Living arrangements, health Living arrangements, health and well-being: and well-being:

A European PerspectiveA European Perspective

UPTAP Inaugural ConferenceUPTAP Inaugural Conference30-31 March 200630-31 March 2006

Harriet Young and Emily GrundyHarriet Young and Emily GrundyLondon School of Hygiene and Tropical MedicineLondon School of Hygiene and Tropical Medicine

Aim of the study Aim of the study

To examine the possible consequences of To examine the possible consequences of different types of living arrangements for different types of living arrangements for the health and well-being of older people.the health and well-being of older people.

BackgroundBackground

Demographic changes over the last Demographic changes over the last century have led to older age structures century have led to older age structures throughout Europe. throughout Europe.

Declines in the proportions of older people Declines in the proportions of older people living with children and increases in living with children and increases in proportions living alone.proportions living alone.

BackgroundBackground

Research to date: Research to date: Those living with spouse are the most healthyThose living with spouse are the most healthy

Contradictory evidence: more healthy living Contradictory evidence: more healthy living with other relatives (no spouse) or with other relatives (no spouse) or living alone ? living alone ? • Mor et al (1989), Grundy (2001)Mor et al (1989), Grundy (2001)

Framework for examining effects of living Framework for examining effects of living alone in different social groups and settingsalone in different social groups and settings

Type of effectType of effect NegativeNegative Positive/neutralPositive/neutral

PsychologicalPsychological If living alone is If living alone is seen as seen as stigmatisingstigmatising

If independence If independence and autonomy and autonomy valuedvalued

Economic Economic Low income no Low income no opportunity for opportunity for economies of scaleeconomies of scale

No effect on high No effect on high income elderlyincome elderly

Services/careServices/care Elderly lacking Elderly lacking domestic skillsdomestic skills

No effect on No effect on ‘competent’ elderly‘competent’ elderly

Social SupportSocial Support If few other social If few other social tiesties

No effect on well-No effect on well-supportedsupported

Research ObjectivesResearch Objectives

1 & 2: Analyse associations between living 1 & 2: Analyse associations between living arrangements, health and well-being among arrangements, health and well-being among older people older people

Across Europe, examining differences between Across Europe, examining differences between groups of countriesgroups of countries

In more detail for England / England and WalesIn more detail for England / England and Wales

3: Examine pathways to living arrangements 3: Examine pathways to living arrangements and the effect that allowing for these has on and the effect that allowing for these has on health in England and Waleshealth in England and Wales

VariablesVariables

Different outcome variablesDifferent outcome variables Self-rated health, objective health measuresSelf-rated health, objective health measures Happiness scale, quality of life indicatorHappiness scale, quality of life indicator Indicators of functional capacityIndicators of functional capacity Psychological morbidityPsychological morbidity

Explanatory variableExplanatory variable Living arrangements: Living arrangements:

• spouse only, spouse only, • spouse and other,spouse and other,• Children or others only,Children or others only,• Alone Alone

1. Living arrangements and health: 1. Living arrangements and health: EuropeEurope

Dataset: European Social Survey (ESS)Dataset: European Social Survey (ESS)

Two cross-sectional rounds of data – 2002 and Two cross-sectional rounds of data – 2002 and 20042004

Using data from 18 countries - Excluded 7 Using data from 18 countries - Excluded 7 countries with response rates below 50%countries with response rates below 50%

Sample size 17,250 people aged 60+ Sample size 17,250 people aged 60+

Response rates – Round 1Response rates – Round 1CountryCountry Response rate Response rate

(%)(%)Country Country Response rateResponse rate

(%)(%)

GreeceGreece 8080 AustriaAustria 6060

FinlandFinland 7373 BelgiumBelgium 6060

Poland Poland 7373 GermanyGermany 5656

SloveniaSlovenia 7171 UKUK 5555

HungaryHungary 7070 SpainSpain 5353

SwedenSweden 7070 LuxembourgLuxembourg 4444

PortugalPortugal 6969 Italy Italy 4444

Netherlands Netherlands 6868 Czech Czech 4343

Denmark Denmark 6868 FranceFrance 4343

Norway Norway 6565 SwitzerlandSwitzerland 3434

*Note we have excluded *Note we have excluded Ireland & Israel Ireland & Israel from our samplefrom our sample

Country groupingsCountry groupings

NorthNorth West West SouthSouth EastEast

SwedenSweden

NorwayNorway

FinlandFinland

DenmarkDenmark

NetherlandsNetherlands

GermanyGermany

BelgiumBelgium

UKUK

AustriaAustria

PortugalPortugal

GreeceGreece

SpainSpain

PolandPoland

SloveniaSlovenia

SlovakiaSlovakia

HungaryHungary

UkraineUkraine

EstoniaEstonia

N=4184N=4184 N=4698N=4698 N=3865N=3865 N=3873N=3873

2. Living arrangements and health:2. Living arrangements and health:EnglandEngland

English Longitudinal Study of Ageing English Longitudinal Study of Ageing (ELSA)(ELSA)

First and second rounds of data – mainly First and second rounds of data – mainly use as cross-sectional resourceuse as cross-sectional resource

Approx 7000 people aged 60+Approx 7000 people aged 60+

3. Pathways to living arrangements 3. Pathways to living arrangements and associations with health and associations with health

Office for National Statistics Longitudinal Office for National Statistics Longitudinal Study (LS)Study (LS)

A record linkage study of population of A record linkage study of population of England and Wales, with 4 census points England and Wales, with 4 census points linked in, plus census information on linked in, plus census information on household members at each census. household members at each census.

117,000 people aged 60+ in 2001117,000 people aged 60+ in 2001 We use data from all 4 census points: We use data from all 4 census points:

1971-20011971-2001

AnalysisAnalysis

Carry out all analyses separately by gender, and Carry out all analyses separately by gender, and for Europe by region (sample sizes allowing)for Europe by region (sample sizes allowing)

Descriptive analysesDescriptive analyses

Logistic regression for binary outcomes (e.g. Logistic regression for binary outcomes (e.g. presence or absence of health condition)presence or absence of health condition)

Multinomial regression for categorical outcomes Multinomial regression for categorical outcomes (e.g. poor, fair, good health)(e.g. poor, fair, good health)

Progress to dateProgress to date European Social Survey: European Social Survey:

Chosen variablesChosen variables Selected groups of countriesSelected groups of countries Analysis planAnalysis plan Initial analyses of ESS datasetInitial analyses of ESS dataset

English Longitudinal Study of Ageing English Longitudinal Study of Ageing Chosen variables to useChosen variables to use Analysis planAnalysis plan

ONS Longitudinal StudyONS Longitudinal Study Started analysis planStarted analysis plan