Health and Well-Being in Later Life: Measurement, Predictions, and Interventions

在联合王国和国际上，改善老年人的健康和福祉具有相当大的政策利益，部分原因是这是决定保健和社会保健预算需求的主要驱动因素。该研究金将调查英国境内老龄化人口的健康和福祉。这将通过执行下面列出的三个相互关联的分析片段来实现。第一项工作将调查老年人健康的两种常见主观衡量标准之间的差异，并分析我们可以从这些差异中学到什么。自我评估的健康和对健康的满意度在老年人中有显著差异，并随着年龄的增长以不同的方式变化。我们将研究在出现某些健康状况后，这两项措施会发生什么变化，使用的方法是：(i)用于研究经济动态的技术；（ii）小插曲（将个人反应固定在一个共同的尺度上）。这可以检验短期和长期的不同影响，也告诉我们个人考虑他们主观健康的方式。了解这些动态尤为重要，因为对健康的满意度可以说是决定个人健康行为和坚持治疗的最重要因素。第二项工作的目的是通过在弱势群体达到老年之前识别他们，为未来的政策提供信息；那就是确定老年时健康状况不佳和幸福感较低的可能性较高的群体。它将使用来自英国家庭小组调查（British Household Panel Survey）及其后续项目“理解社会”（Understanding Society）的数据，跟踪从工作年龄进入老年的个人，并将使用捕捉工作年龄期间报告的生活事件的变量来预测老年人的健康和福祉。这项工作将建立在现有文献的基础上，使用在较早年龄（在工作寿命期间）收集的数据，而不是回忆可能有误差的事件。例如，如果我们找到证据表明，失业的人在健康和福祉方面遭受了长期的影响，我们就可以使政府的政策更早地针对这些人，从而提高他们老年时的生活质量。第三项工作将评估加强社区资产对老年人健康和福祉的影响。它将利用索尔福德（英格兰西北部的一个贫困地区）的综合护理倡议，根据该倡议，社区中心将提供额外的社会活动。这些干预措施被认为减少了对正规保健和社会护理服务的需求，但几乎没有定量证据支持这一假设。作为国家卫生研究所资助项目的一部分，本研究将利用收集的独特队列，估计社区资产对健康和福祉的因果影响。所有这三件工作都使用了代表性的纵向数据集，并将应用先进的计量经济学和统计方法来处理这些数据集，以回答根本性的重要研究问题。本人（申请人）将在Matt Sutton教授（曼彻斯特卫生经济学中心）和Andrew Jones教授（约克大学经济及相关研究系）的资助下进行上述研究项目。他们都是各自领域的世界领导者，我将受益于他们的专业知识和他们的研究网络，以及曼彻斯特大学人口健康研究所的多学科网络。我还将受益于对该大学经济与社会研究中心的Arie Kapteyn的研究访问。位于南加州。最后，我将受益于在英国，欧洲和国际机构的培训课程和参加会议的形式。

There is considerable policy interest in the UK and internationally in improving the health and well-being of older people, in part because it is a major driving factor in determining the demand on the health and social care budgets. This Fellowship will investigate the health and well-being of the ageing population within the UK. This will be achieved by performing the three linked pieces of analysis outlined below.The first piece of work will investigate differences between two common subjective measures of health amongst the older population and analyse what we can learn from such differences. Self-assessed health and satisfaction with health are markedly different in older age, and change in different ways as people age. We will examine what happens to these two measures after the onset of certain health conditions using: (i) techniques used to study the dynamics of the economy; and (ii) vignettes (which anchor individual responses to a common scale). This allows examination of differing effects in the short and long run and also informs us about the way in which individuals consider their subjective health. It is particularly important to understand these dynamics, as satisfaction with health is arguably the most important factor in determining an individual's health behaviours and adherence to treatment. The second piece of work aims to inform future policy by identifying vulnerable groups of individuals before they reach older ages; that is identify groups with higher probabilities of having poor health and low well-being in older age. It will use data from the British Household Panel Survey and its successor Understanding Society to track individuals as they enter older age from working age, and will use variables capturing life-events reported during working age to predict health and well-being in older age. The work will build on the existing literature by using data collected at an earlier age (within the working life period) rather than recalled events which may be measured with error. If we find evidence to suggest, for example, that those who become unemployed suffer from long lasting consequences in terms of health and well-being we can aim government policy at targeting these people earlier, thus increasing their quality of life in older age. The third piece of work will evaluate the impact of strengthening community assets on the health and well-being of the older population. It will take advantage of an integrated care initiative in Salford (a deprived area in the northwest of England) under which additional social events at community centres will be made available. Such interventions are believed to reduce demands on formal health and social care services, but there is little quantitative evidence supporting this hypothesis. Using a unique cohort being collected as part of a National Institute for Health Research funded project, this study will estimate the causal effect of community assets on health and well-being. All three pieces of work make use of representative longitudinal datasets, and will apply advanced econometric and statistical methods to these data sets in order to answer fundamentally important research questions. I (the applicant) will undertake the above research programme under the sponsorship of Prof Matt Sutton (Manchester Centre for Health Economics) and Prof Andrew Jones (Department of Economics and Related Studies, University of York). Both are world leaders in their respective fields, and I will benefit from both their expertise and their research networks as well as from multidisciplinary networks within the Institute of Population Health, at the University of Manchester. I will also benefit from research visits to Arie Kapteyn at the Centre for Economic & Social Research at the Uni. of Southern California. Finally, I will benefit from training at British, European and International Institutions in the form of training courses and conference participation.