In this study, our first objective was to employ a unique framework to operationalize ten domains that encompass a good later life among a large nationally representative sample of individuals aged 50 to 69 residing in England. With the anticipation that a significant proportion of young older adults may not be experiencing these domains fully, we sought to investigate their prevalence. The findings revealed that among the participants in this sample, they most frequently missed on aspects such as Healthy Aging, Good Health, Social Connections, Financial Security, Fulfilling Work, and Safe and Accessible Housing, which are important and will have consequences on how these young older adults will approach older age, in terms of progression and impact of disease (Grant et al., 2009), remaining independent for longer (Shankar et al., 2017), and survival (Zaninotto, Batty, et al., 2020). The high proportion of participants at risk for not reporting Good Health (39%) is a reflection of the fact that many of the chronic long-term conditions of older age first emerge in this age group (MacNee et al., 2014). In part, this is an indication of the substantial numbers who are at risk also of not reporting Healthy Ageing (49%) on account of physical inactivity and alcohol consumption. Adopting healthy lifestyle in young old age has consequences on health in later life, as it has been shown that improving physical activity and reducing alcohol consumption may promote survival (Bowling, 2004), longevity (Zaninotto, Head, et al., 2020) and decrease the risk of serious health adverse outcomes (Shankar et al., 2010), including frailty (Gil-Salcedo et al., 2020).
It is striking that more than one-third of respondents were missing out in terms of Social Connections. The problem of social isolation at older ages is well recognised (Holt-Lunstad et al., 2017; Holt-Lunstad & Steptoe, 2021), results from the National Health and Aging Trends Study showed that 28% of people aged 65–69 reported social isolation (Cudjoe et al., 2020). Social isolation in turn impacts on future health outcomes. A longitudinal analysis of the National Health and Aging Trends Study restricted to people aged 65 + showed that a 1-unit increase in the Social Isolation Index resulted in an average decrease of 0.27 units in the Short Physical Performance Battery (Cruz et al., 2021). Whereas, evidence from ELSA (age range 50 to 100) showed that social isolation is negatively related to cognitive function (Shankar et al., 2017).
The high percentages of people at risk on Safe and Accessible Housing (35%) is an inditement of the quality of the housing stock in England with many people suffering from crowded, noisy, and poorly heated and insulated accommodation. Recent results from the English Housing Survey (Rottier, 2020) showed that in 2019 4.1 millions of homes in England failed to meet the Decent Home Standard, with the majority being in the private rented sector. Poor housing conditions have been associated with poor mental health (Evans et al., 2003), physical functioning limitations (Perez-Hernandez et al., 2018) and respiratory diseases (Webb et al., 2013) at older ages. People at younger old age might be particularly affected and at higher risk of poor health outcomes, as data from Office for National Statistics has shown that increases from the private rental sector are most pronounced in mid-life (ONS, 2020).
It is therefore evident that being at risk in any of these domains will certainly have important consequences for older people, however, some might argue that being at risk on one or a few of these domains might not necessarily translate into less enjoyable older age. To understand whether this might be the case, and to explore whether the conceptual framework can be successfully used for this purpose in research, the second aim of this study was to group individuals into risk categories of not having a good later life based on their risk status the items described above. We found three risk categories of individuals, confirming that the conceptual framework can be successfully applied to research. One in five people were in the high risk group, consisting on those at risk of Good Health, Healthy Ageing, Social Connections, Meaning and Purpose, Financial Security, Safe and Accessible Housing and Work and Health. We showed how the interaction of these domains contributed to risks of poor mental health and wellbeing in later life.
Out last aim was to explore the consequences of missing out on a good later life by reporting the associations between risk groups and outcomes such as mental health, loneliness, wellbeing and a life satisfaction. We showed that people in the high risk group, compared to those in the low risk group (i.e. at risk on Healthy Ageing only), reported higher levels of depression, loneliness, as well as lower wellbeing and life satisfaction.
The framework acknowledges the idea that older adults can experience a sense of enjoyment and fulfilment in their lives despite not being in good health or in the presence of chronic disease or cognitive impairment. It recognizes that a good later life is a multidimensional construct that goes beyond physical health and cognitive functioning. By considering diverse domains, the framework provides a more holistic understanding of older adults' lives. It recognizes that even with the challenges posed by chronic disease or cognitive impairment, individuals can still find meaning, engage in meaningful relationships, pursue personal interests, and have a sense of purpose and satisfaction in their lives, in line with other studies on wellbeing in later life (Blane et al., 2004; Lee et al., 2021; Wiggins et al., 2004). In doing so, the framework challenges the notion that a good later life is solely determined by health status. It emphasizes the importance of creating supportive environments, fostering social connections, promoting connected communities, fulfilling work and enabling individuals to maintain their autonomy and agency. This perspective allows for a more comprehensive assessment of older adults' lives and opens up opportunities for interventions and policies that can enhance their quality of life, despite the presence of chronic disease or cognitive impairment. Direct comparisons with other conceptual frameworks was not possible as to our knowledge there has not been an attempt to conceptualise a good later life using domains such as housing, financial security, etc alongside health and wellbeing.
Overall, the policy implications of these results emphasize the need for comprehensive approaches that address multiple domains of a good later life. Interventions should focus on promoting healthy behaviours, strengthening social connections, ensuring financial security, facilitating fulfilling work opportunities, and improving housing conditions. Support aimed at improving working conditions, affordable and suitable housing options, and improve accessibility and safety standards, will allow young older adults to maintain their independence for longer, contribute to improved mental health outcomes, enhanced quality of life, as they approach older age.
This study has several strengths. First it involved a holistic analysis of the experience of ageing, involving a wide range of aspects from health through social and economic issues to living environments. Such an analysis is only possible using a multidisciplinary study like ELSA which gathers information across a broad spectrum of topics relevant to later life. Second it employed a large nationally representative sample of older adults living in England. Furthermore, the Centre for Ageing Better’s framework presented here offers a unique perspective by encompassing domains that are often overlooked in the existing wellbeing literature, such as safe housing. This novel approach takes into account crucial structural social factors that significantly contribute to a comprehensive understanding of wellbeing in older age. By considering these factors within the broader conceptualization of wellbeing, the framework holds significant potential for meaningful applications in policymaking. Lastly it used a state-of-the-art methodological techniques to classify individuals into risk groups (latent class analysis). A possible limitation of our work is that the categories of good later life might differ in studies employing different domains of a good later life or different characteristics. We used the Centre for Ageing Better’s conceptual framework, but future studies might consider a more restricted or wider set of characteristics to conceptualise good later life. Finally, our analyses are restricted to those aged 50 to 69, different results might be obtained in a population with a different age composition, i.e. people over the age of 70 might be classified in the high risk group.
To conclude our study showed that a large number of young older adults are high risk group for not having a good later life and that this in turn has important consequences in terms of mental health, wellbeing, and life satisfaction. Considering that these adults are soon approaching later life interventions should be in place to change their trajectory through appropriate support and services to make sure that everyone is able to live longer in good conditions.