Generalised and abdominal obesity and risk of diabetes, hypertension and hypertension–diabetes co-morbidity in England

Objectives To look at trends in generalised (body mass index (BMI) ≥30 kg m–2) and abdominal (waist circumference (WC) >102 cm in men, >88 cm in women) obesity among adults between 1993 and 2003, and to evaluate their association with diabetes, hypertension and hypertension–diabetes co-morbidity (HDC) in England. Design Analyses of nationally representative cross-sectional population surveys, the Health Survey for England (HSE). Subjects Non-institutionalised men and women aged ≥35 years. Measurements Interviewer-administered questionnaire (sociodemographic information, risk factors, doctor-diagnosed diabetes), measurements of height and weight to calculate BMI. WC and blood pressure measurements were taken by trained nurses. Results Generalised obesity increased among men from 15.8% in 1993 to 26.3% in 2003, and among women from 19.3% to 25.8%. Abdominal obesity also increased in both sexes (men: 26.2% in 1993 to 39.0% in 2003; women: 32.4% to 47.0%). In 1994, 1998 and 2003, generalised and abdominal obesity were independently associated with risk of hypertension, diabetes and HDC. The odds of diabetes associated with generalised obesity in 1994, 1998 and 2003 were 1.62, 2.26 and 2.62, respectively, in women and 1.24, 1.82 and 2.10, respectively, in men. Similar differences were observed for hypertension and HDC. Men and women with abdominal obesity also showed a higher risk for diabetes, hypertension and HDC than those with a normal WC. Conclusions If current trends in obesity continue then the risk of related morbidities may also increase. This will impact on cardiovascular disease morbidity and mortality, with cost implications for the health service. Therefore there is an urgent need to control the epidemic of obesity

Gender differences in quality of life and depression among older people with coronary heart disease

This study explored gender differences in quality of life and depressive symptoms over time among people with coronary heart disease (CHD) and compared them with a healthy population. Using three waves of the English Longitudinal Study of Ageing (2002-03, 2004-05 and 2006-07) methodological problems such as missing data and sources of error and uncertainty which may arise from reliance on a self-reported measure of CHD were addressed. A simulation study was set up to compare three techniques for dealing with missing data: full information maximum likelihood, multivariate normal imputation and a two-fold fully conditional specification. Results supported the use of the latter technique which outperformed the other two techniques in recovering the targeted parameters, especially with a binary outcome. Results based on imputed data showed that compared to people from the healthy population, men and women with CHD had on average lower levels of quality of life. Men with CHD were also at higher risk of having depressive symptoms than men from the healthy population. Women with CHD were as likely as women from the healthy population to have depressive symptoms. Trajectories over time of quality of life had a different shape from trajectories of depressive symptoms after the onset of CHD. Men’s quality of life declined over time and no changes in depressive symptoms were found. Women’s quality of life declined only between baseline and four year follow-up, while in the same period their risk of having depressive symptoms reduced. A sensitivity analysis based on an external validation study and a deterministic sensitivity analysis helped understand the impact that misclassification of the self-reported CHD measure could have on the results of this thesis. It was found that the reliability of the results presented could be affected by false positive and false negative cases of CHD

Lower socioeconomic status and the acceleration of aging: An outcome-wide analysis

Aging involves decline in a range of functional abilities and phenotypes, many of which are also associated with socioeconomic status (SES). Here we assessed whether lower SES is a determinant of the rate of decline over 8 y in six domains—physical capability, sensory function, physiological function, cognitive performance, emotional well-being, and social function—in a sample of 5,018 men and women aged 64.44 (SD 8.49) y on average at baseline. Wealth was used as the marker of SES, and all analyses controlled for age, gender, ethnicity, educational attainment, and long-term health conditions. Lower SES was associated with greater adverse changes in physical capability (grip strength, gait speed, and physical activity), sensory function (sight impairment), physiological function (plasma fibrinogen concentration and lung function), cognitive performance (memory, executive function, and processing speed), emotional well-being (enjoyment of life and depressive symptoms), and social function (organizational membership, number of close friends, volunteering, and cultural engagement). Effects were maintained when controlling statistically for other factors such as smoking, marital/partnership status, and self-rated health and were also present when analyses were limited to participants aged ≤75 y. We conclude that lower SES is related to accelerated aging across a broad range of functional abilities and phenotypes independently of the presence of health conditions and that social circumstances impinge on multiple aspects of aging

Joint Trajectories of Spousal Social Support and Depressive Symptoms in Older Age

