Siobhan Leahy

OP85 Investigating the health of older carers within different social care systems in ireland and england: evidence from the irish longitudinal study on ageing (TILDA) and the english longitudinal study of ageing (ELSA)

Background The continuing social participation of older people through informal caring of family members and friends provides an important economic and social contribution to society. Participation in leisure activities and supportive social ties have been associated with improved physical and mental health. These health effects work through a number of pathways, both behavioural and psychological, which can result in better health behaviours, and buffering of the harmful effects of stress. We investigated and compared the prevalence of the provision of informal caring by the older population in Ireland and England. We investigated predictors of, and health outcomes associated with informal caring and determined whether these are moderated by social participation and receipt of formal care services and support in two different social care systems. Methods We examined measures of physical function (hand-grip strength), mental health (CES-D, CASP-12), economic and social participation, associated with provision of informal care, using multivariate models, in the Irish Longitudinal Study on Ageing (TILDA) (Wave 3, 2014, n=6,649), and the English Longitudinal Study of Ageing (ELSA) (Wave 6, 2012–2013, n=10,372). Caring was defined as having provided care for at least one hour: in the last month, the last week and the numbers of hours of care. Results A higher proportion of the population aged 50 and over reported caring in the last month in England (22.3%) compared to Ireland (8.9%). Caring was associated with similar characteristics (younger age, female, not employed and being married). There were similar health outcomes for both countries. The health outcomes associated with providing low intensity caring (<20 hours/week) were higher grip strength (ELSA β=1.12 (95% CI 0.63, 1.61) p<0.001), higher quality of life (TILDA β=1.23 (95% CI 0.44, 2.03) p=0.002; ELSA β=0.38 (95% CI −0.01, 0.78) p=0.056) and lower depressive symptoms (ELSA β=−0.11 (95% CI −20, −0.03) p=0.007). In contrast, intensive provision of care (50+hours/week), was associated with lower quality of life (ELSA β=−1.57 (95% CI −2.19, −0.95), p<0.001) and more depressive symptoms (TILDA B=1.02 (95% 0.24, 1.80) p=0.01; ELSA B=0.27 (95% CI 0.14, 0.41) p<0.001). These associations were moderated by active social activities, positive social relationships and access to formal care services (p=0.05). Conclusion Across two separate social care systems, the older population contribute substantially to the support and informal care of their family and friends. Overall, informal caring was associated with positive health outcomes, but this depended on both intensity of care provided and accessibility to both social supports and formal care provision.

Kidney Disease in Women is Associated with Disadvantaged Childhood Socioeconomic Position

Background: Socioeconomic position (SEP) is an important determinant of health and it is dynamic across the entire lifespan. We sought to investigate the relationship between life-course SEP and chronic kidney disease (CKD) using 3 conceptual models: critical period, pathway and accumulation. Methods: Cross-sectional analysis of 4,996 participants from The Irish Longitudinal Study on Ageing, a nationally representative cohort of community-dwelling adults aged ≥50 years. We defined childhood and adulthood SEP according to father’s and respondent’s occupation respectively. SEP was categorised as high (reference), intermediate, low and never worked. CKD was defined as a glomerular filtration rate < 60 mL/min/1.73 m2 estimated from the combination of creatinine and cystatin C. We used logistic regression to estimate the age-adjusted association between SEP and CKD separately in men and women. Results: Low childhood SEP was strongly associated with CKD in women, after adjusting for adulthood SEP (OR 1.90 [95% CI 1.24–2.92]), supporting the critical period hypothesis. This association was not explained by traditional CKD risk factors. Women who experienced low childhood SEP and whose circumstances improved in adulthood also had increased odds of CKD, further supporting a critical period effect in childhood. There was comparatively less evidence in support of the pathway or accumulation models. We did not observe a statistically significant association between SEP and CKD in men. Conclusions: Our findings suggest that women exposed to disadvantaged SEP in childhood represent an at-risk group in whom there may be opportunities for identification of CKD and facilitation of health-promoting behaviours from an early age.