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Introduction: The Health and Retirement Study International Partner Surveys (HRS IPS) have rich longitudinal data, but the brevity of cognitive batteries is a limitation., Methods: We used data from a substudy of the English Longitudinal Study of Ageing (ELSA) administering detailed cognitive assessments with the Harmonized Cognitive Assessment Protocol (ELSA-HCAP) (N = 1273) to inform approaches for estimating cognition in ELSA (N = 11,213). We compared two novel approaches: confirmatory factor analysis (CFA)- and regression-based prediction., Results: Compared to estimates from the full HCAP battery, estimated cognitive functioning derived using regression models or CFA had high correlations (regression: r = 0.85 [95% confidence interval [CI]: 0.83 to 0.87]; CFA: r = 0.83 [95% CI: 0.81 to 0.85]) and reasonable mean squared error (regression: 0.25 [0.22 to 0.27]; CFA: 0.29 [0.26 to 0.32]) in held-out data. The use of additional items from waves 7 to 9 improved performance., Discussion: Both approaches are recommended for future research; the similarity in approaches may be due to the brevity of available cognitive assessments in ELSA., Highlights: Estimates of cognitive functioning informed by English Longitudinal Study of Ageing-Harmonized Cognitive Assessment Protocol (ELSA-HCAP) data had an adequate performance. Standard errors were smaller for associations with example risks when using measures informed by ELSA-HCAP. Performance was better when including additional cognitive measures available in waves 7 to 9. Conceptual advantages to the confirmatory factor analysis (CFA) approach were not important in practice due to the brevity of the ELSA cognitive battery., (© 2024 The Author(s). Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Background: Intrinsic capacity (IC) is a new concept in the healthy aging field and has many operationalized definitions. In this study, we operationalized IC using item response theory in the English Longitudinal Study of Ageing (ELSA) and tested the predictive value of the scale using a subsequent functional ability, mortality, and hospital admission., Methods: IC was measured at baseline (2004, Wave 2) using 14 dichotomous indicators: word recall, orientation in time, balance, chair rises, walking speed, upper mobility, lower mobility, eyesight, hearing, grip strength, body mass index, waist circumference, depressive symptoms, and life satisfaction. A 2-parameter item response theory model was used to generate a scale of IC at baseline. Logistic regression was used for the prediction of subsequent difficulties, measured by difficulties with ≥1 activities of daily living (ADLs) and ≥1 instrumental activities of daily living (IADLs) at 4 and 8 years after baseline. Competing risk and Cox regressions were employed to test the prediction of hospital admission and mortality, respectively, over a 14-year follow-up., Results: IC scores were generated for 4 545 individuals aged on average 70.8 years (standard deviation [SD] 7.93). Better baseline IC scores were associated with reduced risk of subsequent difficulties with ADLs and IADLs, hospital admission (subdistribution hazard ratios [SHR] = 0.99, 95% confidence interval [CI] 0.98-0.99), and mortality (hazard ratios [HR] = 0.98, 95% CI 0.98-0.99), when adjusted for sociodemographic and health-related covariates., Conclusion: These results suggest the utility of this IC score as a measure of risk for future adverse outcomes in older people, potentially above that indicated by other sociodemographic and health-related factors., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Background: Although medicines are prescribed based on clinical guidelines and expected to benefit patients, both positive and negative health outcomes have been reported associated with polypharmacy. Mortality is the main outcome, and information on cause-specific mortality is scarce. Hence, we investigated the association between different levels of polypharmacy and all-cause and cause-specific mortality among older adults., Method: The English Longitudinal Study of Ageing is a nationally representative study of people aged 50+. From 2012/2013, 6 295 individuals were followed up to April 2018 for all-cause and cause-specific mortality. Polypharmacy was defined as taking 5-9 long-term medications daily and heightened polypharmacy as 10+ medications. Cox proportional hazards regression and competing-risks regression were used to examine associations between polypharmacy and all-cause and cause-specific mortality, respectively., Results: Over a 6-year follow-up period, both polypharmacy (19.3%) and heightened polypharmacy (2.4%) were related to all-cause mortality, with hazard ratios of 1.51 (95% CI: 1.05-2.16) and 2.29 (95% CI: 1.40-3.75) respectively, compared with no medications, independently of demographic factors, serious illnesses and long-term conditions, cognitive function, and depression. Polypharmacy and heightened polypharmacy also showed 2.45 (95% CI: 1.13-5.29) and 3.67 (95% CI: 1.43-9.46) times higher risk of cardiovascular disease deaths, respectively. Cancer mortality was only related to heightened polypharmacy., Conclusion: Structured medication reviews are currently advised for heightened polypharmacy, but our results suggest that greater attention to polypharmacy in general for older people may reduce adverse effects and improve older adults' health., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Aim: To study the association between diabetes and the prevalence of and risk factors for polypharmacy among adults aged 50 and older in England., Methods: A cross-sectional study (2012-2013) of the English Longitudinal Study of Ageing. Polypharmacy was defined as taking 5-9 long-term medications a day and heightened polypharmacy as 10 or more. Diabetes included diagnosed and undiagnosed cases (glycated haemoglobin ≥ 6.5% (48 mmol/mol))., Results: Of 7729 participants, 1100 people had diabetes and showed higher prevalence rates of polypharmacy (41.1% vs 14.8%) and heightened polypharmacy (5.8% vs 1.7%) than those without diabetes, even when antihyperglycemic medications were excluded. Risk factors for polypharmacy also differed according to diabetes status. Among people with diabetes, risk factors for polypharmacy and heightened polypharmacy were having more long-term conditions (relative risk ratio (RRR) = 1.86; 3.51) and being obese (RRR = 1.68; 3.68), while females were less likely to show polypharmacy (RRR = 0.51) and heightened polypharmacy (RRR = 0.51) than males. Older age (RRR = 1.04) was only related to polypharmacy among people without diabetes., Conclusions: Adults with diabetes had higher prevalence rates of polypharmacy and heightened polypharmacy than those without diabetes, regardless of including antihyperglycemic drugs. Early detection of polypharmacy among older people with diabetes needs to focus on co-morbidities and obesity., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

