Stephen Jivraj

Association between frailty and quality of life among community-dwelling older people: a systematic review and meta-analysis

Background With growing numbers of older people worldwide, improving and maintaining quality of life during the extended years of life are a major focus for healthcare providers and policymakers. Some studies have suggested frailty may be associated with worse quality of life. Objectives To review the associations between frailty and quality of life among community-dwelling older people. Methods A systematic literature search was performed using five databases for cross-sectional and longitudinal studies examining associations between frailty and quality of life among community-dwelling older people published in 2000 or later. Reference lists of relevant studies were also manually searched. Authors were requested for data for a meta-analysis if necessary. Meta-analysis was attempted for studies using the same frailty criteria and quality-of-life instrument. Methodological quality, heterogeneity and publication bias were assessed. Results The systematic review identified 5145 studies, among which 11 cross-sectional studies and two longitudinal studies were included in this review. Meta-analysis including four cross-sectional studies using the Fried Phenotype and 36-Item Short Form Health Survey showed that those classified as frail and prefrail had significantly lower mental and physical quality-of-life scores than those classified as non-frail. High heterogeneity and possible publication bias were noted. Conclusions This systematic review and meta-analysis has demonstrated the evidence of a consistent inverse association between frailty/prefrailty and quality of life among community-dwelling older people. Interventions targeted at reducing frailty may have the additional benefit of improving corresponding quality of life. More longitudinal analysis is required to determine this effect.

Aging and Subjective Well-Being in Later Life

OBJECTIVES This paper examines age-related changes in subjective well-being (SWB) in later life using multiple measures that cover eudemonic, evaluative, and affective dimensions of well-being. METHOD Using data from 5 waves of respondents aged 50 and older from the English Longitudinal Study of Ageing (2002-11), we fit multilevel linear growth curve models to examine the cohort differences and individual aging effects on quality of life, depressive symptomatology, and life satisfaction. RESULTS Older cohorts are shown to have equivalent or better SWB than younger cohorts for each well-being measure. Nonetheless, individual aging effects for each well-being measure were observed with deterioration in well-being being greatest in older cohorts, even when adjusting for age-related changes in later life, including widowhood, retirement, and declining health. DISCUSSION The results suggest that although older cohorts enjoy higher levels of SWB than their younger counterparts when under similar circumstances, they experience sharper declines, especially in the very oldest cohorts. The findings demonstrate the importance of separating out cohort differences and aging effects and also of taking into account the multidimensionality of SWB to determine the point at which age deterioration begins to occur across different measures.

Ethnic Group Population Change and Neighbourhood Belonging

The community cohesion agenda in Britain has focused attention on the ethnic character of neighbourhoods and how population change affects cohesion. This paper examines the relationship between neighbourhood ethnic group population change and belonging. The paper measures population change as immigration, gross internal migration and with a categorisation of ethnic group population dynamics that combines migration and natural change. Pooled 2005 and 2007 Citizenship Survey data are analysed using multilevel logistic regression models. The paper does not find evidence for relationships between immigration or local population turnover and levels of neighbourhood belonging; nor is there evidence that ethnically differentiated population change matters. However, belonging does vary by individual’s ethnicity; and strong belonging is associated with high co-ethnic density for minorities. In addition, the overall population change of an area may be significant: highest levels of belonging were found in areas of White and Minority population growth driven by migration.

Determinants of socioeconomic inequalities in subjective well-being in later life: a cross-country comparison in England and the USA

PurposeTo explore country-specific influences on the determinants of two forms of subjective well-being (life satisfaction and quality of life) among older adults in England and the USA.MethodsHarmonised data from two nationally representative panel studies of individuals aged 50 and over, the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS), are used. Linear regression models are fitted separately for life satisfaction and quality of life scales using cross-sectional samples in 2004. The ELSA sample was 6,733, and the HRS sample was 2,300. Standardised coefficients are reported to determine the country-specific importance of explanatory variables, and predicted values are shown to highlight the relative importance of statistically significant country-level interaction effects.ResultsHaving a disability, been diagnosed with a chronic conditions or having low household wealth are strongly associated with poorer life satisfaction and quality of life. These statistical effects are consistent in England and the USA. The association of years spent in education, however, varied between the two countries: educational inequalities have a greater adverse effect on subjective well-being in the USA compared with England.ConclusionInterventions are required to counterbalance health and socioeconomic inequalities that restrict sections of the population from enjoying satisfying and meaningful lives in older age. The differential association between education and well-being in England and the USA suggests that the provision of welfare benefits and state-funded public services in England may go some way to protect against the subsequent adverse effect of lower socioeconomic status on subjective well-being.

