnections

55. Social Connections and Wellbeing
in Later Life
19th February 2015
#socialconnections