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., Competing Interests: The authors declare no competing interest., (Copyright © 2020 the Author(s). Published by PNAS.)

Background: Hearing impairment is common at an older age and has considerable social, health and economic implications. With an increase in the ageing population, there is a need to identify modifiable risk factors for hearing impairment. A shared aetiology with cardiovascular disease (CVD) has been advanced as CVD risk factors (e.g. obesity, type 2 diabetes) are associated with a greater risk of hearing impairment. Moreover, low-grade inflammation is implicated in the aetiology of CVD. Accordingly, our aim was to investigate the association between several markers of inflammation - C-reactive protein, fibrinogen and white blood cell count - and hearing impairment., Methods: Participants of the English Longitudinal Study of Ageing aged 50-93 were included. Inflammatory marker data from both wave 4 (baseline, 2008/09) and wave 6 (2012/13) were averaged to measure systemic inflammation. Hearing acuity was measured with a simple handheld tone-producing device at follow-up (2014/15)., Results: Among 4879 participants with a median age of 63 years at baseline, 1878 (38.4%) people presented hearing impairment at follow-up. All three biomarkers were positively and linearly associated with hearing impairment independent of age and sex. After further adjustment for covariates, including cardiovascular risk factors (smoking, physical activity, obesity, diabetes, hypertension, cholesterol), memory and depression, only the association with white blood cell count remained significant: odds ratio per log-unit increase; 95% confidence interval = 1.46; 1.11, 1.93., Conclusions: While white blood cell count was positively associated with hearing impairment in older adults, no relationships were found for two other markers of low-grade inflammation., (Copyright © 2019 Elsevier Inc. All rights reserved.)

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.

Objectives: To explore age trajectories of body mass index (BMI) and waist circumference (WC) and to examine whether these trajectories varied by wealth., Design: Nationally representative prospective cohort study., Setting: Observational study of people living in England., Participants: 7416 participants aged 52 and over of the English Longitudinal Study of Ageing (2004-2012)., Primary Outcome Measures: BMI and WC assessed objectively by a trained nurse., Main Exposure Measure: Total non-pension household wealth quintiles defined as financial wealth, physical wealth (such as business wealth, land or jewels) and housing wealth (primary and secondary residential housing wealth), minus debts., Results: Using latent growth curve models, we showed that BMI increased by 0.03 kg/m 2 (95% CI 0.02 to 0.04, p<0.001) per year and WC by 0.18 cm (95% CI 0.15 to 0.22, p<0.001). Age (linear and quadratic) showed a negative association with BMI and WC baseline and rates of change, indicating that older individuals had smaller body sizes and that the positive rates of change flattened to eventually become negative. The decline occurred around the age of 71 years for BMI and 80 years for WC. Poorest wealth was significantly related to higher baseline levels of BMI (1.97 kg/m 2 95% CI 0.99 to 1.55, p<0.001) and WC (4.66 cm 95% CI 3.68 to 2.40, p<0.001). However, no significant difference was found in the rate of change of BMI and WC by wealth, meaning that the age trajectories of BMI and WC were parallel across wealth categories and that the socioeconomic gap did not close at older ages., Conclusions: Older English adults showed an increase in BMI and WC over time but this trend reversed at older old age to display a sharp decrease. At any given age wealthier people had more favourable BMI and WC profile., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)

