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

Lead Research Organisation: University College London
Department Name: Epidemiology and Public Health

Abstract

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.

Technical Summary

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.

Publications

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Allen J (2014) Social determinants of mental health. in International review of psychiatry (Abingdon, England)

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Baum F (2014) Evaluation of Health in All Policies: concept, theory and application. in Health promotion international

 
Description Andrew Steptoe - Economics 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Department of Economics, Peking University, Beijing, China. Psychological wellbeing and health in the ageing population.

Not applicable.
Year(s) Of Engagement Activity 2012
 
Description Andrew Steptoe - LSE 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact London School of Economics. Positive affect and longevity.

Not applicable.
Year(s) Of Engagement Activity 2012
 
Description Aparna Shankar - Cafe Scientifique 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Shankar, A. (2011) Social isolation, loneliness and health in older adults. Invited talk at the UCL-Brunel Café Scientifique on Loneliness in Older age at UCL. June 16th, 2011

Not applicable.
Year(s) Of Engagement Activity 2011
 
Description Contributions to ELSA wave 4 report 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact This research contributed to the report of Wave 4 of the English Longitudinal Study of Ageing. Specifically, the following chapter:
Health risk and health protective biological measures in later life
Cesar de Oliveira, Aparna Shankar, Meena Kumari, Susan Nunn and
Andrew Steptoe
In Financial circumstances, health and well-being of the older population in England. The 2008 English Longitudinal Study of Ageing (wave 4), edited by J. Banks, C. Lessof, J. Nazroo, N. Rogers, M. Stafford and A. Steptoe. London: Institute for Fiscal Studies. pp275-346.




This report is specifically designed to provide data on ageing, health and social circumstances to policy makers in Government Departments, notabvly Work and Pensions, Health, Transport, Communities and Local Government, and HMRC.
Year(s) Of Engagement Activity 2010
 
Description Steptoe - Behav Med 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Academy of Behavioural Medicine Research, Monterey, CA. Invited presentation. ELSA.

N/A
Year(s) Of Engagement Activity 2013
 
Description Steptoe - CLOSER 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact CLOSER (Cohort and Longitudinal Studies Enhancement Resources) symposium, London. Invited presentation. Subjective wellbeing in later life: an international perspective.

N/A
Year(s) Of Engagement Activity 2013
 
Description Steptoe - Health & Retirement 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Health and retirement study data monitoring committee, Bethesda. Invited presentation. Update on ELSA.

N/A
Year(s) Of Engagement Activity 2013
 
Description Steptoe - Keio 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Keio University, Tokyo. Invited presentation. Social factors in health and ageing.

N/A
Year(s) Of Engagement Activity 2013
 
Description Steptoe - NIA 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact National Institute of Ageing, Bethesda, USA. Invited presentation. New insights from ELSA.

N/A
Year(s) Of Engagement Activity 2012