Education and Aging: transitions from multi-morbidity to functional limitations

项目摘要 这一应用的中心主题是教育对老年人健康的影响，具体而言， 多发病及其与残疾的关系。发病率和死亡率的差异 教育是流行病学研究最一致的结果之一。教育的影响 这种不平等会延续到老年，表现在功能障碍、残疾和预期寿命方面的不平等。 最近的数据表明，预期寿命的持续增长伴随着教育水平的提高。 预期寿命和残疾的差异。我们确定了多种慢性疾病，由于老化的 对残疾人及其对功能轨迹和残疾的影响认识不足， 了解教育对老年人健康的影响。大部分的横截面性质 关于多发病和残疾的研究无法确定可以预防的目标， 用于缩小老年人健康状况的差距。 这个应用程序的总体目标是检查教育对老年人健康的影响， 纵向研究设计，随访跨越整个成人生命过程。我们的建议是基于 白厅II研究开创了健康不平等研究的先河。当前的具体焦点 建议是多方面的，慢性疾病使用金标准措施评估， 功能轨迹，使用测量和报告的功能。一系列的社会心理， 行为和生物途径将被检查。我们的研究的一个优势是全面的数据， 教育后的社会经济轨迹，允许独立估计教育的影响 这条路。研究中的无应答率较低，并与所有人的电子健康记录相关联 参与者，无论他们是否继续参与，都是另一个优点。我们建议研究 基于教育的多媒体不平等及其潜在机制（AIM 1），评估 以及解释与教育有关的测量和报告功能差异的机制 轨迹和残疾在成人生命历程（AIM 2），并检查是否教育缓冲 多种吗啡对老年残疾影响并确定潜在机制（AIM 3）。我们 总体假设是，风险因素的多变量和次优控制解释了更大的风险因素。 低学历群体的残疾负担。 健康促进可以确保患有慢性病和残疾的老年人保持活跃， 独立，防止机构化和健康下降。预期寿命的提高， 高等教育群体的残疾率表明，有可能将这些教育推广到所有人口， 我们的目标是确保大多数老年人尽可能长时间地保持健康、活跃和独立。在 为了做到这一点，更好地了解教育影响老年人健康的途径， 年龄是必要的;证据，这一建议旨在产生。

Project Summary The central theme of this application is the effect of education on health at older ages, specifically multimorbidity and its association with disability. Differences in morbidity and mortality as a function of education constitute one of the most consistent findings of epidemiologic research. The effects of education extend into old age as evident in inequalities in functional impairment, disability, and life expectancy. Recent data suggest that ongoing increases in life expectancy are accompanied by widening of educational differences in life expectancy and disability. We identify multiple chronic conditions due to aging of populations and poor understanding of their impact on functioning trajectories and disability as critical to understanding the effects of education on health at older ages. The cross-sectional nature of much of the research on multimorbidity and disability does not allow identification of prevention targets that could be used to close the gap in health stats of older adults. The overall aim of this application is to examine the effects of education on health at older ages using a longitudinal study design, with a follow-up spanning the entire adult lifecourse. Our proposal is based on the Whitehall II study which has pioneered research on health inequalities. The specific focus of the current proposal is multimorbidity, with chronic diseases assessed using gold standard measures and its impact on functioning trajectories, using both measured and reported functioning. A range of psychosocial, behavioral, and biological pathways will be examined. An advantage of our study is comprehensive data on socioeconomic trajectory subsequent to education, allowing estimation of effects of education independent of this pathway. Non-response in the study is low and linkage to electronic health records for all participants, irrespective of their continued participation is a further advantage. We propose to examine education based inequalities in multimorbidity and underlying mechanisms (AIM 1), assess the associations and mechanisms that explain education related differences in measured and reported functioning trajectories and disability over the adult lifecourse (AIM 2), and examine whether education buffers the effect of multimorbidity on disability at older ages and identify underlying mechanisms (AIM 3). Our overarching hypothesis is that multimorbidity and suboptimal control of risk factors explain the greater burden of disability in lower education groups. Health promotion can ensure that older people with chronic conditions and disabilities remain active and independent, preventing institutionalization and declining health. The improvements in life expectancy and disability rates in the high education groups suggests that it is possible to extend these all population groups to ensure that most older people remain healthy, active, and independent for as long as possible. In order to do this, a better understanding of the pathways through which education affects health at older ages is needed; evidence that this proposal aims to generate.