Background: Elevated systematic inflammation is a hallmark of aging, but the association of long-term inflammation trajectories with subsequent aging phenotypes has been little examined. We assessed inflammatory marker C-reactive protein (CRP) repeatedly over time and examined whether long-term changes predicted aging outcomes., Methods: A total of 2,437 men and women aged 47-87 years at baseline (1998-2001) who were participants in the English Longitudinal Study of Ageing had CRP measured on two or three occasions between 1998 and 2009. Inflammation trajectories were computed using latent-class growth mixture modeling and were related to aging outcomes measured in 2012/2013: physical functioning, cardiometabolic, respiratory, mental health, and a composite "healthy aging" outcome., Results: Four CRP trajectories were identified as follows: "stable-low" (71 per cent of the sample) with baseline mean 1.33 mg/L remaining <3 mg/L; "medium-to-high" (14 per cent) with baseline 2.7 mg/L rising to 5.3 mg/L; "high-to-medium" (10 per cent) with baseline 6.6 mg/L decreasing to 2.4 mg/L; and "stable-high" (5 per cent) with levels from 5.7 to 7.5 mg/L. Relative to the stable-low trajectory, individuals in the medium-to-high had a higher risk of limitations in basic activities of daily living (ADL, odds ratio; 95% confidence interval: 2.09; 1.51, 2.88), instrumental ADL (1.62; 1.15, 2.30), impaired balance (1.59; 1.20, 2.11) and walking speed (1.61; 1.15, 2.24), arthritis (1.55; 1.16, 2.06), hypertension (1.57; 1.21, 2.04), obesity (1.95; 1.36, 2.80), poor respiratory function (1.84; 1.36, 2.50), and depression (1.55; 1.13, 2.12). A lower odds of healthy aging was observed in people in the medium-to-high (0.57; 0.40, 0.79) and stable-high (0.50; 0.27, 0.91) trajectories., Conclusions: Older people who displayed an elevation in CRP levels over a decade experienced an increased risk of adverse aging outcomes.

Background: Maintaining cognitive function is an important aspect of healthy ageing. In this study, we examined age trajectories of cognitive decline in a large nationally representative sample of older people in England. We explored the factors that influence such decline and whether these differed by gender., Methods: Latent growth curve modelling was used to explore age-specific changes, and influences on them, in an 8-year period in memory, executive function, processing speed and global cognitive function among 10 626 participants in the English Longitudinal Study of Ageing. We run gender-specific models with the following exposures: age, education, wealth, childhood socioeconomic status, cardiovascular disease, diabetes, physical function, body mass index, physical activity, alcohol, smoking, depression and dementia., Results: After adjustment, women had significantly less decline than men in memory (0.011, SE 0.006), executive function (0.012, SE 0.006) and global cognitive function (0.016, SE 0.004). Increasing age and dementia predicted faster rates of decline in all cognitive function domains. Depression and alcohol consumption predicted decline in some cognitive function domains in men only. Poor physical function, physical inactivity and smoking were associated with faster rates of decline in specific cognitive domains in both men and women. For example, relative to study members who were physically active, the sedentary experienced greater declines in memory (women -0.018, SE 0.009) and global cognitive function (men -0.015, SE 0.007 and women -0.016, SE 0.007)., Conclusions: The potential determinants of cognitive decline identified in this study, in particular modifiable risk factors, should be tested in the context of randomised controlled trials., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: A rapidly ageing population presents major challenges to health and social care services. Cross-country comparative studies on survival among older adults are limited. In addition, Japan, the country with the longest life expectancy, is rarely included in these cross-country comparisons., Objective: We examined the relative contributions of social and behavioural factors on the differences in survival among older people in Japan and England., Methods: We used data from the Japan Gerontological Evaluation Study (JAGES; n = 13,176) and the English Longitudinal Study of Ageing (ELSA; n = 5,551) to analyse all-cause mortality up to 9.4 years from the baseline. Applying Laplace regression models, the 15th survival percentile difference was estimated., Results: During the follow-up, 31.3% of women and 38.6% of men in the ELSA died, whereas 19.3% of women and 31.3% of men in the JAGES died. After adjusting for age and baseline health status, JAGES participants had longer survival than ELSA participants by 318.8 days for women and by 131.6 days for men. Family-based social relationships contributed to 105.4 days longer survival in JAGES than ELSA men. Fewer friendship-based social relationships shortened the JAGES men's survival by 45.4 days compared to ELSA men. Currently not being a smoker contributed to longer survival for JAGES women (197.7 days) and ELSA men (46.6 days), and having lower BMI reduced the survival of JAGES participants by 129.0 days for women and by 212.2 days for men., Conclusion: Compared to participants in England, Japanese older people lived longer mainly because of non-smoking for women and family-based social relationships for men. In contrast, a lower rate of underweight, men's better friendship-based social relationships, and a lower smoking rate contributed to survival among participants in England., (© 2018 S. Karger AG, Basel.)

