Policy Research Programme Policy Research Unit - Healthy Ageing

Area of Research: Healthy Ageing

Section 1: Summary of main strands/themes for research

In October 2021, the Office for Health and Improvement and Disparities (OHID) was formed, with the intention of tackling health disparities across the UK. OHID also works to prevent health conditions developing, with the aim of reducing pressure on the health and care system.

Health disparities, prevention and health improvement are therefore centre stage. Issues specific to healthy ageing include extending the period of independent living in later years by preserving functional capacity, supporting the development of policies which promote a positive concept of ageing, and enabling older people to do what they have reason to value.

This PRU should provide evidence to better understand what policy would be most effective in extending healthy life expectancy and closing the gap between the most and least deprived 20%. This includes an understanding of the way policies are implemented to ensure they reach the populations most in need and avoid negative unintended consequences. There is an assumption, often unchallenged in policymaking, that ageing inevitably leads to ill health. We require research to understand the extent to which this is true; what constitutes ‘optimal ageing’ with a focus on how healthy ageing policy can increase healthy life expectancy and improve quality of life.

In order to address the overarching research issue above, there are several areas where this PRU could usefully contribute, including:

1. Improve healthy life expectancy up to state pension age, with a focus on less affluent populations where the gains could be greatest, and including prevention, system design and delivery

The Government has committed to increasing healthy life expectancy (HLE) by 5 years by 2035 and reducing the gap between the most and least affluent.

We need to understand how effective are existing interventions/services that aim to increase healthy life expectancy among older adults? What contribution have these interventions made to reducing the gap in HLE?

More research is required with communities that have the poorest healthy life expectancy (HLE) to identify what policies are needed to reduce the gap in HLE and in specific geographic areas, such as coastal towns and in rural communities; those living in deprivation and in occupations that increase their risk of poor health; and specific population groups, such as those from ethnic minority groups, and people living with multiple long-term conditions and/or frailty. The Unit should also identify and consider learning from the Government’s Levelling Up agenda to inform future policy.

We would like to understand more about age-friendly places – what makes somewhere a good place in which to age, and what is the most effective way of improving areas that are yet to show best practice? How can different policy approaches be used to promote the value of healthy environments? How can the health and social care system meet the needs of older people in rural and coastal areas, especially people living alone?

2. Improve healthy life expectancy for those over age 65, with a focus on less affluent populations

Over 500,000 people have taken early retirement since the COVID-19 pandemic, with many retiring early due to ill health. This will have long-term financial and therefore health implications.

Current government policy around retirement planning is focussed on financial preparedness, with a policy gap around broader preparedness (planning for future health and care, social connections, etc). What policies might help to prepare people in the poorest social or geographical groups for retirement in this broader sense, and what might their impact be?

What are the most effective measures of people's functional capacity, both physical and mental, that can be used across the life course?

3. Evidence is also required to support people wishing to stay in or return to work

Improving work and health outcomes amongst working-age people has the potential to deliver substantial economic and social benefits for individuals, employers and wider society.

We would like the PRU to carry out research to understand the most effective interventions to support people returning to work, and people with long-term conditions or disability to stay in work, in particular those with common mental health problems, Musculo-skeletal conditions and those living with multiple long-term conditions. This includes how existing data can be used to develop policies to support people living with these and other long-term conditions.

4. Supporting women to access services and improve quality of life during the menopause

Millions of women in England go through menopause every year. Symptoms can be severe and impact on daily life, including work. The Call for Evidence for the women’s health strategy found that women face barriers to accessing healthcare support, and there are disparities in access to menopause care. It also found that many women did not feel supported to manage symptoms in the workplace and as a result took time off work or left the workplace. How might this be addressed?

5. How can physical activity support people to live well longer?

The former Chief Medical Officer, Dame Professor Sally Davies, once said, ‘If physical activity was a drug, we would describe it as a miracle cure’. How can we engage people in physical activity to support healthy ageing, including but not limited to:

• What is the best point in the life course to introduce strength and balance activity and how might uptake be improved? How should strength and balance activity be accurately measured?
• How does regular physical activity in early adulthood mitigate deconditioning and onset of disease in later life in the older population generally and in specific communities such as people living in more deprived areas and from ethnic minority groups?
• How might research-grade physical activity and sedentary time devices be used to monitor some guidelines that are currently inadequately measured or not measured by self-report instruments.

