The Irish LongitudinalStudy on Ageing
October 2011The Irish Longitudinal Study on Ageing (TILDA) is supported by the Department of Health and Children, Irish Life and the Atlantic Philanthropies.
What is TILDA (The Irish Longitudinal Study on Ageing)?
Nationally‐representative study of people aged 50+ (and their spouses or partners of any age) resident in Ireland
Work started in 2006: 2 pilots + data collection for wave 1 started in October 2009
10 year study (5 waves)
Funders: Irish Life, Atlantic Philanthropies, Department of Health and Children
Questions asked in such a way that TILDA is comparable with other international studies on ageing (HRS, ELSA, SHARE) + Qs relevant to Ireland (e.g. impact of recession)
TILDA Sample• Scientifically designed random
sample• Geo Directory ‐ 640 clusters of
addresses randomly selected (out of 3,155)
• 40 households per cluster were selected
• Initial households=25,600 (40*640)
• Selection of eligible respondents within dwellings
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Overview of design
CAPI
SCQ
Health Assessment
Economics Health
Social
Interdisciplinary study :
What is TILDA (The Irish Longitudinal Study on Ageing)?
Data collection is finished N = 8,507
CAPI response rate: 62%
Of those who completed the CAPI: 84.5% have completed the SCQ 72.4% have done the HA
“Small” financial incentive for respondents: €20
If 2 respondents were married/cohabiting a ‘financial respondent’ and a ‘family respondent’ were identified
Economic domain (CAPI)
Employment Situation
Planning forRetirement
Sources of Income Assets Service
Utilisation
‐ Current Activity Status‐Main Job‐ Subsidiary Jobs‐Self‐Employment‐ Unemployment and Permanent Sickness‐Previous Job‐ Job History‐ Life Long Learning
‐Occupational Pensions ‐Public Sector Pensions‐Personal RetirementSaving Account ‐ Personal Pensions Plans‐ Expectations
‐ Income form employment‐ Income from State and occupational pensions‐ State Welfare payments‐ Income from assets (rent, interest, dividends)
‐ Home ownership
‐ Car ownership
‐ Financial
Assets
‐ Healthcare
‐ Care
Social Domain
Demographics; Household & Family Structure
Transfers (to and from) Children (Grandchildren)
Transfers to (and from) Parents
(Instrumental) Activities of Daily Living and Helpers
Social Connectedness & Transport
Perceived stress & Stressful Life Events
(Grand)Parents
Children(Grandchildren)
Respondents(Parents)
Space, Time, Money
Space, Time, Money
Social domain: CAPI & SCQ
Transfers to and from Children
Transfers to and
from Parents
(I)ADL and helpers
Social Connectedness & Transport
Demographic & Soc‐Econ Info about Respondent’s Children
Financial & Practical Assistance to Children
Financial & Practical Assistance from Children
Practical Assistance from/to Other Relatives; Friends & Neighbours
Demographic & Soc‐Econ Characteristicsof Respondent’s Parents
Financial and Non‐Financial Assistance to Parents [Siblings]
Financial Assistance from Parents
ADL, Help with ADL and Assistive Devices
IADL, Help with IADL
Frequency and Intensity of Help Provided,
Types of Helpers
Cost of Paid Helper; Who covers;Irish/non‐Irish Paid Helpers
Social Network Index
ParticipationSocial/RecreationalActivities*
Religiosity
Relationship Quality*Loneliness*
Transport
Perceived Stress*Stressful Life Events *
*SCQ
Health domain: CAPI & SCQ
Physical Health
Cognitive Health
PsychologicalHealth
BehaviouralHealth
Health CareUtilisation
SR health
Chronic illness
Functional ability
Falls, Fear of falling
Pain
Sensory Decline
Incontinence
Medical screening
Medications (DMA)
SR Memory
Forgetfulness
Orientation
Memory•Immediate & delayed recall
•Prospective
Executive function•Verbal fluency
SR Mental Health
Depression •CES-D 20 item
•Suicide
Anxiety & Worry*•HADS – A
•PSWQ 8 item
Loneliness*•UCLA Loneliness
QOL*•CASP-19
Life satisfaction
Ageing Perceptions*
Exercise
•IPAQ short form
Alcohol*•Patterns of drinking
•CAGE
Smoking
Sleep
Quality of healthcare
Access to healthcare
‘Met need’ versus ‘unmet need’
*SCQ
HEALTH ASSESSMENT
All respondents offered HAC assessment
If unable/unwilling, offered home assessment*
*Shortened version of the HAC assessment
8507
6,158 (72%)
876 Home (14%)
5,282Centre (86%)
1. Well timed PR & media2. Reimbursement for ‘out of pocket’3. Novelty / Feedback4. Social interviewers underwent a
TILDA health assessment
HEALTH ASSESSMENT
Cognition
Gait & Balance
Cardiovascular
Eye
Global cognition
Sustained attention
Height & Weight
Balance*Dual tasks*GAITrite*
BP Phasic BP*
TUG
HRV*
MemoryExecutive function
CRT
Acuity* Contrast sensitivity*
Retinal photo*
Macular pigment*
Grip strength
PWV*
Heel U/S*
General WHR
*HAC only
* HAC only
Neurocardiovascular Instability
Gait & Balance
Vision
Interdisciplinary team
Researchers have background in:• Economics• Social • Health
But also…1 bioengineer (HA equipment)1 statistician 1 data manager1 survey manager
Missingness
We thought that most sensitive Qs (highest missingness) would be suicide / incontinence
But highest missingness is actually on assets / wealth!