Objective: To examine the prospective relation between animal companionship and biomarkers of ageing in older people., Design: Analyses of data from the English Longitudinal Study of Ageing, an ongoing, open, prospective cohort study initiated in 2002-03., Setting: Nationally representative study from England., Participants: 8785 adults (55% women) with a mean age of 67 years (SD 9) at pet ownership assessment in 2010-11 (wave 5)., Main Outcome Measure: Established biomarkers of ageing in the domains of physical, immunological, and psychological function, as assessed in 2012-13 (wave 6)., Results: One third of study members reported pet ownership: 1619 (18%) owned a dog, 1077 (12%) a cat, and 274 (3%) another animal. After adjustment for a range of covariates, there was no evidence of a clear association of any type of pet ownership with walking speed, lung function, chair rise time, grip strength, leg raises, balance, three markers of systemic inflammation, memory, or depressive symptoms., Conclusion: In this population of older adults, the companionship of creatures great and small seems to essentially confer no relation with standard ageing phenotypes., Competing Interests: Ethical approval: Data collection for this study was approved by the London Multicentre Research Ethics Committee., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Insulin-like Growth Factor 1 (IGF-1) is associated with cardiovascular disease, itself a risk factor for hearing impairment, and, in animal studies, molecular evidence suggests a role for IGF-1 in hearing function. However, the link between IGF-1 and the occurrence of hearing impairment is untested in population-based studies of humans. A total of 4390 participants aged ≥50 y (mean [SD] age 64.2 [8.0] years at baseline, 55% women) from the English Longitudinal Study of Ageing provided serum levels of IGF-1 in 2008 and again in 2012. Hearing acuity was assessed by an objective hearing test (HearCheck handheld device) in 2014 when the prevalence was 38.2%. In the full cohort, IGF-1 was not associated with subsequent hearing impairment (OR 5nmol/L increase ; 95% CI: 1.01; 0.94, 1.09). However, this relationship appeared to differ by age (p-value for interaction = 0.03). Thus, in younger participants (aged 50-60 y, n = 1400), IGF-1 was associated with lower odds of hearing impairment (0.86; 0.73, 1.00) after adjustment for a range of potential confounders. Among people ≥60 y (n = 2990) there was a non-significant 'J'-shaped association. Our observational evidence that higher levels of IGF-1 appeared to confer some protection against hearing impairment in some older adults warrants replication in other prospective cohort studies.

Background: The relationship between the duration of depressive symptoms and mortality remains poorly understood., Aims: To examine whether the duration of depressive symptoms is associated with mortality risk., Method: Data (n= 9560) came from the English Longitudinal Study of Ageing (ELSA). We assessed depressive symptom duration as the sum of examinations with an eight-item Center for Epidemiologic Studies Depression Scale score of ⩾3; we ascertained mortality from linking our data to a national register., Results: Relative to those participants who never reported symptoms, the age- and gender-adjusted hazard ratios for elevated depressive symptoms over 1, 2, 3 and 4 examinations were 1.41 (95% CI 1.15-1.74), 1.80 (95% CI 1.44-2.26), 1.97 (95% CI 1.57-2.47) and 2.48 (95% CI 1.90-3.23), respectively (Pfor trend <0.001). This graded association can be explained largely by differences in physical activity, cognitive function, functional impairments and physical illness., Conclusions: In this cohort of older adults, the duration of depressive symptoms was associated with mortality in a dose-response manner., (© The Royal College of Psychiatrists 2016.)

