Luke Archer (p), Benjamin Wilson, Bryan Tysinger, Nik Lomax

Around the world, virtually all developed and developing nations are experiencing population ageing. The United Nations predicts that, between 2015 and 2030, the number of people aged 60 years or over will grow by 56 percent, from 901 million to 1.4 billion. By 2050, the global population of older people (defined as those aged 60 years and older) is projected to reach nearly 2.1 billion. The effects of population ageing will be broad and significant, putting increasing pressure on healthcare systems and governments around the world. It is very important therefore that policy makers plan effectively for this future, and enact policy to help populations age more healthily. Tools to provide evidence for and assist in making these decisions are therefore crucial. This paper outlines the development of a tool which allows us to assess the impact of policy decisions on future health in England.

The model is being developed in collaboration with a team at the Leonard D. Schaeffer Centre for Health Policy & Economics at the University of Southern California (USC). For over a decade, this team has been developing a dynamic demographic microsimulation model to investigate health policy for the elderly US population (aged 50+), known as the Future Elderly Model (FEM). We have adapted this model to use the English Longitudinal Study of Ageing (ELSA) as host data, in place of the US Health and Retirement Study (HRS). Our model uses ELSA to generate a baseline population and calculate transition probabilities over time, for the purpose of projecting the individual health trajectories of respondents into the future. These health trajectories include information on non-communicable diseases, functional limitations, mortality, and health-impacted economic outcomes.

As an example of the potential of this tool, we investigate the impact of specific behaviours related to health, with a particular focus on smoking. We assess the benefits of some hypothetical policy interventions, looking in particular at the wider impact on the prevalence of related diseases, as well as changes in life expectancy and disability-free life years.

Elena Maggi, Evangelia Pantelaki (p), Daniele Crotti, Federica Rossi

According to United Nations (2015), Italy is destined to be the second country (after Japan) with the oldest population in the world. Thus, researchers demonstrate a growing interest to study the potential of the public transport policies (e.g., concessionary fares, dedicated services, etc.) to increase the accessibility of the elderly to public transit, and therefore favor their ability to reach desired places improving in the same time their life satisfaction and health. However, to the best of our knowledge, any study on this issue has not been conducted yet in the Italian context. In this paper, in the framework of the Project HAPPY (Health, Accessibility, Public transport Policies for elderly), financed by “Fondazione Cariplo”, using data retrieved from the Italian Institute of Statistics (ISTAT) ‘Aspects of daily life’ survey, we investigate the relationship between the health status of individuals over 60 years old and their transport behavior, in terms of transport modal choice, public transport (bus, tram and trolley) versus car. Controlling for various socio-demographic characteristics (e.g., gender, education, income, living arrangements) and for other daily-life conditions, such as social inclusion or participation to associations, political parties, voluntary organizations, etc., an econometric model will estimate the causality between transport-related mobility and health status. Moreover, the findings will be compared with those coming from other European and non-European surveys, such as the UK survey “English Longitudinal Study of Ageing (ELSA)”, that collects data from people aged over 50 to understand all aspects of ageing in England. The preliminary results of the econometric analysis confirm that self-perceived health is higher for the elderly who consider among their transport options the public transport. Even though the relationship is not very strong, although it is present, we cannot conclude on the direction of the causal relationships due to the cross-sectional nature of the dataset. Our research findings complement the scientific evidence and have the potential to orientate policy-makers’ decisions on integrating mobility policies within a multidisciplinary framework, considering also the public transport systems when assessing healthcare issues in ageing societies and, thus, guaranteeing also more sustainable transport solutions.

Silvia Coretti (p), Martina Celidoni, Chiara Dal Bianco, Vincenzo Rebba, Lorenzo Rocco

Introduction and aim. This piece of research is part of the HAPPY (Health Accessibility transport Public Policies for elderlY) project concerned with understanding which suitable public transport policies could contribute to increase positive social connections and health conditions of the ageing population by considering different Italian contexts, such as densely populated (urban) and more remote (inner) areas. At this stage, we focus on the potential health needs of the elderly over 65s, across the national territory and within Veneto and Lombardia, that are the regions of interest for the core part of the HAPPY project.
Methods. We analyze selected items of the Survey of Health, Ageing and Retirement in Europe (SHARE) to study the social deprivation index in Italian geographical areas and its correlation with several measures of health. Moreover, we analyze several items of the Survey of Italian Households conducted by the Italian National Institute of Statistics in 2017, to describe the general health status and access to health care services by individuals aged 65 and over in Lombardia and Veneto regions.
Results. The social deprivation index is higher in southern and central regions. For Veneto and Lombardia, it is lower than the national average. Health deterioration and social deprivation are strongly positively correlated, with individuals in poor health showing higher levels of social deprivation on average. The average social deprivation for individuals having no limitations is lower compared to individuals having at least one limitation in the Activities of Daily Living (ADL) or the Instrumental Activities of Daily Living (IADL). Finally, the average social deprivation index tends to be higher for individuals at risk of developing sarcopenia.
In Lombardia, 45% of individuals between 65 and 74 years of age reports good or excellent health. The share drops to 32% in the older population group (over 75). The most common chronic conditions are arterial hypertension, osteoarthritis, high blood pressure and myocardial infarction. In Veneto, more than 40% of individuals aged 65-74 reports good or very good health. This percentage drops to 32% in the older age cohort. The most common chronic conditions are arterial hypertension and osteoarthritis. In both regions, patients most often access the NHS (National Health Service) services for blood sampling and diagnostic services.
Conclusions. These results provide us with useful information in order to ascertain the health care and mobility needs of the elderly and will inform the next stages of the HAPPY research project.