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

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.

The dramatic increase in human longevity has been accompanied by an increasing burden of frailty and of chronic poor health. 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 find ways of improving health and maintaining wellbeing throughout the life-course.

In contrast with the wealth of observational data supporting the hypothesis that health and wellbeing in later life are influenced strongly by behavioural factors and social conditions, there is a dearth of evidence about interventions that are effective in promoting improved health and wellbeing. Prerequisites for the development of such interventions include identification of i) intervention modalities that will be effective, culturally appropriate and cost effective; ii) windows of opportunity when interventions are likely to be most effective; and iii) outcomes measures responsive to the interventions that can measure change in health and wellbeing. The LIVEWELL programme will fill this research gap by addressing these prerequisites for interventions. Based on the MRC framework for development and evaluation of complex interventions, we will identify types of intervention that are expected to be feasible, effective, and cost effective i.e. behavioural and social changes that will be attractive to older people. The lack of outcome measures which capture the healthy ageing phenotype, as distinct from measuring disability or ill-health, is a significant impediment to the evaluation of interventions. We will develop tools for this purpose.

We will focus on the ?retirement window? i.e. the period before and after the main income provider in a household retires from primary employment. In discussion with older people, and based on both rigorous systematic reviews of the literature and behaviour change theory, we will develop interventions to address each of the main modifiable behavioural and social factors. 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 moderate 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.