We examined the little-tested associations between general cognitive function in middle and older age and later risk of death from chronic diseases. In the English Longitudinal Study of Ageing (2002-2012), 11,391 study participants who were 50-100 years of age at study induction underwent a battery of cognitive tests and provided a range of collateral data. In an analytical sample of 9,204 people (4,982 women), there were 1,488 deaths during follow-up (mean duration, 9.0 years). When we combined scores from 4 cognition tests that represented 3 acknowledged key domains of cognitive functioning (memory, executive function, and processing speed), cognition was inversely associated with deaths from cancer (per each 1-standard-deviation decrease in general cognitive function score, hazard ratio = 1.21, 95% CI: 1.10, 1.33), cardiovascular disease (hazard ratio = 1.71, 95% CI: 1.55, 1.89), other causes (hazard ratio = 2.07, 95% CI: 1.79, 2.40), and respiratory illness (hazard ratio = 2.48, 95% CI: 2.12, 2.90). Controlling for a range of covariates, such as health behaviors and socioeconomic status, and left-censoring to explore reverse causality had very little impact on the strength of these relationships. These findings indicate that cognitive test scores can provide relatively simple indicators of the risk of death from an array of chronic diseases and that these associations appear to be independent of other commonly assessed risk factors., (© The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: This study examines the differential associations of structural and functional social capital with objective and subjective measures of oral health, and the interactions between social capital and other sociodemographic and health factors., Methods: Secondary analysis of data on 8552 adults 50 years and older from the third wave (2006-2007) of the English Longitudinal Study of Ageing was conducted. Oral health outcomes were self-rated oral health, edentulousness (having no natural teeth), and Oral Impacts on Daily Performances. Structural social capital was measured by membership of social organizations and volunteering. Functional social capital was measured by the number of close ties and perceived emotional social support. Logistic regression models were sequentially adjusted for demographic, socioeconomic, health-related factors, and smoking status., Results: Structural social capital was primarily associated with edentulousness. Not being a member of any organization was associated with higher odds of being edentate (odds ratio [OR] = 1.77, 95% confidence interval [CI] = 1.43-2.16). Functional social capital was associated with self-rated oral health and oral impacts. Low social support was associated with poor self-rated oral health (OR = 1.41, 95% CI = 1.16-1.72) and Oral Impacts on Daily Performances (OR = 1.69, 95% CI = 1.27-2.24)., Conclusions: The association of structural social capital with edentulousness may reflect health selection effects. The availability of a supportive social network seems to be the aspect of social capital most strongly associated with oral health.

There are a number of studies linking social capital to oral health among older adults, although the evidence base mainly relies on cross-sectional study designs. The possibility of reverse causality is seldom discussed, even though oral health problems could potentially lead to lower social participation. Furthermore, few studies clearly distinguish between the effects of different dimensions of social capital on oral health. The objective of the study was to examine the longitudinal associations between individual social capital and oral health among older adults. We analyzed longitudinal data from the 3rd and 5th waves of the English Longitudinal Study of Ageing (ELSA). Structural social capital was operationalized using measures of social participation, and volunteering. Number of close ties and perceived emotional support comprised the functional dimension of social capital. Oral health measures were having no natural teeth (edentate vs. dentate), self-rated oral health and oral health-related quality of life. Time-lag and autoregressive models were used to explore the longitudinal associations between social capital and oral health. We imputed all missing data, using multivariate imputation by chained equations. We found evidence of bi-directional longitudinal associations between self-rated oral health, volunteering and functional social capital. Functional social capital was a strong predictor of change in oral health-related quality of life - the adjusted odds ratio of reporting poor oral health-related quality of life was 1.75 (1.33-2.30) for older adults with low vs. high social support. However in the reverse direction, poor oral health-related quality of life was not associated with changes in social capital. This suggests that oral health may not be a determinant of social capital. In conclusion, social capital may be a determinant of subjective oral health among older adults rather than edentulousness, despite many cross-sectional studies on the latter.

Background: Positive affective well-being (i.e., feelings of happiness and enjoyment) has been associated with longer survival and reduced incidence of serious illness. Our objective was to discover whether enjoyment of life also predicted a reduced risk of functional impairment over an 8-year period in a large population sample., Methods: We carried out a prospective analysis involving 3199 men and women aged 60 years or older from the English Longitudinal Study of Ageing. Enjoyment of life was assessed by questionnaire. Outcomes were impairment in 2 or more activities of daily living and changes in gait speed on a walking test. Covariates included sociodemographic factors, baseline health, depressive symptoms, impairment of mobility and health behaviours., Results: Two or more impaired activities of daily living developed among 4.4%, 11.7% and 16.8% of participants in the high, medium and low enjoyment-of-life tertiles, respectively. After adjustment for covariates, the odds of impaired activities of daily living developing were 1.83 (95% confidence interval 1.13-2.96) in the low compared with high tertile. Gait speed after 8 years was also related to baseline enjoyment of life after adjustment for gait speed and other covariates at baseline (p < 0.001). We obtained similar results when we limited analyses to participants younger than 70 years at baseline., Interpretation: This is an observational study, so causal conclusions cannot be drawn. But our results provide evidence that reduced enjoyment of life may be related to the future disability and mobility of older people.

