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

A European PerspectiveA European Perspective

UPTAP-ONS MeetingUPTAP-ONS MeetingSouthampton UniversitySouthampton University

1919thth December 2007 December 2007

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

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.

BackgroundBackgroundWhat are the implications for health and well-being ? What are the implications for health and well-being ?

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

Contradictory evidence for those not living with Contradictory evidence for those not living with spouse: more healthy living with other relatives or spouse: more healthy living with other relatives or living alone ? living alone ? • Michael et al (2001), Grundy (2001)Michael et al (2001), Grundy (2001)

Selection effectsSelection effects

Effects vary according to cultural and socio-Effects vary according to cultural and socio-economic contexteconomic context

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 Scales of happiness scale, satisfaction with life & Scales of happiness scale, satisfaction with life &

lonelinessloneliness Psychological morbidity – CES-D depression scalePsychological morbidity – CES-D depression scale Self-rated health & limiting long term illnessSelf-rated health & limiting long term illness Indicators of functional capacityIndicators of functional capacity MortalityMortality

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

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

Two cross-sectional rounds of data – 2002 Two cross-sectional rounds of data – 2002 and 2004and 2004

Using data from 19 countriesUsing data from 19 countries

Sample size 18,131 people aged 60+ Sample size 18,131 people aged 60+

Country groupingsCountry groupingsNorthNorth West West SouthSouth EastEast

SwedenSweden

NorwayNorway

FinlandFinland

DenmarkDenmark

GermanyGermany

BelgiumBelgium

UKUK

AustriaAustria

NetherlandsNetherlands

PortugalPortugal

GreeceGreece

SpainSpain

PolandPoland

SloveniaSlovenia

SlovakiaSlovakia

HungaryHungary

UkraineUkraine

EstoniaEstonia

Czech Czech RepublicRepublic

N=3621N=3621 N=5867N=5867 N=3857N=3857 N=4786N=4786

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

Two waves of data in 2002 and 2004Two waves of data in 2002 and 2004

Cross-sectional dataset of population aged Cross-sectional dataset of population aged 60+ in Wave One – 7146 people60+ in Wave One – 7146 people

Longitudinal dataset of population aged Longitudinal dataset of population aged 60+ in Wave One and present at Wave 60+ in Wave One and present at Wave Two – 5443 peopleTwo – 5443 people

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

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

Dataset of population aged 60+ at 2001 Census Dataset of population aged 60+ at 2001 Census and present at all 4 census points: and present at all 4 census points: 80,937 people. 80,937 people.

Dataset of population aged 60+ at 1991 Census Dataset of population aged 60+ at 1991 Census and present 1971-1991: 91,155 peopleand present 1971-1991: 91,155 people

Psychological health and well-beingPsychological health and well-being

Associations between living arrangements Associations between living arrangements and….and…. ESS: Happiness and satisfaction with life ESS: Happiness and satisfaction with life

scales (0-10): ordinal regressionscales (0-10): ordinal regression ELSA: 8 point CES-Depression score : ordinal ELSA: 8 point CES-Depression score : ordinal

regressionregression ELSA: Loneliness scale (9 item scale from 4 ELSA: Loneliness scale (9 item scale from 4

questions): linear regressionquestions): linear regression

This model controlled for gender, age, smoking, wealth, housing tenure, contact with This model controlled for gender, age, smoking, wealth, housing tenure, contact with relatives, contact with friends, membership of social organisations and ADL limitationsrelatives, contact with friends, membership of social organisations and ADL limitations

Odds from ordinal logistic regression of being depressed compared with those living alone,

people aged 60+ in England, ELSA 2002 (low OR = less depressed)

0.5

0.6

0.7

0.8

0.9

1

1.1

Spouse only Spouse and others Non-spouse others

Living arrangement

Od

ds

ra

tio

ELSA

This model controlled for gender, age, contact with relatives, contact with friends, membership of social organisations, health status at wave one, presence of depression at wave 1

Loneliness coefficient from linear regression compared with those living alone, people aged

60+ in England, ELSA 2002-4 (lower coefficient= less lonely)

-1

-0.8

-0.6

-0.4

-0.2

0

0.2

Spouse only Spouse & others Non-spouse others

Living arrangement

Od

ds

ra

tio

ELSA

Adjusted odds ratios from ordinal regression of living Adjusted odds ratios from ordinal regression of living arrangements on happiness compared with living alone, arrangements on happiness compared with living alone,

aged 60+,19 European Countries, ESS 2002-4aged 60+,19 European Countries, ESS 2002-4(h(higher OR =happier)igher OR =happier)

Models adjusted for region, age, income, education, feelings about income, social Models adjusted for region, age, income, education, feelings about income, social meetings and activities, current widowhood and limiting long term illness. meetings and activities, current widowhood and limiting long term illness.

