Social Connections and Wellbeing

in Later Life

19th February 2015

#socialconnections

Welcome

Paul CannAge-UK Oxfordshire

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Welcome

Professor Andrew SteptoeUniversity College London

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Dr Aparna ShankarUniversity College London

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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

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

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

• 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

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

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

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

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

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)

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

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

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

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

Acknowledgements

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

Thank you!

Dr Snorri RafnssonUniversity College London

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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

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

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

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”.

Quality of life at baseline and 6 years later bysocial network diversity

Baseline

Follow-up

Quality of life at baseline and 6 years later bysocial network size

Baseline

Follow-up

Quality of life at baseline and 6 years later bysocial network contact frequency

Baseline

Follow-up

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

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: s.rafnsson@ucl.ac.uk

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%

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

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

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

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

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

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

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?

Quality of life at baseline and 2 years later bytype of caregiving transition - WOMEN

Baseline

Follow-up

Depression at baseline and 2 years later bytype of caregiving transition - WOMEN

BaselineFollow-

up

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”.

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: s.rafnsson@ucl.ac.uk

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

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)

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

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%

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

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

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

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%

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

Panel Responses

Chris Sherwood, Relate

Andy Kaye, Independent Age

Laura Alcock-Ferguson, Campaign to End

Loneliness

Emily Holzhausen, Carers UK

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Open Discussion

Chaired by Paul CannAge-UK Oxfordshire

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Social Connections and Wellbeing

in Later Life

19th February 2015

#socialconnections