English Longitudinal Study of Ageing

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Differences in physical aging measured by walking speed: evidence from the English Longitudinal Study of Ageing

Differences in physical aging measured by walking speed: evidence from the English Longitudinal Study of Ageing

We used the English Longitudinal Study of Ageing (ELSA), which is a longitudinal study of a representative sam- ple of the English non-institutionalized population aged 50 years and older [15]. The first wave was collected in 2002 and thereafter participants were reinterviewed every second year until 2012. New samples were added in waves three, four and six [16, 17]. Data were col- lected via face-to-face interviews using computer-assisted personal interviews and a self-completion questionnaire. In addition, a nurse visited participants in waves two, four, and six to measure physical functioning and to take blood samples and anthropometric measurements. Ethi- cal approval for all the ELSA waves was granted by the National Research and Ethics Committee. All participants signed full informed consent to participate in the study. More information on ELSA can be found at http://www. ifs.org.uk/elsa/documentation.php.
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Impact of COPD and anemia on motor and cognitive performance in the general older population: results from the English longitudinal study of ageing

Impact of COPD and anemia on motor and cognitive performance in the general older population: results from the English longitudinal study of ageing

The ELSA (English Longitudinal Study on Ageing) study is a prospective cohort study funded by a consortium of UK-Government departments and the National Institute of Aging in the UK to study the socio-economic and health implications of aging. It collects longitudinal, multidisciplinary data from a representative sample of the English general population aged 50 and older living at private residential addresses [17, 18]. After the first wave of recruitment, 12,099 participants were enrolled and household interviews were conducted. To maintain the size and representativeness of the panel over time, additional study participants aged 50–55 were recruited during waves 3, 4, and 6. In the present study, we used interview data collected every year in combination with the nursing data subset. In this subset of participants, medical information was collected in waves 2, 4 and 6 over a period of 8 years. During wave 2, nursing data were obtained for 7666 participants for the first time and blood samples were collected from 5841 of those participants (Fig. 1).
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Loneliness as a risk factor for care home admission in the English Longitudinal Study of Ageing

Loneliness as a risk factor for care home admission in the English Longitudinal Study of Ageing

24. Gale CR, Westbury L, Cooper C. Social isolation and loneliness as risk factors for the progression of frailty: the English Longitudinal Study of Ageing. Age and Ageing. 2017. 25. Valtorta NK, Kanaan M, Gilbody S, Hanratty B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart. 2016;102:1009-16.

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Physical activity pre  and post dementia: English Longitudinal Study of Ageing

Physical activity pre and post dementia: English Longitudinal Study of Ageing

Background: To inform public health interventions, further investigation is needed to identify: (1) frequency/intensity of everyday physical activity (PA) needed to reduce dementia risk; (2) whether post-diagnosis reduction in PA is associated with cognitive outcomes. Methods: Data from 11,391 men and women (aged ≥50) were obtained in the English Longitudinal Study of Ageing. Assessments were at baseline (2002-2003) and biannual follow-ups (2004-2013). Results: Older adults who carried out moderate to vigorous activity at least once per week had a 34%-50% lower risk for cognitive decline and dementia over an 8-10 year follow-up period. From pre- to post-diagnosis, those that decreased PA levels had a larger decrease in immediate recall score, compared to those that maintained or increased PA levels (adjusted for changes in physical function). Conclusion: These findings provide a guideline for everyday PA levels needed to
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The role of childhood social position in adult type 2 diabetes: evidence from the English Longitudinal Study of Ageing

The role of childhood social position in adult type 2 diabetes: evidence from the English Longitudinal Study of Ageing

Background: Socioeconomic circumstances in childhood and early adulthood may influence the later onset of chronic disease, although such research is limited for type 2 diabetes and its risk factors at the different stages of life. The main aim of the present study is to examine the role of childhood social position and later inflammatory markers and health behaviours in developing type 2 diabetes at older ages using a pathway analytic approach. Methods: Data on childhood and adult life circumstances of 2,994 men and 4,021 women from English Longitudinal Study of Ageing (ELSA) were used to evaluate their association with diabetes at age 50 years and more. The cases of diabetes were based on having increased blood levels of glycated haemoglobin and/or self-reported medication for diabetes and/or being diagnosed with type 2 diabetes. Father ’ s job when ELSA participants were aged 14 years was used as the measure of childhood social position. Current social characteristics, health behaviours and inflammatory biomarkers were used as potential mediators in the statistical analysis to assess direct and indirect effects of childhood circumstances on diabetes in later life.
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Does pain predict frailty in older men and women? : findings from the English Longitudinal Study of Ageing (ELSA)

