LIFE2YEARS1066 · 10/66 ten years on – monitoring and improving health expectancy by targeting frailty among older people in middle income countries

Population ageing and the transition from infectious to chronic diseases is occurring more rapidly in middle than it did in high income countries. Chronic diseases are already leading causes of death in all regions, but the focus on preventing premature mortality neglects the societal impact of the emerging epidemic on disability/dependence, particularly in older people. The PIs 12 year program of population research in Latin America, China and India provides uniquely detailed data on the extent, patterning and impact of the epidemic among older people in societies undergoing profound demographic, social and economic change. The focus for this project is the potential to modify trajectories of ageing through prevention and targeted intervention. Whether, in ageing societies, we can add ‘life to years’ as well as ‘years to life’ is an unresolved question.The project will delineate secular trends (2005-2015) in the health of older people by completing a third prevalence wave survey in catchment areas previously surveyed in 2004-2006 and 2007-2009. Health expectancies (HE), summarising effects of morbidity and mortality, provide evidence of direct policy-relevance on the impact of population ageing on health. Inequalities in HE (disability-free and dependence-free life expectancies) will be evaluated within and between countries. Multistate analyses will assess their determinants, unpacking influences of socioeconomic position, chronic disease and underlying frailty on incidence of disability and care-dependence, recovery and mortality, thus identifying priorities for prevention and intervention. Knowledge from the population research will be translated during the project into development of a simple practice-based multidimensional risk assessment tool, which could then be linked to implementation of a new WHO guideline (co-developed by the PI) for prevention/management of care dependence in frail older people in resource poor settings.