Background: Slow walking speed is associated with higher risk of accidents, disability, and mortality in older adults, with people in more disadvantaged socioeconomic positions being at higher risk. We explore the relationship between wealth and age trajectories of walking speed among older adults., Methods: Data come from three waves (2002-2003 to 2006-2007) of the English Longitudinal Study of Ageing. We use latent growth curve models and aging-vector graphs to explore individual changes and average population age trajectories of walking speed by wealth among 7,225 individuals aged 60 and older., Results: For someone aged 71 in the poorest wealth quintile, the baseline mean walking speed was 0.75 m/s, which decreased to 0.71 m/s 4 years later, whereas that of a person in the richest wealth quintile was 0.91 m/s, which decreased to 0.82 m/s. Although the decline in walking speed was faster among people in the richest wealth (net of covariates), the gaps in walking speed between richest and poorest did not close. Even after accounting for covariates, people in the richest wealth only reached critical values (0.60 m/s) of walking speed at the age of 90, whereas people in the poorest wealth reached that level 6 years earlier., Conclusions: Our findings showed continuing gaps in physical functioning by wealth, even among people with the same health, psychosocial, and demographic conditions. As wealth reflects both past and current socioeconomic status, the implications of our findings are that reducing socioeconomic inequalities at all stages of the life course may have a positive impact on functioning in old age.

Objective: To investigate whether the impact of negative and positive social exchanges on depression depends on relationship type among late middle age and older adults., Method: Using data from the English Longitudinal Study of Aging, baseline positive and negative exchanges with partners, children, other family and friends were linked to 2-year changes in depression on the eight-item Center for Epidemiologic Studies Depression Scale., Results: Positive and negative exchanges with partners and with children were independently associated with depression, adjusting for age, gender, wealth, and baseline depression. Negative but not positive exchanges with other family and with friends were associated with depression. The association between depression and positive/negative exchanges was weaker among the above 70s compared with those aged 50 to 70., Discussion: Negative and positive exchanges with partners and children appear equally salient for depression onset although negative exchanges with family and friends contribute to depression whereas positive exchanges do not.

Background: Count outcomes are commonly encountered in many epidemiology applications, and are often characterised by a large proportion of zeros. Although linear or logistic regression models have often been used to analyse count outcomes, the resulting estimates are likely to be inefficient, inconsistent or biased., Methods: Data were taken from the first wave of the English Longitudinal Study of Ageing (ELSA). The main outcome measure is difficulty (ranging from 0 to 6) with 'Activities of Daily Living (ADL-s)', such as dressing, walking across a room, bathing, eating, getting in and out of bed and using the toilet. Four regression models specifically developed for count outcomes were fitted to the data: Poisson, negative binomial (NB), zero-inflated Poisson (ZIP) and zero-inflated negative binomial (ZINB). The models were compared using the Likelihood Ratio (LR) test of overdispersion, the Vuong test and graphical methods., Results: The plots of predictions showed that overall, the ZINB model fit best. Although the ZINB and the ZIP models showed similar fit, the LR test provided strong evidence that the ZINB had improved fit over the ZIP. Increasing difficulties with ADL-s were associated with fair/poor self-reported health, limiting longstanding illness and physical inactivity. The probability of not having any difficulty with ADL-s decreases with a limiting longstanding illness, increasing age, no education, fair/poor self-reported health and with not living with a partner., Conclusion: Models specifically developed for count outcomes with excess zeros such as ZINB can provide better insights into the investigation of the factors associated with the difficulties with ADL-s.

The aim of this study is to examine the association of BMI and waist circumference (WC), with a quality of life (QoL) indicator designed for older ages (CASP19), and with depressive symptoms (Centre for Epidemiologic Studies Depression Scale). We included 8,688 individuals aged ≥52 years who participants of Wave 2 (2004-2005) and Wave 3 (2006-2007) of the English Longitudinal Study of Ageing (ELSA). To explore cross-sectional relationships (2004-2005), we fitted regression models for BMI and WC (included simultaneously) as our predictors of QoL and depressive symptoms adjusted for covariates. To explore longitudinal relationships, BMI and waist at baseline (2004-2005) were related to the each outcome variable measured at follow-up (2006-2007), and adjusted for baseline characteristics (2004-2005). For a given BMI, larger WC was associated with lower QoL and higher risk of depressive symptoms for women in cross-sectional and longitudinal analyses. By contrast for a given WC increased BMI for women was positively associated with QoL and lower odds of depressive symptoms. In men, for a given BMI, increased WC was related to QoL only cross-sectionally; neither WC nor BMI at baseline were associated with depressive symptoms (cross-sectionally or longitudinally). In conclusion among older people, for a given BMI, increased WC was related with higher risk of poor QoL and, for women, of depressive symptoms; whereas for a given WC, increased BMI had a protective effect on QoL for women.

