Understanding today for a healthier tomorrow: The NICOLA study

NICOLA (Northern Ireland Cohort for the Longitudinal Study of Ageing) is the first large scale longitudinal study of ageing in Northern Ireland, providing a basis for future government policy by following the lives of 8,500 men and women aged 50 and over as they grow older.

Life expectancy is rising in Northern Ireland and it is predicted that one in four children born here today will celebrate their 100th birthday. While this trend is good news, by 2048 almost half of the population will be aged over 50 years, thus posing many challenges for our society and policy makers. For example: how can we best maintain and maximise independence and the health and wellbeing of older people?; how do we organise and fund the delivery of care services for older people and make adequate pension provision?; and what are the consequences for the labour market and employment, with an increasing population of people reaching the conventional retirement age?

In 2012, NICOLA was set up to explore and understand why and how certain social, economic and biological factors are changing the lives of older people and to understand what it is like to grow older in Ireland. NICOLA is the first large scale longitudinal study of ageing in Northern Ireland, providing a basis for future government policy by following the lives of 8,500 men and women aged 50 and over as they grow older. The Commissioner for Older People (NI) has highlighted how the NICOLA study is a vital (and in some cases the only) source of data on key targets in the Active Ageing Strategy.

Led by the Centre for Public Health at Queen’s University Belfast (QUB), NICOLA benefits from extensive input from a wide range of research experts. These include the medical and health sciences, economics and management, social sciences, architecture and psychology, thus facilitating multi-disciplinary and cross-disciplinary research both within QUB and externally through extensive collaboration with international research groups. Designed to maximise comparability with other well-established longitudinal ageing studies such as The Irish Longitudinal Study on Ageing (TILDA), the Health and Retirement Survey (HRS) in the United States and the English Longitudinal Study of Ageing (ELSA), NICOLA also has unique aspects including questions about the Troubles, the influence of diet on ageing and changes in eye health.

Based on data collected from the first survey, early key findings were released in November 2017 at the official launch of the Wave 1 report. Held at Riddel Hall, QUB, attendance included representatives from government departments, the third sector, NICOLA funders, academic researchers, NICOLA participants, local health trusts and team members from other ageing longitudinal studies. The report focuses on the following key topics: sociodemographic characteristics, labour market participation, social connectedness and engagement, lifestyle behaviours, self-reported health, healthcare utilisation, and the methodology of the NICOLA Study. As the sample of NICOLA study participants is representative of the Northern Ireland 50 plus population, the results from the baseline data provide an interesting and robust snapshot of older adults in this country. So, what at this stage are some of the health-related findings from NICOLA?

Health and healthcare utilisation

Over one third of participants reported having a limiting long-term illness (LLTI), with the prevalence of LLTI increasing with age. Just over half (51 per cent) reported having very good or excellent self-reported mental health; only 5 per cent reported poor mental health. Fair or poor self-rated mental health was more prevalent in the 50 to 64-year-olds and in lower socio-economic groups. Married or co-habiting participants self-reported the best health on all measures. Generally, those living in the most rural areas reported slightly better health than those living in more populated areas. As expected, better health was also associated with a higher likelihood of being in work (for participants aged 50-74 years).

A large majority (80 per cent) of participants reported that they had visited their GP at least once in the past year, while visits to hospital outpatient clinics (46 per cent), inpatient services (20 per cent) and the emergency department (20 per cent) were relatively modest. Participants reporting the highest use of these services were more likely to self-report their health as ‘poor’, to have difficulties with activities of daily living and/or have a LLTI, and to live in the most socially deprived areas.

Health behaviours

Just under two thirds (61 per cent) of participants reported that they drank alcohol on a regular basis, of which almost one in three (31 per cent) consumed more than the recommended 14 units/week. 17 per cent of participants reported being current smokers; the highest rates of smoking were in those who were single, younger, living in urban areas and/or the most deprived areas, and had the lowest educational levels. Just over half (57 per cent) reported undertaking the recommended 150 minutes or more of physical activity per week. Rates of physical inactivity were higher among women, and in participants who were older, single, lived alone, had the lowest educational levels, and lived in areas of social deprivation.

Social connectedness and engagement

One in four of NICOLA participants were living alone, and this increased with age. Living alone was twice as common in the most deprived areas compared to the least deprived areas, and three times as common in urban areas compared to rural areas. Reassuringly, almost all participants (98 per cent) said they had a source of help if they were ill. Almost one in four participants (22 per cent) were in the ‘sandwich generation’, meaning that they had at least one living parent as well as a child (or children). A quarter of participants reported caring for family, friends, neighbours, or others with long-term physical or mental ill health, disability, or problems related to old age.

Social engagement of participants was evident, with 39 per cent involved in activity groups, and 18 per cent involved in voluntary or charitable work. This was particularly apparent in those who were married/co-habiting, better educated and living in the least deprived areas. Telephone contact was also considered important, with 79 per cent and 63 per cent telephoning relatives and friends each week (respectively).

Conclusion

NICOLA is already proving to be an invaluable resource for understanding what it means to be an older person in Northern Ireland, and is providing a rich data source for researchers and policymakers alike. The Wave 2 survey has been underway for the past year, and plans are being put in place in preparation for the third wave. This additional data will not only enhance this resource even further by enabling the study of changes in key outcomes over time but will also introduce new elements such as utilisation and satisfaction of publicly funded health and social care services, housing and transport needs and subsidiary jobs to name but a few. We anticipate further reports from the health assessment and nutrition components of Wave 1, as well as bespoke reports on specific age-related topics. In the words of NICOLA’s former Principal Investigator, Professor Ian Young: “NICOLA will help us change the way we live for the better and those participating in the study will leave a tangible legacy for future generations.”

Authors include Dr Sharon Cruise, Dr Charlotte Neville (NICOLA Scientific Officer), and Mrs Amanda Coulter (NICOLA Project Manager) on behalf of the NICOLA Study team.

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