Inequalities in later life frailty and wellbeing: an interdisciplinary approach to causality

人口老龄化带来的挑战一再得到记录，认识到有必要最大限度地减少依赖和最大限度地提高社会参与度和福祉。拟议的研究涉及审查与老年人的虚弱和幸福(两者都是广义的)有关的因果过程，包括在整个生命过程中和在特定时期起作用的因素、社会经济不平等、遗传、新陈代谢、心理和社会过程以及复原力和脆弱性。它将使用跨学科的方法，汇集来自生物、临床和社会科学领域的创新方法和领先的学者。这种方法也将是比较的，利用各国在人口、社会、经济和政策环境中的相似和差异，以更清楚地了解政策的影响。工作计划将确保所有用户(老年人、业馀护理者、从业者、专业人士、学者、政府和非政府组织)参与影响研究的进行以及研究成果的沟通和应用。研究将利用英国老龄化纵向研究(ELSA)、美国和欧洲大陆的SISTER研究以及加拿大的一项类似研究提供的数据。ELSA是一项多学科研究，包括对50岁及以上有代表性的人进行重复调查，提供六组访谈数据(每组相隔两年)，三组生物数据(相隔四年收集)，以及使用可靠的方法收集的详细的生活史访谈。可获得的数据范围很广，包括：储存的DNA和血清，适用于更多的遗传、代谢和生物标记物分析；已分析的生物标记物；认知和身体功能的直接评估；以及涵盖人口统计、经济、健康、参与社会、公民和文化活动以及社会网络的一系列自我报告。这些数据在包含跨学科的主题的广度和深度、随着时间的重复测量以及详细的生活史方面是独一无二的。这使得能够结合不同的学科方法来提供独特的分析，这将大大加强我们对老年人积极和消极结果的原因以及这些结果在人口中的分布情况的理解。我们这样做的能力将通过考察国家环境的影响而最大化。这些数据将被用于开发脆弱和健康的衡量标准，模拟包括后来的生活事件在内的生命过程轨迹，检查与社会经济地位的关系，检查基因影响及其与新陈代谢过程、基因与环境相互作用的标记的关系，以及确定对不良事件的韧性和脆弱性。

The challenges posed by the ageing of populations have been repeatedly documented, with recognition of the need to minimise dependency and to maximise social engagement and wellbeing. The proposed research is concerned with examining causal processes relating to frailty and wellbeing (both broadly defined) at older ages, including factors operating across and at particular points of the life-course, socioeconomic inequalities, genetic, metabolic, psychological and social processes, and resilience and vulnerability. It will use an interdisciplinary approach, bringing together innovative methods and leading academics from across the biological, clinical and social sciences. The approach will also be comparative, using similarities and differences across nations in demographic, social, economic and policy circumstances to get a clearer understanding of policy influences. The work plan will ensure that the full range of users (older people, lay carers, practitioners, professionals, academics, Government and NGOs) are engaged in influencing the conduct of the research and the communication and application of findings.The study will make use of data provided by the English Longitudinal Study of Ageing (ELSA), sister studies in the US and mainland Europe, and a similar study in Canada. ELSA is a multidisciplinary study involving repeat surveys with a representative sample of people aged 50 and older, giving six sets of interview data (each two years apart), three sets of biological data (collected four years apart) and a detailed life-history interview collected using robust methods. A wide range of data are available, including: stored DNA and serum suitable for additional genetic, metabolic and biomarker analysis; already analysed biomarkers; direct assessments of cognitive and physical function; and a range of self-reports covering demographics, economics, health, participation in social, civic and cultural activities, and social networks. Such data are unique in containing a breadth and depth of topics across disciplines, repeated measurement over time, and detailed life-histories. This allows the integration of different disciplinary approaches to provide unique analyses that will greatly enhance our understanding of the causes of positive and negative outcomes at older ages, and how these are distributed across the population. Our power to do this will be maximised by examining the influence of national context.These data will be used to develop measures of frailty and wellbeing, model life-course trajectories, including later life events, examine relationships with socioeconomic position, examine genetic influences and their relationship with markers of metabolic processes, gene-environment interactions, and identify resilience and vulnerability to adverse events.