Development of interventions to enhance health and wellbeing in later life (The LIVEWELL programme)

虽然我们比前几代人活得更长，但在许多情况下，更长的生命年数包括更多的慢性健康状况不佳的年数。美国人的健康状况不佳以及医疗和社会护理支出（特别是在西方国家）集中在晚年。我们面临的挑战是找到在整个生命过程中改善健康和保持幸福的方法。有很好的证据表明，行为因素（吸烟、饮食、饮酒、体育活动）和社会条件与晚年的健康和福祉密切相关。然而，很少有证据表明，实际干预措施可以改变这些因素，有效地促进改善晚年的健康和福祉。LIVEWELL计划旨在通过确定i)预期可行、有效和具有成本效益的干预措施类型（即可以纳入日常生活的行为和社会改变）和ii)干预措施可能最有效的机会窗口来解决这一研究差距。此外，我们将开发工具，以衡量针对干预措施的健康和福祉变化。缺乏这样的工具是目前试图改善晚年健康和福祉的研究的一个重大限制。我们计划把重点放在？退休窗口?即一个家庭的主要收入提供者从主要就业岗位退休前后的一段时间。在与老年人讨论他们认为什么是可行和有吸引力的，并在现有最佳研究证据的基础上，我们将制定干预措施，解决每一个可能改变的主要行为和社会因素。这将包括在饮食（鼓励地中海饮食模式）、体育活动（如散步和游泳）和社会交往方面的新干预措施。我们将把这些新的干预措施与更成熟的戒烟和节制饮酒干预措施结合起来，制定一揽子干预措施，并酌情根据个人和社区的需要进行调整。此外，我们将开发提供这些干预措施的新方法，这些方法将是可行的和具有成本效益的，并将鼓励持续的行为改变和改善社会环境，为以后测试干预措施的研究做准备。

Although we are living longer than in previous generations, in many cases the greater number of life years includes more years of chronic poor health so that much of humankind?s experience of ill-health and expenditure on medical and social care (especially in Western countries) are concentrated in the later years of life. The challenge is to finds ways of improving health and maintaining wellbeing throughout the life-course. There is very good evidence that behavioural factors (smoking, diet, alcohol consumption, physical activity) and social conditions are strongly associated with health and wellbeing in later life. However, there is very little evidence about practical interventions to change these factors that are effective in promoting improved health and wellbeing in later life. The LIVEWELL programme is designed to address this research gap by identifying i) types of intervention that are expected to be feasible, effective, and cost effective i.e. behavioural and social changes that can be incorporated into everyday life and ii) windows of opportunity when interventions are likely to be most effective. In addition we will develop tools for measuring change in health and wellbeing in response to interventions ? lack of such tools is a significant limitation on current research attempting to improving health and wellbeing in later life. We plan to focus on the ?retirement window? i.e. the period before and after when the main income provider in a household retires from primary employment. In discussion with older people about what they think would be feasible and attractive and on the basis of the best research evidence available, we will develop interventions will address each of the main behavioural and social factors which are likely to be modifiable. This will include novel interventions in the areas of diet (encouraging a Mediterranean eating pattern), physical activity (e.g. walking and swimming) and social interactions. We will integrate these new interventions with more established interventions on smoking cessation and moderation in alcohol consumption to develop a package of interventions which, when appropriate, can be tailored to the needs of individuals and communities. Further, we will develop novel ways of delivering these interventions which will be feasible and cost-effective and which will encourage sustained behaviour change and improved social circumstances in preparation for later studies to test the intervention package.