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

项目摘要 这个应用程序的中心主题是教育对老年人健康的影响，特别是 多发病及其与残疾的关系。发病率和死亡率作为函数的差异 教育是流行病学研究中最一致的发现之一。教育的作用 延伸到老年，这在功能障碍、残疾和预期寿命方面的不平等表现得很明显。 最近的数据表明，预期寿命的持续增长伴随着受教育程度的扩大 预期寿命和残疾方面的差异。我们发现多种慢性疾病是由于年龄增长引起的。 人口和对其对功能轨迹和残疾的影响认识不足，这对 了解教育对老年人健康的影响。许多建筑的横截面性质 对多发病和残疾的研究不能确定可能是 用来缩小老年人健康统计数据的差距。 这个应用程序的总体目标是使用一个 纵向研究设计，随访跨越整个成人生命周期。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 建议是多发病，使用黄金标准来评估慢性病及其对 运行轨迹，使用测量和报告的运行轨迹。一系列的心理社会， 我们将对行为和生物途径进行研究。我们研究的一个优势是全面的数据 教育之后的社会经济轨迹，允许独立评估教育的影响 在这条道路上。这项研究的无回复率很低，而且与所有人的电子健康记录有关 参与者，无论他们是否继续参与，都是一个进一步的优势。我们建议研究 基于教育的多发病不平等和潜在机制(目标1)，评估两者之间的联系 以及解释与教育相关的测量和报告功能差异的机制 成人生命过程中的轨迹和残疾(AIM 2)，并检查教育是否缓冲 多发病对老年人残疾的影响并确定其潜在机制(目标3)。我们的 最重要的假设是，风险因素的多发病和次优控制可以更好地解释 低教育群体的残疾负担。 健康促进可以确保患有慢性病和残疾的老年人保持活跃和 独立，防止制度化和健康下降。预期寿命的提高和 高教育群体中的残障率表明扩大这些人口是可能的 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……里面 为了做到这一点，更好地理解教育影响老年人健康的途径 年龄是必要的；这项提议旨在产生的证据。

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.