27 Jan 2023
As the English Longitudinal Study of Ageing, or ELSA as it’s known, prepares to launch its tenth wave of data later in 2023, Project Manager, Kate Coughlin, reflects on how and why the Study is a crucial resource.
Older age is a time of significant change, not just in people’s health and wealth, but also in social connections, mental health and wellbeing. Throughout society, we see the extraordinary contributions older people make to business, politics, the voluntary sector, the arts, research and other fields. At the same time, certain demands on society increase as the older population grows. This is why data that enables us to track trends in the lives of the older members of our society is so important.
How it started… and how it’s going
Established in 2002 as a survey to track the dynamics of ageing, ELSA’s chief aim has always been to provide evidence to advance research and inform policy. With fieldwork on wave 10 drawing to a close, ELSA will soon represent over 20 years of longitudinal data – meaning its value as an unrivalled source of data on ageing has never been greater.
ELSA remains unique in its breadth, collecting data on everything from participants’ physical and mental health, cognitive function and financial circumstances, through to their attitudes and beliefs across a range of subjects.
Having started with an initial sample of 12,099 people aged 50 and over, the ELSA panel is refreshed periodically to ensure that it remains representative of the older population in England. By maintaining the sample in this way, alongside tracking different aspects over time, ELSA is uniquely placed to provide key evidence of change across the many different areas of life as people age.
That evidence is vital as we move into an era of an increasing ageing population. The 2021 Census confirmed that in England and Wales, there are more people than ever before in older age groups. Over 18% of the total population were aged 65 and over, compared with just over 16% in the 2011 census.
Innovation …. And COVID-19
Each wave of data collection takes place every two years via various modes. An in-home interview is carried out along with a separate self-completion questionnaire. Our participants also have a health visit periodically where biomedical measures are taken, including a blood test for the extraction of biomarkers and DNA. We also introduced an online component with the nutrition module in Wave 9 and the COVID-19 surveys in 2020.
At ELSA, we try to achieve a balance between collecting the same information from participants in each wave of interviews, while also introducing new content in response to changes in domestic and international policy drivers and scientific priorities. In 2018, we carried out the first Healthy Cognitive Ageing Project (HCAP) as part of an international research collaboration investigating dementia risk, with the second currently underway.
A harmonised protocol is used to carry out face-to-face cognitive assessments in ELSA participants with normal cognition, mild cognitive impairment or dementia. The protocol has now been used by seven ageing studies around the globe, which will allow us to make important cross-country comparisons of the prevalence and trends of dementia in ageing populations.
With funding via the UKRI COVID-19 Rapid Response call, we collected data from our ELSA participants at two points within the COVID pandemic. The first was in June-July 2020 and the second in November-December 2020.
Data collection was carried out via an online questionnaire with the option of a telephone interview for those who could not access the internet. At ELSA, we are keenly aware of the barriers to accessing the internet faced by older people, so we were unsure of the acceptability of an online survey. The online nutrition module we introduced in Wave 9, saw a 61% response rate, so we expected a higher response via the telephone for the COVID-19 survey. However, we found that 83% of our participants who completed the survey did so online, with 17% taking part through a telephone interview. Although there was an age gradient, this nonetheless was a surprising result and one which, in itself, deserves further research. It would seem barriers such as perception of the usefulness of the internet for older people, have potentially been broken down by the pandemic.
As with most studies, our main data collection period has been disrupted by the pandemic. Fieldwork for Wave 10 of ELSA began in the Autumn of 2021. With the potential for new restrictions always in the back of our minds, as well as potential longer-term reticence from our participants about in-home interviewing, we developed an adapted video interview which we will also use to collect data in the future.
Looking ahead to Wave 10
We have introduced several new questions to Wave 10. One of these asks whether participants have been referred by a doctor, social worker or other health professional to take part in art, music, exercise or other similar groups. This is called social prescribing and is becoming increasingly common as we learn more about the benefits of taking part in cultural and social activities, particularly as we get older. ELSA studies have shown that taking part in these activities can reduce the risk of developing dementia and even help us to live longer. And with singing therapy being used to help people with long COVID, social prescribing is likely to become even more commonplace. Gathering information on how and when social prescribing is used will help us to build a picture about how it is working across the country.
We have also added more questions on internet usage and digital access barriers. The importance of online connections through mobile phones, tablets and computers for the maintenance of social relationships has been vividly illustrated by the COVID-19 experience, with online services being one of the primary means of sustaining contact with family and friends during lockdown as well as for buying essentials. ELSA is in a unique position of being able to show where digital access has been improved by the COVID-19 experience and where disparities persist.
Other topics have been rotated back in from previous waves such as discrimination and personality measures. We have also added COVID-19 related questions, including some to identify potential cases of long COVID. Wave 10 also includes the addition of activity monitors to objectively measure participants’ activity and sleep. This is part of a UKRI-funded project in collaboration with our sister study in China, CHARLS.
As well as the main interview and health visit data, researchers can also access various genetic data products, nutrition data, HCAP and COVID-19 Substudy data. Although only available within the ELSA team at the moment, the ELSA dataset is also enriched by linking with various administrative datasets. These include Hospital Episodes Statistics (HES), mortality and cancer registration records, primary care records, and economic records including national insurance contributions and benefits.
We’d be nothing without them
At ELSA, we are lucky to have a cohort of very dedicated participants. By the end of 2023 their life experiences will have been informing policy and practice for over 20 years. From the formation of pension policy, estimation of social care needs and costs, right through to the benefits of continuing the Freedom Pass scheme.
By 2036, it is estimated that 1 in 4 of us will be over 65. We hope that ELSA will continue to contribute data to influence research and policy, helping us all to live longer, happier and healthier lives.
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