Does pain predict frailty in older men and women? : findings from the English Longitudinal Study of Ageing (ELSA)

Socioeconomic factors are an important determinant of frailty risk with evidence that lower socioeconomic status (SES) is asso- ciated with an increased risk of frailty (7–10). Marshall and col- leagues (11) modeled cohort-specific trajectories in frailty among community-dwelling adults aged 50 years and older using five waves of the English Longitudinal Study of Ageing (ELSA), and showed that wealth differences impact on levels of frailty, with the fast- est growth in frailty observed among the poorest participants. We reported recently an association between the occurrence of chronic widespread pain (CWP) and worsening frailty in a population sam- ple of European men (12). The mechanism is unclear; pain experi- ence may be linked with declining activity levels, or the presence of comorbidities which predispose to frailty. There is evidence that lower SES is also associated with CWP (13), chronic disabling pain (14) and disability due to pain (15). To our knowledge, however, there are no data examining whether the relationship between pain and frailty can be explained by SES.
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Cross sectional study of sleep quantity and quality and amnestic and non amnestic cognitive function in an ageing population : the English longitudinal study of ageing (ELSA)

Cross sectional study of sleep quantity and quality and amnestic and non amnestic cognitive function in an ageing population : the English longitudinal study of ageing (ELSA)

The English Longitudinal Study of Ageing (ELSA) is a representative sample of the English population aged 50 years and over (N = 11,050) [16,17]. Data were selected from Wave 4 (2008), at which point sleep data was included for the first time, alongside routine measures of health, disease, cognition, finances, lifestyle and anthropometrics. The full methodology, sampling procedures and details on previous waves of screening have been reported elsewhere [18]. Non-whites (3.5%) and participants under the age of 50 (n = 301) or aged 90 years or above (n = 137) were excluded, as were those with inaccurate or incomplete essential data (n = 1432). The remaining subjects with full data on sleep quantity and quality and cognitive function were included (n = 8,789; 3,968 males and 4,821 females) [18]. Since research has shown pre- and post-retirement changes in health conditions [19] and sleep behaviour [20], the main objective of our analysis was to explore the patterns of associations between sleep and cognition at different stages of ageing. As significant interactions were detected between sleep disturbances and age (quantity: p, 0.001 for ACF and p = 0.06 for nACF; quality: p,0.001 for ACF and p = 0.018 for nACF), the respondents were separated into younger (50–64 years; n = 4,660) and older (65+ years; n = 4,129) age groups and analyses carried out separately.
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Minimum income for healthy living and frailty in adults over 65 years old in the English Longitudinal Study of Ageing: a population based cohort study

Minimum income for healthy living and frailty in adults over 65 years old in the English Longitudinal Study of Ageing: a population based cohort study

Acknowledgements We acknowledge with gratitude the study participants of the English Longitudinal Study of Ageing (ELSA); and those who initiated and currently lead the study including James Banks, Richard Blundell, Roger Jowell, Michael Marmot, James Nazroo and Richard Suzman; as well as Jerry Morris whose ideas inspired the present work. The data were made available through the UK Data Archive. ELSA was developed by a team of researchers based at the NatCen Social Research, University College London and the Institute for Fiscal Studies. The data were collected by NatCen Social Research. The funding is provided by the National Institute of Aging in the USA, and a consortium of UK government departments co-ordinated by the Office for National Statistics. The developers and funders of ELSA and the Archive do not bear any responsibility for the analyses or interpretations presented here. We would also like to thank the reviewers for their helpful comments on the manuscript.
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Television viewing time and risk of incident obesity and central obesity: the English longitudinal study of ageing

Television viewing time and risk of incident obesity and central obesity: the English longitudinal study of ageing