ESS

0.5

1

1.5

2

2.5

Spouse only Spouse andothers

Others only Spouse only Spouse andothers

Others only

Men Women

Od

ds

ra

tio

Table 3: Odds ratios from ordinal logistic regression of Table 3: Odds ratios from ordinal logistic regression of living arrangements & other factors on happiness for living arrangements & other factors on happiness for

non-marriednon-married women, women, 19 European countries ESS 2002-4*19 European countries ESS 2002-4*

* Model also controls for age, region, income, education, feelings about income, * Model also controls for age, region, income, education, feelings about income, indicators of social contacts, whether currently widowed, & region for Europe-indicators of social contacts, whether currently widowed, & region for Europe-wide model * p<0.05 ** p<0.01 *** p<0.001wide model * p<0.05 ** p<0.01 *** p<0.001

Odds RatioOdds Ratio

(lower OR= less happy)(lower OR= less happy)

Living arrangements (living with non-spouse other vv alone) Living arrangements (living with non-spouse other vv alone)

All countriesAll countries 1.71.7 ******

NordicNordic 1.21.2

WestWest 2.12.1 ******

SouthSouth 2.12.1 **

EastEast 1.41.4 **

ESS

Self rated health and mortalitySelf rated health and mortality

Associations between living arrangements and:Associations between living arrangements and: Self rated health usingSelf rated health using

ELSA ( 5 level variable: poor, fair, good, very good, ELSA ( 5 level variable: poor, fair, good, very good, excellent health): ordinal logistic regressionexcellent health): ordinal logistic regression

ONS LS (binary variable: good & fair health vv poor ONS LS (binary variable: good & fair health vv poor health): logistic regressionhealth): logistic regression

ESS (6 level variable): ordinal logistic regressionESS (6 level variable): ordinal logistic regression

ONS LS: death 2001 Census to end 2004: ONS LS: death 2001 Census to end 2004: logistic regressionlogistic regression

This model controlled for gender, age, smoking, wealth, housing tenure, contact with This model controlled for gender, age, smoking, wealth, housing tenure, contact with relatives, contact with friends, membership of social organisations and self-rated relatives, contact with friends, membership of social organisations and self-rated health statushealth status

Odds ratio of having poor self-rated health compared with those living alone, people aged

60+ in England, ELSA 2002(high OR=poorer self-rated health)

0.60.8

11.21.41.61.8

2

Spouse only Spouse & others Non-spouse others

Living arrangement

Od

ds

ra

tio

ELSA

Odds Ratios from logistic regression of poor self-rated Odds Ratios from logistic regression of poor self-rated health on living arrangement change 1991 and 2001 for health on living arrangement change 1991 and 2001 for

people aged 60+. England and Wales, ONS LS. people aged 60+. England and Wales, ONS LS.

Odds ratioOdds ratio

Living arrangement change 1991-2001 Living arrangement change 1991-2001 (ref group: (ref group: with spouse both points or moved to live with spouse)with spouse both points or moved to live with spouse)

Alone bothAlone both 0.930.93 ****

Non-spouse other bothNon-spouse other both 1.211.21 ******

To live aloneTo live alone 0.930.93 ****

To live with non-spouse To live with non-spouse othersothers

1.311.31 ******

To communal To communal establishmentestablishment

1.831.83 ******

Model also controlled for age, gender, tenure and car access score, region and Model also controlled for age, gender, tenure and car access score, region and limiting long term illness in 1991.limiting long term illness in 1991.

ONS LS

Odds Ratios from logistic regression of poor self-rated Odds Ratios from logistic regression of poor self-rated health & death on living arrangement change 1991 and health & death on living arrangement change 1991 and

2001 for people aged 60+. England and Wales, ONS LS. 2001 for people aged 60+. England and Wales, ONS LS.

Self rated health 2001Self rated health 2001

Odds ratioOdds ratio

Death 2001-2004Death 2001-2004

Odds ratioOdds ratio

Living arrangement change 1991-2001 (ref group: with spouse both Living arrangement change 1991-2001 (ref group: with spouse both points or moved to live with spouse)points or moved to live with spouse)

Alone bothAlone both 0.930.93 **** 1.101.10 ****

Non-spouse other bothNon-spouse other both 0.210.21 ****** 1.281.28 ******

To live aloneTo live alone 0.930.93 **** 1.161.16 ******

To live with non-spouse To live with non-spouse othersothers

1.311.31 ****** 1.441.44 ******

To communal To communal establishmentestablishment

1.831.83 ****** 5.695.69 ******

Model also controlled for age, gender, tenure and car access score, region and Model also controlled for age, gender, tenure and car access score, region and limiting long term illness in 1991.limiting long term illness in 1991.

ONS LS

Self rated health and living Self rated health and living arrangements: ESS dataarrangements: ESS data

Women living with others and with spouse had Women living with others and with spouse had better self-rated health than alone. better self-rated health than alone.

Men living with spouse had better self-rated Men living with spouse had better self-rated health than alone, but no difference between health than alone, but no difference between those living with others and alone.those living with others and alone.

Regional analysis: No significant associations. Regional analysis: No significant associations.

ESS

LimitationsLimitations Comparability of variables between datasets Comparability of variables between datasets

Proportion of population in institutions differs Proportion of population in institutions differs throughout Europe – exclusion of this group may throughout Europe – exclusion of this group may have biased ESS results. have biased ESS results.

Longitudinal analysis: 10 yearly interval for Longitudinal analysis: 10 yearly interval for change in living arrangements using ONS LS.change in living arrangements using ONS LS.

In some analyses, small sample sizes limiting In some analyses, small sample sizes limiting power of analysispower of analysis

ConclusionsConclusions

Clear association between living alone and Clear association between living alone and higher levels of depression, loneliness and higher levels of depression, loneliness and unhappiness (ESS & ELSA).unhappiness (ESS & ELSA).

Contradictory findings on self-rated health. Contradictory findings on self-rated health.

Differing findings depending on health Differing findings depending on health indicator usedindicator used

The EndThe End

Thank youThank you

Harriet.Young@lshtm.ac.ukHarriet.Young@lshtm.ac.uk

Emily.Grundy@lshtm.ac.ukEmily.Grundy@lshtm.ac.uk