Unprecendented increase in Life expectancy World wide
Implications for Health and Social Welfare Services
OVERVIEW
dynamic processes, patterns, causal
Healthy
OVERVIEW
•Contribution, Unmet need, Education
profiling and target need
Commercialisation
Technologies, Services, Products
ECONOMICS
ECONOMICS
• The economic elements of the report focus on two issues –labour force participation and income/assets
• The labour market participation of older people is important from a broad range of perspectives
• For the individual, participation in the labour market can be associated with increased resource and enhanced levels of life satisfaction
• For the macro‐economy, higher levels of participation among older people translate into a bigger labour force and hence increased output
• If higher participation is combined with later payment of pensions, reductions in pensions can be achieved
ECONOMICS
• Among those aged 50 to 64, 62% of men and 46% of women are at work
• For those aged 65‐74, 16% of men and 8% of women are at work
• Labour supply of older adults aged 50 to 64 in Ireland is concentrated amongst the healthiest, most educated, wealthiest and most satisfied with life
• The average number of hours worked decreases as workers move closer to age 65, suggesting some form of ‘wind‐down’ in advance of retirement
• 96% women and 98% of men report that they are not affected by any kind of workplace discrimination
ECONOMICS
• The average weekly household disposable income is €767 but for a half of the sample, weekly household disposable income is under €400 per week
• About one in eight of older households have weekly disposable incomes of €1,000 or more
• A quarter of the households depend on state transfers as their sole source of income
• A majority (about 70%) own their home and have finished paying off their mortgage.
• Savings and financial assets (other than property) vary with level of education from an average of €14,000 for those with primary education to €60,000 for those with tertiary education
SOCIAL
SOCIAL
Stereotypes
‘Older people are lonely’
‘Older people don’t enjoy life’
‘Older people are a drain on their families and society’
SOCIAL
Social connectedness (Berkman SNI)
0
10
20
30
40
50
50‐64 65‐74 >=75
Most isolatedModerately isolatedModerately integratedMost integrated
SOCIAL
Loneliness by age (average score on modified UCLA loneliness scale)
0
2
4
6
8
10
50-64 65-74 >=75Note. N = 6055; Missing obs = 2123; Error bars correspond to 95% confidence intervals
SOCIAL
‘Older people are lonely’
Only 6 % are socially isolated
Loneliness increases only very slightly with age
SOCIAL
‘Older people don’t enjoy life’
The older population as a whole experiences a high quality of life
9 / 10 agree that they appreciate things more as they get older
9 / 10 agree that they have control over their ability to live life to the full
SOCIAL
Providing help to & receiving help from children
SOCIAL
Material and financial gifts to / from children
0
10
20
30
Gave property orlarge gift tochildren
Received financialassistance from
children
50‐64 65‐74 >=75
‘Older people are a drain on their families and society’
Quarter of older households have given large material gifts to their children
One third help children with household & other practical tasks
One half regularly help with grandchild care
15 % are very active volunteers
HEALTH
SR Health & Prevalence of disease
75% of older adults rate their health as excellent, very good or good
SR Health declines with age 79%50‐
64 72%65‐74 66%≥75
Cardiovascular and non cardiovascular diseases are common in older adults with the prevalence of most chronic conditions increasing with age
One in three older Irish adults report a diagnosis of high blood pressure
0
20
40
60
High blood pressure - self report High cholesterol Abnormal Heart Rhythm
50-6465-74>=75
•Hypertension•Angina•Stroke
Men
•Osteoporosis•Arthritis
•High cholesterol
Women
Mental Health
High prevalence of anxiety and depression
•10% of population have clinically significant depressive symptoms•18% report ‘subthreshold’ depressive symptoms
Only 5% of respondents reported a ‘doctor’s diagnosis’ of depression
Only 22% of respondents who were depressed (according to CES‐D) reported a ‘doctor’s diagnosis of depression
* Subthreshold: a person has depressive symptoms but does not meet the criteria for a depressive disorder
Significant under‐diagnosis and un‐met need
Depression associated with higher levels of disability, polypharmacy, reduced labour force participation and higher levels of health service utilisation
Objective Health
High levels of obesity ‐ Three quarters of older Irish adults are overweight (44%) or obese (34%)
Not diagnosed Diagnosed
Male
Not hypertensive
Hypertensive
67%
58%
33%
42%
Female
Not hypertensive
Hypertensive
64%
49%
36%
51%
Total
Not hypertensive
Hypertensive
66%
54%
34%
46%
Unrecogniseddisease
1 in 4 older Irish adults has objective hypertension
Significant discrepancy between self reported and objective disease
HEALTHCARE UTILISATION
HEALTHCARE UTILISATION
Key Messages 1• Nearly 60% of people between 50 and 69 have private medical insurance (46% for those in their 70s and 32% of those over 80).
• 97% of those aged 80 or over have medical cards (91% for people in their 70s and 30% of those in their 50s).
HEALTHCARE UTILISATION
Key Messages 2• The likelihood of being a user of GP care rises slightly with age, but is similar for all those over 70.
• The likelihood of having a hospital admission is similar for different ages over 60, but the length of stay increases slightly with age
• People over 80 are lower users of outpatient services than those in their 60s and 70s.
HEALTHCARE UTILISATION
Key Messages 3• Prevalence of disabilities rises with age (less than 10% of those between 50 and 64, nearly 30% of those over 75)
• Chances of receiving home help services higher for those with some disability, as it is for meals on wheels and personal care services.
• People with impairments in ADL and IADLreceive on average 118 hours of help per month.
HEALTHCARE UTILISATION
Key Messages 4• Most common primary helper is the recipients’ spouse representing large contribution by older adults to care of older adults.
• Only 3.5% of people over 50 receive state provided home help services.
• Of those with both ADL and IADLimpairments,12% do not receive formal or informal help ‐ potentially a very vulnerable group.
