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Workpackage 2: Future disease patterns and their implications for disability in later life

Leicester Nuffield Research Unit. Workpackage 2: Future disease patterns and their implications for disability in later life. C. Jagger, R. Matthews, J. Lindesay. Current simulation model. Based on MRC Cognitive Function and Ageing Study (MRC CFAS)

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Workpackage 2: Future disease patterns and their implications for disability in later life

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  1. Leicester Nuffield Research Unit Workpackage 2:Future disease patterns and their implications for disability in later life C. Jagger, R. Matthews, J. Lindesay

  2. Current simulation model • Based on MRC Cognitive Function and Ageing Study (MRC CFAS) • Used in Wanless to explore how changing patterns of disease and treatment in three areas: • stroke and heart disease • dementia and cognitive impairment • arthritis, will impact on the future levels of dependency of older people over the next twenty years

  3. Simulation model • Built on earlier work modelling the impact of diseases on the onset of disability and death (Spiers et al 2005) • Transition phase • Projection phase

  4. MRC Cognitive Function and Ageing Study (MRC CFAS) • Five centres • stratified random sample aged 65+ • includes those in institutions • N=13004 at baseline (1991) • 2 year follow-up • death information from National Death Registry

  5. Transition phaseModelling disease, disability and death Disability: Unable to perform at least one of three ADLS/IADLs independently - put on shoes and socks, have a bath or all over wash, or transfer to and from bed. Diseases and conditions: angina, peripheral vascular disease (PVD), cognitive impairment heart attack, arthritis, asthma, bronchitis high blood pressure, stroke, diabetes hearing, eyesight Statistical analysis: Polytomous regression model (non-disabled, disabled, dead) adjusting for socio-demographic and lifestyle factors in those not disabled at baseline (N=11,491)

  6. Projection phase βs for onset and death from model CFAS disease prevalence Propn dying or becoming disabled Trends in disease prevalence Effects of treatments Population New 65-66 yr olds Future popn by disability

  7. Projection phase 1991 CFAS transition probs + GAD adjustment 1993 Base popn by 2 yr age groups disabled non-disabled 65+ E&W popn by 2 yr age groups simulated popn 67+ by 2 yr age groups and disability status CFAS disability prevalence New 65-66 yrs by disability status CFAS disability prevalence CFAS base popn non-disabled CFAS transition probs by 5 yr age groups transition probs by 2 yr age groups Expand and smooth New 65-66 yrs from GAD

  8. Comparison of simulated population from SIMPOP with GAD Projections

  9. Proposed work Four strands • Gender-specific projections (months 1-6) • Range of measures of disability (months 7-12) • Further scenarios - diseases and ethnic minorities (?months 13-20) • Projections of DFLE (months 21-24)

  10. Proposed work (1) Four strands • Gender-specific projections (months 1-6) • Refitting models separately by gender • Redesigning model • BIG JOB • Range of measures of disability (months 7-12) • Hierarchy of FL/IADL/ADL • Medium job

  11. Proposed work (2) • Further scenarios - diseases and ethnic minorities (?months 13-20) • Literature review diabetes, ethnic minorities • Projections of DFLE (months 21-24) • Add DFLE as output to projections • Small-medium job

  12. Likely problems and solutions • Timing of work with Ruth Matthews’s maternity leave until September • Reorder strands 1 and 2 • Start literature review earlier

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