OBJECTIVE: We describe changes in depressive symptoms and positive and negative social support from the spouse/partner in a representative sample of older people in England. METHOD: Men and women aged 50+ ( N = 7,171) from the English Longitudinal Study of Ageing reported social support and depressive symptoms (Center for Epidemiologic Studies Depression Scale) on up to five occasions between 2002-2003 and 2010-2011. Parallel process latent growth models estimated their bidirectional associations, adjusted for gender, wealth, education, and limiting illness. RESULTS: In age- and gender-adjusted models, positive spousal support decreased and negative support increased over time, especially among women. Greater increases over time in depressive symptoms were seen in those with lower positive support or higher negative support at baseline. More baseline depressive symptoms predicted greater declines in positive support and greater increases in negative support from the spouse. DISCUSSION: Improving older couple's relationship quality may help reduce depressive symptoms

Sustained enjoyment of life and mortality at older ages: analysis of the English Longitudinal Study of Ageing

OBJECTIVE:  To test whether the number of reports of enjoyment of life over a four year period is quantitatively associated with all cause mortality, and with death from cardiovascular disease and from other causes. DESIGN AND SETTING:  Longitudinal observational population study using the English Longitudinal Study of Ageing (ELSA), a nationally representative sample of older men and women living in England. PARTICIPANTS:  9365 men and women aged 50 years or older (mean 63, standard deviation 9.3) at recruitment. MAIN OUTCOME MEASURES:  Time to death, based on mortality between the third phase of data collection (wave 3 in 2006) and March 2013 (up to seven years). RESULTS:  Subjective wellbeing with measures of enjoyment of life were assessed in 2002 (wave 1), 2004 (wave 2), and 2006 (wave 3). 2264 (24%) respondents reported no enjoyment of life on any assessment, with 1833 (20%) reporting high enjoyment on one report of high enjoyment of life, 2063 (22%) on two reports, and 3205 (34%) on all three occasions. 1310 deaths were recorded during follow-up. Mortality was inversely associated with the number of occasions on which participants reported high enjoyment of life. Compared with the no high enjoyment group, the hazard ratio for all cause mortality was 0.83 (95% confidence interval 0.70 to 0.99) for two reports of enjoyment of life, and 0.76 (0.64 to 0.89) for three reports, after adjustment for demographic factors, baseline health, mobility impairment, and depressive symptoms. The same association was observed after deaths occurring within two years of the third enjoyment measure were excluded (0.90 (0.85 to 0.95) for every additional report of enjoyment), and in the complete case analysis (0.90 (0.83 to 0.96)). CONCLUSIONS:  This is an observational study, so causal conclusions cannot be drawn. Nonetheless, the results add a new dimension to understanding the significance of subjective wellbeing for health outcomes by documenting the importance of sustained wellbeing over time

A model-driven approach to better identify older people at risk of depression

Depression in later life is one of the most common mental disorders. Several instruments have been developed to detect the presence or the absence of certain symptoms or emotional disorders, based on cut-off points. However, the use of a cut-off does not allow identification of depression sub-types or distinguish between mild and severe depression. As a result, depression may be under- or over-diagnosed in older people. This paper aims to apply a model-driven approach to classify individuals into distinct sub-groups, based on different combinations of depressive and emotional conditions. This approach is based on two distinct statistical solutions: first, a latent class analysis is applied to the items collected by the depression scale and, according to the final model, the probability of belonging to each class is calculated for every individual. Second, a factor analysis of these classes is performed to obtain a reduced number of clusters for easy interpretation. We use data collected through the EURO-D scale in a large sample of older individuals, participants of the sixth wave of the Survey of Health, Ageing and Retirement in Europe. We show that by using such a model-based approach it is possible to classify individuals in a more accurate way than the simple dichotomisation ‘depressed’ versus ‘non-depressed’

Is grandparental childcare socio-economically patterned? Evidence from the English longitudinal study of ageing

Grandparents play a vital role in providing childcare to families. Qualitative research and evidence from parents raise concerns that it is grandparents who are socio-economically disadvantaged who provide grandchild care more regularly, perform more intensive tasks, and care out of financial necessity. However, no European studies have investigated these issues at population level. This study is based on grandparents aged 50+ who looked after grandchildren. Data are from wave 8 of the nationally representative English Longitudinal Study of Ageing (2016/2017). We exploit newly collected information on frequency of grandchild care, activities, and reasons for care. Using multinomial regressions, we first examined the extent to which grandparents’ socio-economic characteristics (wealth and education) are associated with frequency of grandchild care. Second, using logistic regressions, we investigated whether wealth and education are associated with activities and reasons for grandchild care. Overall, grandparents from disadvantaged socio-economic backgrounds were more likely to provide more regular childcare. Similarly, grandparents in the lowest wealth quartile were more involved in hands-on activities (cooking, taking/collecting grandchildren to/from school), whereas highly educated grandparents were more likely to help grandchildren with homework. Finally, better-off grandparents were more likely to look after grandchildren to help parents and provide emotional support and less likely to report difficulty in refusing to provide care. Our findings show that grandparental childcare varies by socio-economic status with more intensive childcare activities falling disproportionately on those with fewer resources, and this may act to exacerbate existing socio-economic inequalities in later life

