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

2. Leicester Nuffield Research Unit 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. Leicester Nuffield Research Unit 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. Leicester Nuffield Research Unit 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. Leicester Nuffield Research Unit Transition phase Modelling disease, disability and death Diseases and conditions: angina, peripheral vascular disease (PVD), cognitive impairment heart attack, arthritis, asthma, bronchitis high blood pressure, stroke, diabetes hearing, eyesight 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. 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. Leicester Nuffield Research Unit Projection phase CFAS disease prevalence Future popn by disability βs for onset and death from model Population Trends in disease prevalence Propn dying or becoming disabled Effects of treatments New 65-66 yr olds

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

8. Leicester Nuffield Research Unit Comparison of simulated population from SIMPOP with GAD Projections

9. Leicester Nuffield Research Unit 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. Leicester Nuffield Research Unit 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. Leicester Nuffield Research Unit 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. Leicester Nuffield Research Unit Likely problems and solutions  Timing of work with Ruth Matthews’s maternity leave until September –Reorder strands 1 and 2 –Start literature review earlier