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Changes over time in the health and functioning of older people moving into care homes: analysis of data from the English Longitudinal Study of Ageing.

ABSTRACT: Background:the number of people requiring care home support is projected to rise in future years, but little information is available on the needs of new care home residents. Objective:to measure the health and functioning of people moving into care homes and how they have changed between 2002 and 2015. Setting:English Longitudinal Study of Ageing. Participants:two hundred fifty-four of the 313 (1.99%) individuals who moved from the community into a care home, and were interviewed in the survey wave prior to entry. Main outcome measures:changes over time for number of health conditions and functional deficits (deficits in activities of daily living (ADL), and instrumental ADLs (IADLs)), assessed in the survey wave prior to admission. Results:over time there were significant increases in the total number of health conditions and functional deficits amongst soon to be care home entrants (P = 0.0011), the proportion with high blood pressure (OR 1.37, 95% CI: 1.17-1.62, P < 0.0001), memory problems (OR 1.33, 95% CI: 1.11-1.61, P = 0.0021) or total number of IADL deficits (P = 0.008). Non-significant increases were observed in the proportion of care home entrants with cancer (OR 1.23, 95% CI: 0.93-1.65, P = 0.15), lung disease (OR 1.21, 95% CI: 0.85-1.75), heart disease (OR 1.12, 95% CI: 0.95-1.30) and arthritis (OR 1.11, 95% CI: 0.95-1.30). Stroke and ADL deficits did not increase. No differential ageing effect was observed. Conclusions:the support needs of care home entrants in England appear to be increasing over time. This has important implications for the provision and funding of care home places and community services.

SUBMITTER: Green I

PROVIDER: S-EPMC5590718 | biostudies-literature | 2017 Jul

REPOSITORIES: biostudies-literature

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Changes over time in the health and functioning of older people moving into care homes: analysis of data from the English Longitudinal Study of Ageing.

Green Isabel I Stow Daniel D Matthews Fiona E FE Hanratty Barbara B

Age and ageing 20170701 4

<h4>Background</h4>the number of people requiring care home support is projected to rise in future years, but little information is available on the needs of new care home residents.<h4>Objective</h4>to measure the health and functioning of people moving into care homes and how they have changed between 2002 and 2015.<h4>Setting</h4>English Longitudinal Study of Ageing.<h4>Participants</h4>two hundred fifty-four of the 313 (1.99%) individuals who moved from the community into a care home, and we ...[more]

PMID: 28402421

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Project description:BACKGROUND:As the population ages, cognitive decline and dementia have become major health concerns in the UK. Loneliness has been linked to cognitive decline, but the reverse causality of this association remains unclear. This study aims to examine whether there is a bidirectional relationship between loneliness and cognitive function in older English adults (age 50?years and over) over a 10-year follow-up. METHODS:Data came from a nationally representative sample of 5885 participants in the English Longitudinal Study of Ageing (ELSA), free of stroke or dementia and followed every 2 years up to wave 7 (2014-15). At each wave, cognitive function was measured with word recall and verbal fluency tests, and loneliness was measured with the abridged version of the revised UCLA Loneliness Scale. Bivariate dual change score models were used to assess the multivariate associations between loneliness and cognitive function, used interchangeably as exposures and outcomes. RESULTS:Greater loneliness at baseline was associated with poorer memory [? intercept = -0.03, standard error (SE) = 0.01, P? = ?0.016] and verbal fluency (? intercept = -0.01, SE? = ?001, P = ?0.027) at baseline, and with a stronger linear rate of decline in both memory (? linear slope = -0.07, SE? = ?001, P ???0.001) and verbal fluency (? linear slope = -0.09, SE? = ?0.03, P = ?0.003) over a 10-year follow-up period, although the performance on verbal fluency did not change substantially on average over this period. We also found that higher baseline memory, but not verbal fluency, predicted a slower change in loneliness (? linear slope = -0.01, SE? = ?001, P = ?0.004) and that a linear decline in memory was associated with an acceleration in loneliness (? quadratic slope = -0.02, SE? = ?001, P ???0.001) during follow-up. CONCLUSIONS:Higher loneliness is associated with poorer cognitive function at baseline and contributes to a worsening in memory and verbal fluency over a decade. These factors seem, however, to be partially intertwined, since baseline memory and its rate of decline also contribute to an increase in loneliness over time.

Project description: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.

Dataset Information

Changes over time in the health and functioning of older people moving into care homes: analysis of data from the English Longitudinal Study of Ageing.

Publications

Changes over time in the health and functioning of older people moving into care homes: analysis of data from the English Longitudinal Study of Ageing.

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