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Social Connections and Wellbeing in Later Life

19th February 2015 - ILC-UK and UCL

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Social Connections and Wellbeing in Later Life

  1. 1. Social Connections and Wellbeing in Later Life 19th February 2015 #socialconnections
  2. 2. Welcome Paul Cann Age-UK Oxfordshire #socialconnections
  3. 3. Welcome Professor Andrew Steptoe University College London #socialconnections
  4. 4. Dr Aparna Shankar University College London #socialconnections
  5. 5. Aparna Shankar, Snorri Bjorn Rafnsson & Andrew Steptoe Department of Epidemiology & Public Health, UCL Loneliness, social isolation and well-being over 6 years
  6. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 18. Acknowledgements This study was supported by the Economic and Social Research Council Secondary Data Analysis Initiative [Grant number ES/K003178/1].
  19. 19. Thank you!
  20. 20. Dr Snorri Rafnsson University College London #socialconnections
  21. 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. 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. 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. 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. 25. Quality of life at baseline and 6 years later by social network diversity Baseline Follow- up
  26. 26. Quality of life at baseline and 6 years later by social network size Baseline Follow- up
  27. 27. Quality of life at baseline and 6 years later by social network contact frequency Baseline Follow- up
  28. 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. 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
  30. 30. 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%
  31. 31. 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
  32. 32. 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
  33. 33. 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
  34. 34. 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
  35. 35. 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
  36. 36. 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
  37. 37. 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?
  38. 38. Quality of life at baseline and 2 years later by type of caregiving transition - WOMEN Baseline Follow- up
  39. 39. Depression at baseline and 2 years later by type of caregiving transition - WOMEN Baseline Follow- up
  40. 40. 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”.
  41. 41. 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
  42. 42. 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
  43. 43. 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)
  44. 44. 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
  45. 45. 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%
  46. 46. 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
  47. 47. 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
  48. 48. 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
  49. 49. 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%
  50. 50. 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
  51. 51. Panel Responses Chris Sherwood, Relate Andy Kaye, Independent Age Laura Alcock-Ferguson, Campaign to End Loneliness Emily Holzhausen, Carers UK #socialconnections
  52. 52. Open Discussion Chaired by Paul Cann Age-UK Oxfordshire #socialconnections
  53. 53. Social Connections and Wellbeing in Later Life 19th February 2015 #socialconnections

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19th February 2015 - ILC-UK and UCL

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