The metabolic risk associated with obesity is closely correlated with a central rather than peripheral fat pat- tern [13]. Few previous studies investigating the longitu- dinal association between television viewing time and overweight/obesity have investigated the association be- tween television viewing time and region specific adi- posity. In a recent study in a sample of 3846 adults (mean age approximately 48 years) increases in televi- sion viewing time over 5 years were associated with in- creases in waist circumference [14]. Another study found that more frequent television viewing in adoles- cences and early adulthood was associated with greater BMI gains through to mid-adulthood and with central obesity in mid-life [15]. To our knowledge no study has investigated the longitudinal association between televi- sion viewing time and central adiposity in a sample of older adults.
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Pathways to frailty and its adverse outcomes: evidence from the English longitudinal study of ageing

Pathways to frailty and its adverse outcomes: evidence from the English longitudinal study of ageing

Overall, our findings add to the existing body of evidence supporting health and social policies that promote greater physical activity and attempt to prevent cognitive decline in the bid to enhance longevity in older people through modifying the adverse impact of physical frailty. Given that participation in physical activity is low in older people despite public education on its benefits, implementation of multi-modal means of encouraging more physical activity need to be considered (McPhee et al., 2016). Preventing cognitive impairment is a more challenging endeavor. Current evidence suggests that cognitive training, and perhaps physical activity and dietary omega-3 tatty acids may have a role (Plassman et al., 2010). Beyond encouraging physical activity, advice on maintaining or boosting mental activity and encouraging fish consumption are common components of health promotion efforts directed at older people, although the extent of their take up has been less studied. In addition, our findings suggest that addressing high alcohol consumption and poor social integration among older people with physical frailty are potential areas of focus for further investigation. From a broader perspective, addressing these conditions may already be recognized as sensible objectives of health and social policies. In fact, initiatives that are consistent with these objectives may already been implemented in many settings. Nonetheless, frailty-specific evidence such as from this study may assist in bolstering support for the initiation, continuation, or even further expansion of such programs in the face of public resource constraints.
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Physical activity and trajectories of frailty among older adults : evidence from the English Longitudinal Study of Ageing

Physical activity and trajectories of frailty among older adults : evidence from the English Longitudinal Study of Ageing

While our findings demonstrate that the trajectories of frailty appear to be influenced by baseline PA we cannot prove causality. It may be that the respondents who take part in more intensive PA are healthier to begin with in some unobserved way at baseline and it is this underlying health advantage, rather than the level of PA, that results in their less steep frailty trajectories. The findings from this study are however limited to adults who are non-frail at baseline and to some extent this guards against the possibility of reverse causality; that those who are physically active are able to undertake activity because they have better underlying health and so experience a slower increase in frailty as a result. However, we cannot rule out the possibility of a causal link in the opposite direction to that hypothesised. Examination of PA intensity over multiple time-points (rather than at baseline alone) would be useful in the assessment of whether a sustained rather than a short-lived period of physical activity is of additional benefit in terms of frailty progression in older adults. A recent study which also used the ELSA data showed that PA levels in older English adults were fairly stable across the various waves [31]. In light of this finding, we have operationalised the baseline PA data as a fair approximation of long term PA behaviours, without compromising the protection against problems relating to reverse causality that come from using multiple waves of PA data.
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Cardiovascular risk factors and memory decline in middle-aged and older adults: the English Longitudinal Study of Ageing

Cardiovascular risk factors and memory decline in middle-aged and older adults: the English Longitudinal Study of Ageing

The ELSA study includes a battery of cognitive tests to measure cognitive functioning in the elderly [21]. We fo- cused on verbal episodic memory, which is related to every-day activities of older adults and has been shown to be sensitive to age-related decline [22]. The measure was assessed in the six waves using both immediate and de- layed word recall tasks in which ten common words were presented aurally by computer to ensure standardised de- livery. Participants were asked to recall them immediately and after a short delay, which was filled with other cogni- tive tests. There were four alternative lists, so that different lists could be given in distinct waves. The number of cor- rect responses was recorded each time. This approach has been used elsewhere [21], and the word lists used here were those developed for the Health Retirement Study (HRS) [23]. The number of recalled words from both tests was added to obtain a total memory score (ranging from 0 to 20) with higher scores indicating better memory. The correlation coefficients between the immediate and de- layed recall at baseline was 0.65. Immediate and delayed recalls have been known to have good construct validity and consistency [24].
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Risk factors for incident falls in older men and women: the English longitudinal study of ageing

