England may have an ageing population but it does not follow that it is stagnant or all older people a burden. One aim of ELSA is to demonstrate the variety of life after age 50 years. This longitudinal study, half funded by a consortium of UK Government departments and half by the US National Institute for Aging, is undertaken jointly by University College London, the National Centre for Social Research, and the Institute for Fiscal Studies. A key condition of its funding is that ELSA provides a data resource for academics, governments and others who have an interest in the circumstances and wellbeing of older people.

ELSA follows cohorts of older people with biennial interviews; at the time of their first ELSA interview they have to be living in the community in England and to be aged 50 and over. We aim to retain them in the sample until they die or emigrate, i.e. we follow them into long-term residential care if we can. They are selected from participating households in the Health Survey for England. The technical details of the sample can be found in ELSA technical reports [1,2,3]. These also give information about attrition.

In essence it is a study of ageing that incorporates all of the key elements of quality of life among older people. The design assumed that there are connections between our health and functioning, our social networks, our economic position, and our perceptions of wellbeing. Age 50 onwards is a time when much can happen in our lives: retirement, children leaving home, grandchildren being born, enjoyment of more leisure, adjustment to less physical strength, onset of chronic disease, loss of loved ones, drawing on savings and more

Each wave (round) of fieldwork includes an interview and self-completion module. These cover: demographic circumstances; self-perceived health and functioning; self-reported health behaviours; some direct measures of functioning; employment; income; wealth; housing; social and cultural activity; quality of life; psychosocial measures such as loneliness, perceptions of ageing, demands in life and rewards. At even-numbered waves there is also a nurse visit in which anthropometric measures are taken as well as various biological markers and a range of physical tests. Most of the participants have also had a life-history interview that gives some handle on the timing and sequence of experiences in employment, family formation and composition; it also includes some indicators of major health events and traumas experienced during their lives.

One interesting aspect of the study is its choice of CASP19 as a quality of life measure. CASP being an acronym for Control, Autonomy, Self-realisation and Pleasure [4]. The advantages of this measure are that it is derived from aspects of life that people in their 50s and 60s reported as important to them in qualitative studies and, unlike health-related measure of quality of life, conceptualises quality of life as distinct from the factors that influence it.

The rest of this paper gives a few examples of the way ELSA data have been used so far. Many more are found on the IFS ELSA website.

Health inequalities
For health policy ELSA can assess the drivers of change and factors that lead to both positive and negative outcomes. A core part of the rationale of ELSA is to further understanding of socioeconomic inequalities in health and health care. Tackling health inequalities has been one of the top priorities for the NHS for several years [5, 6 p 11]. However, there has been less attention on inequalities within older groups than among those of working age and ELSA can rectify this.

Several papers and report chapters from ELSA have been concerned with health inequalities. Among people aged under 75 years at Wave 1, greater wealth was accompanied by better health at Wave 2 with respect to: incidence of at least one of the 17 conditions, still being free of diagnoses of these conditions, experience of chest pain, experience of balance problems and dizziness, severe pain at two or more specific parts of the body (back, hip, knee, foot). However, once aged at least 75 years, associations between health indicators and wealth largely disappeared, the exceptions being cardio vascular disease (CVD) related indicators and severe pain for women [7].

Cross-sectional analyses from Wave 2 showed that several biological risk factors for CVD were also worse for poorer people. By contrast there was no association with diastolic blood pressure and the prevalence of high total cholesterol and high LDL cholesterol were greater for richer people [8].

The morbidity results given above echo other research showing smaller inequalities for health outcomes for older than for younger people. McMunn et al [9] tested the hypothesis that survival differentials account for this. The outcomes were onset over a two year period of i) functional impairment ii) heart disease iii) poor self-reported health. Wealth gradients were shallower among the oldest old than among those in their fifties for the second and third outcomes. Selective mortality partially explained differences in gradients by age.

Timing of retirement
The Pensions Commission recommended putting back the state pension age to 68.The Government strategy, as expressed in Opportunity Age [10, Executive Summary] is "to achieve higher employment rates overall and greater flexibility for over 50s in continuing careers, managing any health conditions and combining work with family (and other) commitments”. In Opportunity Age, Wave 1 results were cited to show that many problems such as impairment in activities of daily living are not common until age 75 and over. Such findings provide important encouragement for policies to extend working lives and abolish compulsory retirement ages below age 65. This is very much a current issue of debate for 2009 [11].