Purpose: To explore age-trajectories of quality of life (QoL) and influences on them in a 4-year period among older adults living in England., Methods: Data come from three waves (2002-2003 and 2006-2007) of the English Longitudinal Study of Ageing, a large panel study of 11,392 individuals aged 50 and over. We used Latent Growth Curve models and ageing-vector graphs to describe both individual differences and average population age-trajectories in QoL (measured by the CASP19 questionnaire)., Results: QoL at baseline was poorer for older than younger respondents, with the differences widening with age. QoL also declined more rapidly for older individuals. Gender, education, depression, limiting long-standing illness, difficulty with ADL-s, lack of wealth, non-employment, decreased number of friends and low positive support had a negative impact on QoL. Living with a partner had a positive effect on the QoL of men but not of women. The ageing-vector graphs revealed a clear gradient in age-trajectories of QoL for those in the best to the worst psychosocial, socioeconomic and health conditions., Conclusions: Younger old adults can be prepared for further ageing by increasing their network of friends and engaging with the wider community while they are able.

Vascular aging, i.e., the deterioration of the structure and function of the arteries over the life course, predicts cardiovascular events and mortality. Vascular degeneration can be recognized before becoming clinically symptomatic; therefore, its assessment allows the early identification of individuals at risk. This opens the possibility of minimizing disease progression. To review these issues, a search was completed using PubMed, MEDLINE, and Google Scholar from 2000 to date. As a network of clinicians and scientists involved in vascular medicine, we here describe the structural and functional age-dependent alterations of the arteries, the clinical tools for an early diagnosis of vascular aging, and the cellular and molecular events implicated. It emerges that more studies are necessary to identify the best strategy to quantify vascular aging, and to design proper physical activity programs, nutritional and pharmacological strategies, as well as social interventions to prevent, delay, and eventually revert the disease. [ABSTRACT FROM AUTHOR]

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We examined whether the co-occurrence of four behavioural risk factors (alcohol consumption, smoking, physical inactivity and obesity) is associated with disability-free and chronic disease-free life expectancy similarly in two longitudinal studies of ageing in England and the United States. Data were from 17,351 individuals aged 50+ from the US Health and Retirement Study (HRS) and, 10,388 from the English Longitudinal Study of Ageing (ELSA), from 2002 to 2013. Disability-free life expectancy was estimated using repeat measures of limitations with instrumental activities and activities of daily living and, chronic disease-free life expectancy was based on chronic health conditions. Multistate life table models were used to estimate sex-specific health expectancy at the ages of 50, 60 and 70. In both countries and at all ages, there was a clear gradient towards shorter health expectancy with increasing number of behavioural risk factors. Compared to people with 2+ behavioural risk factors, in both countries, those with no behavioural risk factors could expect to live up to 11 years longer without disability and, up to 12 years longer without chronic conditions. Individual and co-occurring behavioural risk factors were strongly associated with shorter healthy life expectancy in both countries, attesting to the robustness of the contribution of lifestyle factors on health expectancy. [ABSTRACT FROM AUTHOR]

Objectives To extend research on workforce participation beyond age 50 by describing entire employment histories in later life and testing their links to prior life course conditions. Methods We use data from the English Longitudinal Study of Ageing, with retrospective information on employment histories between age 50 and 70 for 1,103 men and 1,195 women (n = 2,298). We apply sequence analysis and group respondents into eight clusters with similar histories. Using multinomial regressions, we then test their links to labor market participation, partnership, and parenthood histories during early (age 20–34) and mid-adulthood (age 35–49). Results Three clusters include histories dominated by full-time employees but with varying age of retirement (before, at, and after age 60). One cluster is dominated by self-employment with comparatively later retirement. Remaining clusters include part-time work (retirement around age 60 or no retirement), continuous domestic work (mostly women), or other forms of nonemployment. Those who had strong attachments to the labor market during adulthood are more likely to have histories of full-time work up until and beyond age 60, especially men. Parenthood in early adulthood is related to later retirement (for men only). Continued domestic work was not linked to parenthood. Partnered women tend to work part-time or do domestic work. The findings remain consistent after adjusting for birth cohort, childhood adversity, life course health, and occupational position. Discussion Policies aimed at increasing the proportion of older workers not only need to address later stages of the life course but also early and mid-adulthood. [ABSTRACT FROM AUTHOR]

