Sociodemographic, economic and biomedical determinants of multiple health behaviours in older adults

Everyday activities such as not smoking, exercising, drinking alcohol prudently and choosing healthy diets are important to the maintenance of health and avoidance of chronic disease. They are particularly significant in middle and old age, since this is the phase of life in which serious diseases such as coronary heart disease, type 2 diabetes, and various cancers develop. We therefore need to understand what factors determine healthy behaviour choices. These activities are typically studied in isolation, but looking at multiple behaviours will help us understand the factors underlying broader healthy lifestyles. This proposal is for a series of analyses of the English Longitudinal Study of Ageing (ELSA), a longitudinal study of more than 11,000 men and women from all regions of England who were aged between 50 and 100 when the study began in 2002. Our analysis will investigate whether smoking, alcohol misuse, physical activity, and fruit and vegetable intake cluster together in middle-aged and older adults, and if so, how these patterns of behaviour relate to socioeconomic position and geographical location. We will also investigate how patterns of health behaviour change over an 8 to 10 year period, and what role is played by economic, social and personal factors such as changing wealth, work and family situation, social support and physical and mental health. Our third aim is understand how these health behaviours are related to measures of biological function and mobility in older adults. The results will give us vital knowledge about the barriers to healthy lifestyles, and levers for change that operate for multiple health behaviours. They will help us develop new methods of encouraging lifestyle changes, particularly in socially disadvantaged sectors of the population, so as to maintain health in older people. This will also aid the promotion of active ageing and enhanced quality of life in later years.

Cigarette smoking, physical activity, alcohol misuse and diet are related to risk of chronic illness, and understanding their determinants will help identify better methods of encouraging the maintenance of healthy lifestyles. These activities are often studied in isolation, but there are strong arguments for investigating the patterns of multiple health behaviours, and the incidence of combinations of risk behaviours in different sectors of society. This application is for analysis of data on multiple health behaviours collected over a 10 year period in the English Longitudinal Study of Ageing (ELSA). Existing research on multiple behaviours has primarily focussed on younger and middle-aged populations in cross-sectional surveys, but older adults are at high risk for the chronic conditions that prudent lifestyles help to prevent, while longitudinal studies allow changes in multiple behaviours to be mapped in relation to the significant life transitions. We plan to study three broad issues. First, whether important health behaviours (smoking, alcohol consumption, physical activity, and fruit and vegetable intake) cluster together in middle-aged and older adults, and how behaviour clustering varies with socioeconomic circumstances and geographical location across in England. Second, how individual activities and clusters of health behaviours change over an 8 to 10 year period among older people, and what role is played by economic, social and personal factors such as changing wealth, work and family situation, social support and physical and mental health. Third, how these health behaviours are related to biomarkers (C-reactive protein, fibrinogen, and metabolic variables) and functional health in older adults. ELSA, a longitudinal study of 5,111 men and 6,121 women ranging in age from 50 to 100 years, is uniquely suited to addressing the determinants of multiple health behaviours, since it includes a wide range of information on social and economic circumstances, labour market activity, social networks and support, family and household structure, chronic illness, and biomarkers. Information collected across four waves of data collection will be analysed. The study will be carried out by an interdisciplinary team with expertise in health behaviour, economics, epidemiology, clinical medicine and medical sociology. Members of the team have been involved in the design of ELSA, data collection and processing, so are very familiar with the data set. The results will provide vital knowledge about the barriers and levers on multiple health behaviours, paving the way for innovative methods of encouraging lifestyle changes that will promote health and reduce inequalities in older populations.