6. Preventing and delaying the onset of long-term conditions and disability, and extend the period of independent living at the end of life

We are currently responding to the pandemic by boosting the physical, social and mental health of older adults through a reconditioning programme (building a more resilient older population). This raises several questions that the Unit might address:

• What is resilience in older adults, and how might it be improved?
• Is there a particular population of older adults who are on the cusp of needing social care? How might we effectively identify this population, what tips them over into social care need, and what policy interventions could help?
• What are the policy implications of the 1.2m over 65s who are ageing without children? What specific support might be required?
• What improvements have occurred to ensure that older adults are routinely referred to Improving Access to Psychological Therapies (IAPT) services for mental health disorders? What examples of good practice can be scaled up at pace?
• What preventative measures to promote physical and mental health prevent demand for social care or delay/change it? How might services for people living with multiple long-term conditions be configured to best achieve this? How substantial are the potential impacts of different preventative interventions on long term demand for adult social care? What is the cost and return on investment of preventative interventions, including the costs of inequality persistence?
• What technology interventions can assist in extending the period of independent living at home and what will increase uptake of these interventions to older adults?

Section 2: Details of policy context and background

The work of the Unit will support the policy aim of improving the nation's health so that older adults can expect to live more of life in good health, and on levelling up health disparities to break the link between background and prospects for extending the period of healthy living as we age.

We expect the PRU to make use of the latest census data to get insight into what new policy priority areas should be.

The breadth of the policy agenda is illustrated by key documents including, but not limited to:

• COVID-19: wider impacts on people aged 65 and over - GOV.UK
• People at the Heart of Care: adult social care reform white paper
• A Connected Society – A Strategy for addressing Loneliness
• Living well with dementia – a national strategy for dementia

As a minimum, applicants should be familiar with the relevance of the following documents:

• NHS Long Term Plan
• Fair Society, Healthy Lives: the Marmot Review and The Marmot Review 10 years on
• Relevant NICE guidance for older adults
• Background to Integrated Care Systems
• Independent report on menopause and employment

Section 3: Justification for research topics

Research is needed to feed into policy-making processes at various points from the initial discussions of policy options through to evaluation of key policies and their associated interventions. Effective policy in this area has large potential impacts for the ageing population. As England’s population ages and increases, there is an even greater need for research to highlight where effective policy can enhance quality of life as we age and reduce demand on the health and care system.

The findings of the Unit’s research will inform the strategic and policy work of a range of Directorates within the Department of Health and Social Care (DHSC) and across government including OHID, the joint DHSC-Department for Work and Pensions (DWP) Work and Health Unit, NHS England and UK Health Security Agency (UKHSA), by supporting better health policy and cross-cutting policy to reduce healthy inequalities and extend the period of healthy ageing.

The findings of the Unit’s research will support the Department’s compliance with the public sector equality duty under the Equality Act 2010 and the Secretary of State for Health’s health inequalities duty under the National Health Service Act 2006 as amended by the Health and Social Care Act 2012.

The research will also be used to help local authorities, Integrated Care Boards and Integrated Care Programmes to develop improvements in national and local practice.

Section 4: Other related research activity of which the Unit will need to be aware

The OHID Healthy Ageing Team is reconvening the Older Adults Expert Advisory Group, which is comprised of leading academics who are active in the field of prevention and health improvement. The aim of this group is to ensure the Healthy Ageing programme is evidence based and to support translation of theory into practice.

There is a proposed new unit for reproductive health which provides a link with the menopause area.

Section 5: Other issues relevant to this programme of research

Applicants should consider how they would work with other PRUs that have research on healthy ageing, such as the PRUs on Reproductive Health (to ensure that the sexual health needs of older adults are included in future policy making), Dementia (for example, susceptibility of people from ethnic minority groups, and the gender gap in people living with dementia) and Adult Social Care.

The National Institute of Health and Care Research (NIHR) has a large-scale programme of research on healthy age of which applicants should be aware.