Tracking people over four years showed that onset of major health conditions is associated with greater likely of leaving full-time work and stopping completely rather than stepping down to part-time work. This is likely in turn to affect wealth for retirement. Other findings relevant to extending working lives included below [12]:
• People are much more likely to remain in work / return to work if partner also working
• For men at least, membership of defined benefit pension scheme associated with greater likelihood of leaving work
• People are less likely to return to work if have been out of work for a long time and less likely to phase retirement if they have been in same job for a long time.

Whether or not working lives are extended, many of us will have a long retirement and the adequacy of resources to sustain us is an important question. There is substantial variation in wealth among people aged 50 years and over as can be seen in Figure 1 [13]. In evidence to the Turner commission, IFS concluded that about “60% of 50-65 year olds may be on target on the basis of pension wealth alone to enjoy pensions above the ‘adequacy’ benchmarks" [the Turner Commission] [op cit, p42].

In summary, ELSA is a rich source of data on many aspects of our lives as we age. I strongly encourage readers to have a look at the publications and to consider using these for their own research.

Reference List

1. Taylor R, Conway L, Calderwood L, Lessof C, Cheshire H, Cox K, Scholes S. Technical report (wave 1): health, wealth and lifestyles of the older population in England: the 2002 English Longitudinal Study of Ageing. National Centre for Social Research. 2007. 74 pp

2. Scholes S, Taylor R, Cheshire H, Cox K, Lessof C. Technical report (wave 2): retirement, health and relationships of the older population in England: the 2004 English Longitudinal Study of Ageing. National Centre for Social Research. 2008. 107 pp

3. Scholes S, Medina J, Cheshire H, Cox K, Hacker E, Lessof C. Technical report (wave 3): The 2006 English Longitudinal Study of Ageing. London National Centre for Social Research. 2009. 151 pp. In press

4. Hyde M,Wiggins R, Higgs P, Blane D. A measure of quality of life in early old age: the theory, development and properties of a needs satisfaction model (CASP-19), Aging and Mental Health 2003; 7: 186–194.

5. Department of Health, 2002 Tackling health inequalities. 2002 cross-cutting review. Department of Health 2002. 67pp

6. National Health Service. The operating framework for the NHS in England 2009/10. High quality care for all. London Department of Health. 2008. pp 52. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_091446.pdf
7. Breeze E, Cheshire H, Zaninotto P. Self-reported physical health. In Banks J, Breeze E, Lessof C, Nazroo J. (Eds) Retirement, health and relationships of the older population in England: the 2004 English Longitudinal Study of Ageing. London. Institute for Fiscal Studies. 2006. pp83-125

8. Pierce M, Tabssum F, Kumari M, Zaninotto P. Steel N. Measures of physical health. In Banks et al (eds) 2006 op cit. pp 127-163

9. McMunn A, Nazroo J, Breeze E. Inequalities at older ages: a longitudinal investigation of onset of illness and survival effects in England. Age Ageing. 2009; 38(2): 181-187

10. Department for Work and Pensions. Opportunity for All. First Report. London. Department for Work and Pensions. 2005. http://www.dwp.gov.uk/policy/ageing-society/strategy-and-publications/opportunity-age-first-report/volume-1/

11. Department for Work and Pensions. Building a Society for All Ages. July 2009. http://www.hmg.gov.uk/buildingasocietyforallages/executive_summary.aspx

12. Banks J, Tetlow G. Extending working lives, In Banks et al 2008 op cit. pp 19-56

13. The Pensions Commission. A new pension settlement for the Twenty-first Century. London. The Pensions Commission. 2005 459pp http://www.webarchive.org.uk/wayback/archive/20070801230000/

Data available from the Economic and Social Data Archive, University of Essex

See http://www.esds.ac.uk/longitudinal/access/elsa/l5050.asp

Websites: www.ifs.org.uk/elsa; www.natcen.ac.uk/elsa