Does the level of wealth inequality within an area influence the prevalence of depression amongst older people

This paper considers whether the extent of inequality in house prices within neighbourhoods of England is associated with depressive symptoms in the older population using the English Longitudinal Study of Ageing. We consider two competing hypotheses: first, the wealth inequality hypothesis which proposes that neighbourhood inequality is harmful to health and, second, the mixed neighbourhood hypothesis which suggests that socially mixed neighbourhoods are beneficial for health outcomes. Our results are supportive of the mixed neighbourhood hypothesis, we find a significant association between neighbourhood inequality and depression with lower levels of depression amongst older people in neighbourhoods with greater house price inequality after controlling for individual socio-economic and area correlates of depression. The association between area inequality and depression is strongest for the poorest individuals, but also holds among the most affluent. Our results are in line with research that suggests there are social and health benefits associated with economically mixed communities.

The stability of ethnic identity in England and Wales 2001-2011

Summary The instability of ethnicity measured in the national census is found to have doubled from the period 1991–2001 to the period 2001–2011, using the Longitudinal Study that links a sample of individuals’ census records across time. From internal evidence and comparison with results from the Census Quality Survey and the Labour Force Survey, estimates are made of instability due to changing question wording, imputation of missing answers, proxy reporting, recording errors and changes in the allocation of write‐in answers. Of the remaining instability, durable changes of ethnicity by individuals are thought to be considerably less common than changes due to a persons sense of identity not closely fitting the categories offered in the census question. The instability creates a net change in size of some ethnic groups that is usually small compared with the change in population between censuses from births, deaths and migration. Consequences for analysis of census aggregate and microdata are explored.

International and internal migration measured from the School Census in England

SummaryThe School Census is the only regularly updated dataset covering almost all of the population of a specific age, which records changes of address along with ethnicity and some family economic circumstances. It can be used to measure internal and international family migration as shown in this report.The School Census is suited to identify and quantify new local migration streams between censuses, successfully identifying the local distribution of Eastern European immigration in the decade since 2000.The measures do not provide a complete measure of migration, either internally or internationally. The exclusion of those outside the state school system means that internal migration is under‐estimated, and international migration is approximately measured.The advantages of the School Census are its frequent updates, its fine geographical information, and its indicators of ethnicity and low family income, which powerfully complement other sources.

Short- and long-term determinants of social detachment in later life

ABSTRACT The benefits of engagement with social activities on health and wellbeing are widely reported by gerontologists. Less is known, however, about what drives withdrawal from and re-engagement with social activities in later life. This is an important area of research which has direct implications for public policies that aim to ensure equitable outcomes among older adults. Much of the existing literature supports continuity theory which assumes people will not alter their level of social engagement as they age or after life-changing events. This paper uses data from the English Longitudinal Study of Ageing over an eight-year period (2002–2010) to determine the effect of short-term changes in marital, employment and health status over an initial four-year period on the dynamics of social detachment over the following four years. We control for underlying socio-economic disadvantages built up during the lifecourse and find that these effects, including poor education, wealth and health, are the most important determinants of persistent detachment from social activities as well as movement into and out of social detachment. The effects are consistent in men and women. The effects of short-term changes in marital and employment status have little effect on social detachment. Recent deterioration in health, however, predicted movement into social detachment, which implies the relationship between health and social detachment is reciprocal.

The Components of Socioeconomic Neighbourhood Change: An Analysis of School Census Data at Varying Spatial Scales in England

Most studies investigating neighbourhood change use repeated cross-sectional data to document how neighbourhood characteristics change over time. Although such analysis can be useful, it cannot be used to uncover the causes of change. The population composition of a neighbourhood can change because of differences in the characteristics of the in-coming and out-going of residents, and because some of the non-moving residents change over time as well. This study explores the causes of neighbourhood change by investigating how the effects of residential mobility of low income primary school-aged pupils in England compares with other components of change in the concentration of low income pupils in an area. The results show that the two dominant components of neighbourhood change are in-situ change and residential mobility.

Local Distribution and Subsequent Mobility of Immigrants Measured from the School Census in England

This paper provides an examination of the initial location of recent pupil immigrants in England and their subsequent internal migration and emigration. The unique analysis is conducted using data from the School Census, with a focus on migrants from A8 countries between 2003 and 2007. Recent pupil immigrants, including A8 migrants, initially concentrate in London, though A8 pupil immigrants are much more geographically dispersed than all other pupil immigrants. Overall, pupil immigrants are highly geographically mobile in the short period following their arrival. This may reflect an inability to select appropriate housing and environments when families first arrive because they are limited to low-cost private housing. A8 pupil immigrants, in particular, have tended to move away from the areas where they are initially concentrated through internal migration. On average, 10% of all pupil immigrants are also identified as emigrants in the period between 2004 and 2007, suggesting that permanent settlement in England is not the experience for many immigrant families. These findings contribute to policy-based migration research indicating where resources to assist immigrant groups should be directed and whether, as a result of subsequent dispersal, resources will need to be redistributed as immigrants move within England and beyond.