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

2. WP 2: Future disease patterns and their implications for disability Previous work Simulation model developed in background paper for ‘ Securing Good Care for Older People ’ Explored how changing patterns of disease and treatment would impact on the future levels of dependency of older people over the next 20 years for three diseases/conditions: –stroke and heart disease –dementia and cognitive impairment –arthritis,

3. WP 2: Future disease patterns and their implications for disability Simulation model Based on MRC Cognitive Function and Ageing Study (MRC CFAS) Has two stages: –Transition builds on earlier work modelling the impact of diseases on the onset of disability and death (Spiers et al 2005) –Projection applies transition rates to ‘age’ the population

4. WP 2: Future disease patterns and their implications for disability MRC CFAS Five centres used 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. WP 2: Future disease patterns and their implications for disability Transition stage:Modelling 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. WP 2: Future disease patterns and their implications for disability Projection stage

7. WP 2: Future disease patterns and their implications for disability 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

8. WP 2: Future disease patterns and their implications for disability Change in disabled population if disease prevalence is decreased by 1% every two years from 2001

9. WP 2: Future disease patterns and their implications for disability Proposed work Four strands Gender-specific projections –Refitting models separately by gender Range of measures of disability –Hierarchy of FL/IADL/ADL Further scenarios - diseases and ethnic minorities –Literature review diabetes, ethnic minorities Projections of DFLE –Add DFLE as output to projections

10. WP 2: Future disease patterns and their implications for disability Mortality trends and their implications (WP1) Future disease patterns & their implications for disability in later life (WP2) Changing family units & kinship structure (WP3) Household & family resources (WP4) Projections of pensions, incomes, savings, care (paid & unpaid); expenditure on pensions & long- term care (WP5)