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

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.

The aim of this Fellowship is to apply sophisticated econometric techniques to UK longitudinal data to develop the measurement, prediction and improvement of the health and well-being (H&WB) of older people.
The objectives are to answer the following research questions:

1) What causes the marked differences between self-assessed health and satisfaction with health in older age?
2) Can older individuals at higher risk of poor health and low well-being be identified earlier using observable life-event data?
3) Are community assets an alternative to formal health and social care services in improving the health and well-being of the older population?

Methodology:
Study 1) will utilise techniques more commonly associated with macroeconometrics to analyse impulse response functions. These functions provide information on the dynamic relationships of key variables after the onset of given shocks. Study 1) will additionally utilise anchoring techniques associated with the reporting of vignette health states. Study 2) will employ dynamic random- and fixed-effects econometric models to longitudinal data that track individuals as they age. Particular attention will be given to i) attrition and ii) endogeneity and reverse causation. To overcome i) we correct for panel attrition, whereas for ii) we will consider sources of exogenous variation (e.g. large scale plant closures). Study 3) will apply non-experimental policy evaluation methods (e.g. difference-in-difference with and without continuous treatment) to unique data. We can measure the effects of treatment and distance to treatment centres by employing spatial econometric techniques.

Scientific and medical opportunities:
The scientific opportunity is the novel application of advanced econometric techniques and the exploitation of existing and novel secondary data. The medical opportunity is the improvement of the H&WB of older people and reductions in associated health and social care costs.

It is envisaged that the economic and societal impact of this Fellowship will be felt by four distinct groups. First, as a direct result of the third piece of research, charitable organisations will benefit. "Inspiring Communities Together" is a charity organisation based in Salford, and they have the aim of improving the health and well-being of its residents, particularly the older aged population. They are involved with the setting up of new community assets which are designed to encourage the old to become more socially inclusive. These assets cost the charity time and money. To date there is positive qualitative evidence regarding the effectiveness of these community assets, but not robust quantitative evidence. This Fellowship will provide this evidence, which is needed such that the charity continues to receive financial support from the local authorities. By working closely with this charity, this Fellowship will ensure that they are involved at each stage of project 3. Similarly, AgeUK are involved in similar projects at a more national level and will benefit from this provision of quantitative evidence.

Second, results obtained from research carried out as part of this Fellowship will be conveyed to policy makers at both regional and national levels. National policy makers will benefit from project 2. If there is robust evidence to suggest that certain groups of the population are at a higher risk of having poorer health and well-being in later life, then these individuals can be targeted earlier. For example, if unemployment spells lead to poor later life health and well-being, then policies can be targeted at those individuals who become unemployed to ensure they do not suffer from persistent poor health and well-being. I (the applicant) will target national policy makers through the dissemination of results to media, and through academic journals. Local policy makers will benefit as a direct result of project 3. If community assets are shown as a good way of increasing health and well-being amongst the elderly, then councils can commission more of these assets. I will engage local policy makers through attendance and presentation at the "Salford Community Asset Action Team". Both pieces of work have the possibility of directly reducing the demands placed on the formal health and social care services by an ageing population. This, in turn, will lead to a reduction in the health budget, which means this money may be spent elsewhere.

Third, this fellowship has the ability to directly lead to a better quality of life for the ageing population. If policy makers listen to the research findings, and implement suitable polices, then as a direct result the health and well-being of older people should increase. As we are in a time of ageing populations, these health and well-being benefits are critical to improve quality of life.

Fourthly, the wider research community will benefit from this research. This Fellowship is attempting to answer fundamentally important research questions, and the results will be of interest to academics in similar research fields. This dissemination will take place through conference/seminar presentations, both internally within the Universities of Manchester and York (in various faculties and at the Manchester Institute for Collaborative Research on Ageing) and also within the academic profession more generally through presentations at international conferences, such as the Royal Economics Society, the American Society for Health Economists and the European Workshop on Econometrics and Health Economics. Collaborating with my sponsors, I will also produce at least three research articles detailing our methods, results, and findings, and submit these articles to world leading peer-revived journals. More specifically, I will benefit from working with my two Sponsors and developing new research networks. Additionally, I will benefit from exposure to the collaborators of my mentor.