Identifying Targets for Interventions to Improve Functional Ability to Work over the Life Course

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PROJECT SUMMARY/ABSTRACT As individuals age, their health may decline, in some cases leading to the loss of key functional abilities that enable them to work. These functional losses jeopardize prospects for healthy aging, which calls for ongoing engagement in socially productive activities of one’s choosing. Despite the importance of maintaining functional abilities with age, we do not yet understand how losses in particular cognitive, physical or psychosocial abilities interact with job requirements to impede work activity. In addition, it is unknown whether public health interventions could restore losses in critical abilities once they occur, or even prevent such losses in the first place. Understanding which ability losses cause the most loss in work capacity in the population is a prerequisite to identifying targets for interventions to improve functional work capacity. Once these ability losses and their impacts are understood, potential work- capacity interventions can be identified and evaluated. The ideal targets of work-capacity interventions are ability losses that lead to large productivity losses in the population, but for which relatively low- cost, effective interventions could be developed or, if interventions currently exist, could be made widely accessible. The goal of this project is to build the research base upon which work-capacity interventions may be developed. To do so, we will draw upon methods used for disability determination in the Netherlands, which measures work capacity by mapping standardized measures of functional abilities to standardized requirements of jobs across the national economy. This comprehensive mapping between abilities and jobs allows for direct computation of the set of feasible jobs and potential earnings for an individual, conditional on their education. The Netherlands is unique among countries in this approach to disability determination. First, we will adapt and harmonize the Dutch functional assessment instrument to the U.S. context and then field the assessment to a representative sample of Americans ages 25-75 at two points in time. After mapping respondents’ functional abilities to occupational requirements in the U.S., we will estimate cross-sectional levels of functional work capacity as well as longitudinal ability loss/recovery rates, overall and for different age groups. Next, we will conduct counterfactual simulations to determine the critical functional abilities that, if their loss could be reversed through future intervention, would have the greatest impact on work capacity in the U.S. population. Since prevention targets may differ from rehabilitation targets, we will also conduct the reverse exercise: we will use counterfactual simulations to determine the critical functional abilities that, if deterioration could be prevented through future intervention, would have the greatest impact on work capacity in the U.S. population. Lastly, we will simulate the effects of changes in occupational requirements arising from factors like technological change, pandemic risk, and climate change.