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

人口老龄化带来的挑战已被反复记录，并认识到需要最大限度地减少依赖并最大限度地提高社会参与和福祉。拟议的研究涉及审查与老年人的脆弱和福祉（两者都是广义的）有关的因果过程，包括在生命过程中和特定时刻起作用的因素，社会经济不平等，遗传，代谢，心理和社会过程，以及复原力和脆弱性。它将采用跨学科的方法，汇集来自生物，临床和社会科学的创新方法和领先学者。这一方法也将是比较性的，利用各国在人口、社会、经济和政策环境方面的相似性和差异，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、非专业护理人员、从业人员、专业人员、学者、政府和非政府组织）参与影响研究的进行以及研究结果的传播和应用，研究将利用英国老龄化纵向研究（艾尔莎）、美国和欧洲大陆的姐妹研究以及加拿大的类似研究提供的数据。艾尔莎是一项多学科研究，涉及对50岁及以上人群的代表性样本进行重复调查，提供六组访谈数据（每隔两年收集），三组生物数据（每隔四年收集）和使用稳健方法收集的详细生活史访谈。可获得的数据范围广泛，包括：储存的DNA和血清，适用于额外的遗传、代谢和生物标志物分析;已分析的生物标志物;对认知和身体功能的直接评估;以及一系列自我报告，涵盖人口统计、经济、健康、参与社会、公民和文化活动以及社交网络。这些数据的独特之处在于包含了跨学科主题的广度和深度，随着时间的推移重复测量，以及详细的生活史。这使得不同学科的方法相结合，提供独特的分析，这将大大提高我们对老年人积极和消极结果的原因的理解，以及这些结果如何在人群中分布。这些数据将用于制定脆弱和幸福的衡量标准，模拟生命历程轨迹，包括以后的生活事件，检查与社会经济地位的关系，检查遗传影响及其与代谢过程标记的关系，基因-环境相互作用，并确定对不利事件的弹性和脆弱性。

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.