Prevalence of Undiagnosed Diabetes in 2004 and 2012: Evidence From the English Longitudinal Study of Aging

BACKGROUND: In light of recent publicity campaigns to raise awareness of diabetes, we investigated changes in the prevalence of diabetes and undiagnosed diabetes in adults age 50 and older in England between 2004 and 2012, and explored risk factors for undiagnosed diabetes. METHOD: 7666 and 7729 individuals were from Wave 2 (2004-2005, mean age 66.6) and Wave 6 (2012-2013, mean age 67.6) of the English Longitudinal Study of Ageing. Diagnosed diabetes was defined as either self-reported diabetes or taking diabetic medications. Undiagnosed diabetes was defined as not self-reporting diabetes and not taking diabetic medications, but having a glycated haemoglobin measurement ≥ 48 mmol/mol (6.5%). RESULTS: There were increases in both diagnosed diabetes (7.7% to 11.5%) and undiagnosed diabetes (2.4% to 3.4%) between 2004 and 2012. However, a small decrease in the proportion of people with diabetes who were unaware of this condition (24.5% to 23.1%, p<0.05) was observed. Only men aged 50-74 showed a stable prevalence of undiagnosed diabetes, with better recognition of diabetes. Age, non-white ethnicity, manual social class, higher diastolic blood pressure and cholesterol level were factors associated with higher risks of undiagnosed diabetes, whereas greater depressive symptoms were related to lower risks. CONCLUSION: This study suggests that the greater awareness of diabetes in the population of England has not resulted in a decline in undiagnosed cases between 2004 and 2012. A greater focus on people from lower socioeconomic groups and those with cardiometabolic risk factors may help early diagnosis of diabetes for older adults

The experience of older people with multimorbidity during the COVID-19 pandemic

The risk of severe COVID-19 disease is known to be higher in older individuals with multiple long-term health conditions (multimorbidity). In this briefing, we report the latest findings from the English Longitudinal Study of Ageing COVID-19 Substudy on the experiences of older people with multimorbidity during the pandemic. Not all people with multimorbidity would be classified as clinically vulnerable. We found that 35% of older individuals with multimorbidity were instructed by the NHS or their GP to shield (staying at home at all times and avoiding any face-to-face contact) on account of their vulnerability, and the majority were largely compliant with this advice. Relative to study members without multimorbidity, respondents with multimorbidity were more likely to report poor sleep quality, eating less, and being worried about not having enough food and other essentials. Unhealthy behaviours (sitting time, physical inactivity etc), poor mental health, and loneliness deteriorated considerably during the lockdown and in the two months following the lockdown. Access to medications among people with multimorbidity was not a problem, however, a fifth of individuals with multimorbidity did not have access to community health, social care services and support from other health professionals (e.g., dentist, podiatrist). When considering policies which advise people to shield or self-isolate because of their COVID-19 risk, it is important for policymakers to acknowledge that older people with multiple long-term health conditions are at higher risk of experiencing greater mental distress and worry, of engaging in unhealthy behaviours and are less likely to access health services when needed; all these factors together could potentially influence disease progression

Looking after grandchildren: gender differences in 'when,' 'what,' and 'why': Evidence from the English Longitudinal Study of Ageing

Background: Grandparents play a vital role in providing childcare to families. However, little is known about when grandmothers and grandfathers look after grandchildren, what they do with them, and why. / Objective: Using novel questions on grandparenting, we first describe the periodicity of grandchild care, activities undertaken with/for grandchildren, and motivations for such care to then assess if there are gender differences. / Methods: We used wave 8 (2016/17) of the nationally-representative English Longitudinal Study of Ageing. The extent to which the periodicity, activities, and motivations are gendered was assessed using logistic regressions. Analyses were carried out on the entire sample of grandparents who provide childcare as well as on coresiding grandparent couples where both grandparents provide grandchild care. / Results: More than 50% of grandparents looked after grandchildren, with the majority doing so throughout the year and about one in four during school holidays. Few gender differences were observed in the periodicity of grandchild care and reasons for looking after grandchildren, with almost two-thirds reporting that they wanted to help parents go to work and give them a break. However, when activities undertaken for/with grandchildren were analysed, clear gender differences emerged. Overall, grandmothers were more likely to report caring and helping activities (e.g., cooking, caring when sick, helping with homework, and collecting them from school) than grandfathers, even when they coresided. / Contribution: Our study is the first to document, at a population level, gender differences in the periodicity of grandchild care, what grandparents do when they look after grandchildren, and why they provide such care