1. „Determinants and trajectories of healthy life expectancy and deficit accumulation in older adults in Germany – follow-up of the KORA-Age cohort study“
Funded by: German Research Foundation (DFG)
Grant Number: GR 3608/3-1
In cooperation with: Helmholtz-Zentrum München
Period: January 2017 – December 2019
Rising life expectancy constitutes a financial and organisational challenge to health systems unless accompanied by a simultaneous increase in healthy life expectancy. It is an open question if these developments will eventually result in a compression or expansion of morbidity in the general population. A large variability can be observed between countries with regard to healthy life expectancy (HLE) with Germany being below European average. The respective trends in HLE in German birth cohorts are difficult to interpret. Potential causes for these trends may be found in different birth-cohort specific life experiences (e.g. being born before, during, or after the second world war, which may have resulted in very different early life experiences) or different trajectories in the accumulation of health deficits (deficit accumulation, DA) over the individual life course.
The second follow-up of the established KORA (Cooperative Health Research in the Region of Augsburg)-Age cohort study allows to investigate the trends in HLE and DA in a representative population sample of critical birth cohorts. Since 1984, four population-based surveys (KORA S1 to S4) have been conducted in Augsburg and two adjacent counties. To date, the KORA-Age cohort comprises of all participants from these four surveys who were aged 65 years or older at the end of 2008 (1943 birth cohorts and earlier). The KORA-Age baseline data collection took place in 2009, a first follow-up in an age- and sex-stratified subsample was conducted in 2012. In 2016/2017 the second follow-up with all survivors from the baseline data collection was conducted. Participants were aged 73 to 96 years old. Additionally, an age- and sex-stratified sample of 2000 younger S1-S4 participants who were aged 65 to 72 years by the end of 2015 (birth cohorts 1944-1950) was included. Data collection procedures included postal questionnaires and telephone interviews. This cohort study is conducted by the Helmholtz-Zentrum München. Our team works as a cooperation partner for the KORA-Age interview modules concerning falls, fractures, vertigo symptoms and functioning.
- To construct a deficit accumulation index (DAI) following established procedures as an instrument to measure deficit accumulation. The DAI will include symptoms, diseases and limitations in activities of daily life and functioning.
- Healthy life expectancy will be defined as the number of years spent in pre-defined health states before death.
- Investigation of predictors for HLE and DA in the KORA-Age cohort.
- Investigation of the association of DA and mortality in the KORA-Age cohort using multi-variate log-linear mixed-effects and cox-regression models. By taking into account age, period and cohort effects we expect to be able to identify the mechanisms which lead to a compression or expansion of morbidity and to establish prognoses for future trends in morbidity in the general population.
2. Systematic review on the effectiveness of national and international approaches to health promotion and prevention in older adult
Funded by: Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZgA)
The upcoming challenges for society and the health system which are linked to demographic change underline the importance of prevention and health promotion in all phases of life. A systematic and evidence-based investigation of existing prevention strategies requires a holistic perspective on intervention approaches. In the older population, multimorbidity, chronic diseases, dependence on long-term care and dementia all cause high costs for the health system, but to date the potential for prevention in this target group has not yet been investigated in a systematic and evidence-based way. Complex interventions comprise of multiple interacting components, include different heterogeneous target groups, have a multitude of outcomes and also allow for a certain amount of flexibility in their implementation. They depend on context and thus may not be effective in every setting. As a consequence, the results may differ depending on different modes of implementation. It can be assumed that measures which are supposed to promote „successful“ ageing are more or less appropriate, accepted and successful depending on gender, biography, environment, social and economic capital and further stratification characteristics.
- Exploration and definition of the term „intervention approaches in older people“ and further relevant terms, analysis of potential strategies, causal mechanisms and quality criteria for appraisal.
- Representation of all relevant aspects (target groups, interventions, comparison groups and outcomes). This shall also serve to gain an overview of barriers and facilitators, client preferences and their interactions. Systematic appraisal of the effect of modifying factors which can change the effect on outcomes (such as context, biography, social capital).
- Quantitative synthesis and appraisal of results regarding their internal and external validity, uncertainty and consistency. Qualitative synthesis of results regarding their relevance and acceptance.
Susanne Marlene Ulrich