Risk factors for incident falls in older men and women: the English longitudinal study of ageing

Our finding that higher levels of pain was associated with a significantly greater risk of having an incident fall in men than in women is consistent with recent findings in the Swedish National Study on Aging and Care [27]. In that prospective study, several measures of pain (having daily pain, or pain that affected daily activities, or was at least mild to moderate) were linked with an in- creased risk of having a fall that required outpatient or inpatient care in men, but not in women [27]. In our study, as in the Swedish study, women were more likely to report higher levels of pain than men. There is con- siderable evidence, largely from studies using retrospect- ive data on falls, but also from some studies with prospective data, that the presence of pain, and particu- larly more severe pain, is associated with greater likeli- hood of falls [28, 29]. With the exception of the study by Welmer et al. [27] we are not aware of any other pro- spective studies that have reported a sex difference in the relationship between pain and risk of falls. One pos- sible explanation for the sex difference observed in the current study and in that by Welmer et al. may relate to the way women tend to view pain. Welmer et al. suggest that because women tend to be more fearful of pain than men [30], they may behave more carefully when in pain
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A comparison of response rates in the English Longitudinal Study of Ageing and the Health and Retirement Study

A comparison of response rates in the English Longitudinal Study of Ageing and the Health and Retirement Study

For purposes of comparison across studies, it may be of practical interest to supplement the rates proposed by Lynn (2005) with other types of response rates. For example, the impact of fieldwork management can be represented by using the field response rate, based only on those cases actually issued to field in a given wave. The conditional cross- sectional response rate in Lynn’s framework (presented in Table 6) is most similar to the field response rate, except that it excludes sample members who did not complete an interview in the prior wave and, thus, will always be higher than the field response rate. However, a downside of the conditional cross-sectional rates in this paper (conditional on participation in the immediately prior wave) is that they do not capture respondents’ movement in and out of the study. A critical element of longitudinal studies is bringing people back in after they missed a wave (e.g. see the Kapteyn et al article in this Special Issue) and this could be tracked by using yet another response rate: the cross-sectional response rate conditional on baseline response.
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MODEM: A comprehensive approach to modelling outcome and costs impacts of interventions for dementia  Protocol paper

MODEM: A comprehensive approach to modelling outcome and costs impacts of interventions for dementia Protocol paper

CFAS II: Cognitive function and ageing study; CSRI: Client service receipt inventory; ELSA: English longitudinal study of ageing; ESRC: Economic and social research council; HSE: Health survey of england; ICF: International classification of functioning, disability and health; MicSIMPOP: Micro-SIMulation POPulation model; MODEM: MODelling outcome and costs impacts of interventions for DEMentia.; NCDS: National child development study; NHS: National health service; NIHR: National institute for health research; PSSRU: Personal social services research unit; RUD: Resource utilization in dementia; SHIELD CSP RYCT: Carer supporter programme — remembering yesterday caring today; SIMPOP: Macro-SIMulation POPulation model; sMMSE: Standardised mini ‐ mental state examination; START: StrAtegies for RelaTives study; UK: United Kingdom; WHO: World Health Organization
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Older adults’ experiences of sexual difficulties: Qualitative findings from the English Longitudinal Study on Ageing (ELSA)

Older adults’ experiences of sexual difficulties: Qualitative findings from the English Longitudinal Study on Ageing (ELSA)

8 about current sexual partnerships. At the end of the SRA-Q there was an open comment box which invited participants to provide additional information. The specific prompt asked: “If there is anything else you would like to tell us, please write in the space below. We shall be very interested to read what you have to say.” Participants completed the SRA-Q in private and then sealed it in an envelope. All responses were anonymous. The qualitative data provided in the open comment boxes ranged from one sentence statements to six sentence descriptions. Ethics approval was obtained from NRES Committee South Central-Berkshire and full details of the study design have been described elsewhere (Steptoe et al., 2013).
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Economic inequalities in burden of illness, diagnosis and treatment of five long-term conditions in England: panel study.

Economic inequalities in burden of illness, diagnosis and treatment of five long-term conditions in England: panel study.