Background: Socio-economic status from early life has been linked to cardiovascular disease risk, but the impact of life-course socio-economic trajectories, as well as the mechanisms underlying social inequalities in cardiovascular disease risk, is uncertain.Objectives: We assessed the role of behavioural, psychosocial and physiological (including inflammatory) factors in the association between life-course socio-economic status and cardiovascular disease mortality in older adults.Methods: Participants were 7846 individuals (44% women) from the English Longitudinal Study of Ageing, a representative study of individuals aged ≥ 50 years, established in 2002-03. Comprising four indicators of socio-economic status (father's social class, own education, occupational position and wealth), we computed an index of socio-economic trajectory and a lifetime cumulative socio-economic score. Behavioural (smoking, physical activity, alcohol consumption, body mass index) and psychosocial (social relations, loneliness) factors, physiological (blood pressure, total cholesterol, triglycerides) and inflammatory markers (C-reactive protein, fibrinogen), measured repeatedly over time, were potential explanatory variables. Cardiovascular disease mortality was ascertained by linkage of study members to a national mortality register. Mediation was calculated using the traditional 'change-in-estimate method' and alternative approaches such as counterfactual mediation modelling could not be applied in this context.Results: During the 8.4-year follow-up, 1301 study members died (438 from cardiovascular disease). A stable low-social-class trajectory was associated with around double the risk of cardiovascular disease mortality (hazard ratio; 95% confidence interval: 1.94, 1.37; 2.75) compared with a stable high social class across the life course. Individuals in the lowest relative to the highest life-course cumulative socio-economic status group were also more than twice as likely to die of cardiovascular disease (2.57, 1.81; 3.65). Behavioural factors and inflammatory markers contributed most to explaining this gradient, whereas the role of psychosocial and other physiological risk factors was modest.Conclusions: In a population-based cohort of older individuals living in England, we provide evidence that disadvantage across the life course is linked to cardiovascular mortality. That behavioural factors and inflammatory markers partially explain this gradient may provide insights into the potential for intervention. [ABSTRACT FROM AUTHOR]

Objectives:The objective of this study is to investigate gender-specific trajectories in well-being among older people with coronary heart disease (CHD) and to compare them with those of healthy people. Method:The study included a sample of 4496 participants from the first three waves of the English Longitudinal Study of Ageing (2002–2003 to 2006–2007). We measured well-being using quality of life (CASP-19; ‘control’, ‘autonomy’, ‘pleasure’ and ‘self-realization’) and depressive caseness (three or more symptoms on the CESD-8; Centre for Epidemiologic Study Depression scale). Results:After adjustment, at two– and four–years follow-ups, women had three points higher quality of life than men (p< 0.001). When looking at each quality of life's domain we found that women reported higher scores of autonomy compared to men. The gender difference in the probability of having depressive caseness reduced to 7 percentage points at four-year follow-up from 13 percentage points in the previous occasions. Men's quality of life declined progressively over time by 3 points (p< 0.001) (equivalent to the effect of having diabetes) but no changes in prevalence of depressive caseness were found. Women's quality of life only declined after four-year follow-up by less than 2 points (p< 0.001), while in the same period their probability of reporting depressive caseness reduced by 6 percentage points (p< 0.001). Conclusion:Women had better quality of life than men in the two and four years following a CHD event, and were not more likely than men to report depressive caseness in the long term. Men's quality of life deteriorated progressively over time, among women it did not deteriorate in the first two years following a CHD event; women had a long-term improvement in depressive caseness. [ABSTRACT FROM PUBLISHER]

This paper examines whether participation in social activities is associated with higher levels of wellbeing among post-retirement age people in England, and, if so, whether these relationships are explained by the reciprocal nature of these activities. Cross-sectional analysis of relationships between social activities (including paid work, caring and volunteering) and wellbeing (quality of life, life satisfaction and depression) was conducted among participants of one wave of the English Longitudinal Study of Ageing (ELSA) who were of state pension age or older. Participants in paid or voluntary work generally had more favourable wellbeing than those who did not participate in these activities. Caring was not associated with wellbeing, although female carers were less likely to be depressed than non-carers. Carers, volunteers and those in paid work who felt adequately rewarded for their activities had better wellbeing than those who were not participating in those activities, while those who did not feel rewarded did not differ from non-participants. These results point to the need to increase the rewards that older people receive from their productive activities, particularly in relation to caring work. [ABSTRACT FROM AUTHOR]

Research has suggested that children of long-lived parents might age more successfully than children of short-lived parents. The aim of this study is to contribute further to the understanding of the association between parental longevity and offspring's successful ageing. We used data from wave one of the English Longitudinal study of ageing (ELSA) to investigate the association between three measures of parental longevity and the respondents' cognitive and physical functioning, self-reported health and several chronic diseases. We found that parental lifespan, especially mother's lifespan, is positively associated with cognitive functioning at older age. Parental lifespan and mother's lifespan were also found to be associated with a decreased likelihood of occurrence of some chronic diseases such as pulmonary disease, coronary heart disease, hypertension and poor health. [ABSTRACT FROM AUTHOR]