Living arrangements, health and well-being: A European Perspective UPTAP Inaugural Conference March 2006 Harriet Young and Emily Grundy London School of Hygiene and Tropical Medicine

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

Background  Demographic changes over the last century have led to older age structures throughout Europe.  Declines in the proportions of older people living with children and increases in proportions living alone.

Background  Research to date: Those living with spouse are the most healthy Those living with spouse are the most healthy Contradictory evidence: more healthy living with other relatives (no spouse) or living alone ? Contradictory evidence: more healthy living with other relatives (no spouse) or living alone ? Mor et al (1989), Grundy (2001)Mor et al (1989), Grundy (2001)

Framework for examining effects of living alone in different social groups and settings Type of effect NegativePositive/neutral Psychological If living alone is seen as stigmatising If independence and autonomy valued Economic Low income no opportunity for economies of scale No effect on high income elderly Services/care Elderly lacking domestic skills No effect on ‘competent’ elderly Social Support If few other social ties No effect on well- supported

Research Objectives  1 & 2: Analyse associations between living arrangements, health and well-being among older people Across Europe, examining differences between groups of countries Across Europe, examining differences between groups of countries In more detail for England / England and Wales In more detail for England / England and Wales  3: Examine pathways to living arrangements and the effect that allowing for these has on health in England and Wales

Variables  Different outcome variables Self-rated health, objective health measures Self-rated health, objective health measures Happiness scale, quality of life indicator Happiness scale, quality of life indicator Indicators of functional capacity Indicators of functional capacity Psychological morbidity Psychological morbidity  Explanatory variable Living arrangements: Living arrangements: spouse only,spouse only, spouse and other,spouse and other, Children or others only,Children or others only, AloneAlone

1. Living arrangements and health: Europe  Dataset: European Social Survey (ESS)  Two cross-sectional rounds of data – 2002 and 2004  Using data from 18 countries - Excluded 7 countries with response rates below 50%  Sample size 17,250 people aged 60+

Response rates – Round 1 Country Response rate (%) Country Response rate (%) Greece80Austria60 Finland73Belgium60 Poland73Germany56 Slovenia71UK55 Hungary70Spain53 Sweden70Luxembourg44 Portugal69Italy44 Netherlands68Czech43 Denmark68France43 Norway65Switzerland34 *Note we have excluded Ireland & Israel from our sample

Country groupings NorthWestSouthEast SwedenNorwayFinlandDenmarkNetherlandsGermanyBelgiumUKAustriaPortugalGreeceSpainPolandSloveniaSlovakiaHungaryUkraineEstonia N=4184N=4698N=3865N=3873

2. Living arrangements and health: England  English Longitudinal Study of Ageing (ELSA)  First and second rounds of data – mainly use as cross-sectional resource  Approx 7000 people aged 60+

3. Pathways to living arrangements and associations with health  Office for National Statistics Longitudinal Study (LS)  A record linkage study of population of England and Wales, with 4 census points linked in, plus census information on household members at each census.  117,000 people aged 60+ in 2001  We use data from all 4 census points:

Analysis  Carry out all analyses separately by gender, and for Europe by region (sample sizes allowing)  Descriptive analyses  Logistic regression for binary outcomes (e.g. presence or absence of health condition)  Multinomial regression for categorical outcomes (e.g. poor, fair, good health)

Progress to date  European Social Survey: Chosen variables Chosen variables Selected groups of countries Selected groups of countries Analysis plan Analysis plan Initial analyses of ESS dataset Initial analyses of ESS dataset  English Longitudinal Study of Ageing Chosen variables to use Chosen variables to use Analysis plan Analysis plan  ONS Longitudinal Study Started analysis plan Started analysis plan