The English Longitudinal Study of Ageing (ELSA) provides new data that can be used to identify barriers to equitable receipt of healthcare, and constitutes a unique source of information on illness burden, self- reported medical diagnosis and treatment. Other data sources cover symptoms or diagnosis or treatment, but no other single source covers all three. ELSA collects data on symptoms and validated markers of common health conditions, as well as diagnosis and treatment. It also contains detailed sociodemographic information, including direct measures of personal wealth, on a sample selected to be representative of the population of England aged 50 years and older. These data can be used to compare socioeconomic inequalities for several conditions, providing insight into a healthcare system with no direct fi nancial barriers to treatment (the National Health Service in England). We aimed to assess socioeconomic inequalities in the burden of illness (esti- mated by validated scales, biomarker and reported symp- toms) of angina, cataract, depression, diabetes and osteoarthritis, and compare them with inequalities in self-reported medical diagnosis and treatment, in order to determine whether key components of healthcare were received equitably.
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Physical Activity and Healthy Ageing: A Systematic Review and Meta analysis of longitudinal cohort studies

Physical Activity and Healthy Ageing: A Systematic Review and Meta analysis of longitudinal cohort studies

12 midlife, were double compared to those that do none or mild exercise. Gu et al. (2009) revealed that elders who do regular exercise could improve the odds of healthy survival by 30% than those who do not, whereas Hamer et al. (2013) by using data from the English Longitudinal Study of Ageing (ELSA) found that people that did moderate or vigorous activity were 3.1-fold and 4.3-fold more likely to be healthy agers. Increased odds of healthy ageing were also reported to Hodge, English et al. (2013), to Hodge, O’Dea et al. (2013) and to LaCroix (2016). The only non-English study was that of Li et al. (2009) where regular exercise was also related to increased odds of successful ageing. Newman et al. (2003), Palmore (1979), Sabia et al. (2012), Shields & Martel (2006), Vaillant & Mukamal (2001), and Sun et al. (2010) also reported a positive association between physical activity and the odds of successful survival. Participants with higher levels of physical activity also reported higher levels of healthy ageing phenotype (Tampubolon et al., 2016). Only six out of the 23 studies report no association between healthy ageing and physical activity (Bell et al., 2014), (Ford et al, 2000), (Gureje et al., 2014), (Kaplan et al, 2008), (Pruchno & Wilson- Genderson, 2014) and (Terry et al. 2005). No study reported a negative association. In Table 2, the analytical results of this systematic review are presented. Statistics per study are provided for every category of the physical activity variable as well as for the most and least adjusted models. In addition, the confounders used for the final adjustment of the models are provided.
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Examining life course trajectories of lesbian, gay and bisexual people in England – exploring convergence and divergence among a heterogeneous population of older people

Examining life course trajectories of lesbian, gay and bisexual people in England – exploring convergence and divergence among a heterogeneous population of older people

Because of limitations in collecting sexuality data, there are very few studies that quantitatively explore the life courses of lesbian, gay, bisexual (LGB) individuals. Likewise it is rare that normative patterns of life course trajectories are assessed in terms of their applicability to LGB individuals. We review the current literature on LGB life course trajectories and discuss potential reasons for gaps in the literature. We explore approaches for defining LGB status. We use data from a cohort of people aged 50 and over (English Longitudinal Study of Ageing) to explore the tempo and occurrences of transitions to adulthood and to older age, and establish some of the differences based on sexual orientation. We examine the connecting health behaviours and life course turning points that may explain some of the differences described above. We show that while the first quartile of transitions to adulthood are experienced fairly uniformly by sexual orientation, differences open up thereafter. LGB people’s life course trajectories are marked by different patterns of care, with LGB people less likely to provide care in the form of parenthood, but potentially more likely to provide care earlier to close friends or relatives. Analyses of connecting events suggest that LGB life course trajectories may be marred by higher levels of volatility, including higher risk financial hardship. Caveats to these results are outlined in full in the paper.
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FOCUS ON Older People

FOCUS ON Older People

The English Longitudinal Study of Ageing showed that, in 2002, those in the older age groups were more likely to use public transport than those in younger age groups. Twenty three per cent of women aged 70–74 said they use public transport a lot, compared with 14 per cent of those aged 50–54. The study also showed that the most common reason for those who never or rarely used public transport was the lack of availability. Around 85 per cent of men and 83 per cent of women aged 50 and over said that they did not take public transport because it is not available.
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