ECONOMIC AND SOCIAL RESEARCH COUNCIL END OF AWARD REPORT

Transcription

1 ECONOMIC AND SOCIAL RESEARCH COUNCIL END OF AWARD REPORT For awards ending on or after 1 November 2009 This End of Award Report should be completed and submitted using the grant reference as the subject, to reportsofficer@esrc.ac.uk on or before the due date. The final instalment of the grant will not be paid until an End of Award Report is completed in full and accepted by ESRC. Grant holders whose End of Award Report is overdue or incomplete will not be eligible for further ESRC funding until the Report is accepted. ESRC reserves the right to recover a sum of the expenditure incurred on the grant if the End of Award Report is overdue. (Please see Section 5 of the ESRC Research Funding Guide for details.) Please refer to the Guidance notes when completing this End of Award Report. Grant Reference RES Grant Title Modelling Needs and Resources of Older People to 2030 (MAP2030) Grant Start Date 01/01/2007 Total Amount 1,164, Grant End Date 30/06/2010 Expended: Grant holding Institution London School of Economics Grant Holder Prof. M Murphy Grant Holder s Contact Details Address Co-Investigators (as per project application): Professor C Jagger Professor E Grundy Professor R Hancock Mr RD Wittenberg Mrs A Comas-Herrera Ms LM Pickard Professor JEB Lindesay Dept. Social Policy London School of Economics Houghton St London WC2A 2AE Institution M.Murphy@lse.ac.uk Telephone University of Leicester London School Hygiene & Trop Medicine University of Essex London School of Economics & Pol Sci London School of Economics & Pol Sci London School of Economics & Pol Sci University of Leicester 1

2 1. NON-TECHNICAL SUMMARY Please provide below a project summary written in non-technical language. The summary may be used by ESRC to publicise your work and should explain the aims and findings of the project. [Max 250 words] The financial, family, social and health resources of the older population have substantial implications for the well-being of those concerned and for public policy, especially with numbers increasing substantially in future decades. This project informs public debate and development of future long-term care and pensions policy by projecting the key determinants of the resources and needs of older people: the numbers, family circumstances, income, pensions, savings, disability and care needs (formal and informal) up to Key issues investigated include how trends in mortality and morbidity will evolve, and if the extra years of life will be lived in good health; the consequences of changes in family circumstances on the availability of informal sources of care and for older people's social participation; and older people's ability to meet care costs. Special attention is given to the inter-relationships between care needs (and their determinants) and economic resources in later life, and to the affordability, and distribution of costs and benefits, enabling sensitivity testing to key trends and scenarios on key unknowns. For the first time, long-term care and pensions policy reform options are analysed together. The project brings together existing simulation models in 5 linked work packages concerned with: 1. Mortality trends and their implications for future numbers of older people 2. Future disease patterns & their implications for disability in later life 3. Changing family units & kinship structure 4. Household & family resources 5. Projections of pensions, incomes, savings, care (paid & unpaid); expenditure on pensions & long-term care 2

3 2. PROJECT OVERVIEW a) Objectives Please state the aims and objectives of your project as outlined in your proposal to the ESRC. [Max 200 words] The overall aim of the research is to project the size of the older population and their financial, health, family, household and social resources and needs for care over the next thirty years. Specific objectives are to: 1) model mortality trends and differentials and use results to project future mortality in the population aged 65 and over in England and Wales 2) model disease patterns and their implications for future levels of disability in the older population 3) model and project the future family units, kin networks and households of the older population 4) model associations between family resources, socio-economic circumstances and social participation; and between family and socio-economic circumstances and use of formal and informal long term care in order to inform future projections. 5) project pensions, incomes, savings, informal care and use of long term care by older people 6) project future aggregate public and private expenditure on pensions and longterm care and its distribution 7) be methodologically innovative in achieving these objectives, and in analysing links between them 8) communicate results effectively to policy makers and iterate models according to insights and requests from policy makers where appropriate. b) Project Changes Please describe any changes made to the original aims and objectives, and confirm that these were agreed with the ESRC. Please also detail any changes to the grant holder s institutional affiliation, project staffing or funding. [Max 200 words] In the course of the project: Professor C Jagger moved from the University of Leicester to the Newcastle University Professor R Hancock moved from the University of Essex to the University of East Anglia A number of staff changes took place during the project, in particular a number of staff took maternity leave, and as a result, the project received a 6-month no cost extension. 3

4 c) Methodology Please describe the methodology that you employed in the project. Please also note any ethical issues that arose during the course of the work, the effects of this and any action taken. [Max. 500 words] The methods used in the project fall into the main areas of statistical modelling, demographic and epidemiological modelling, and development and use of macroand micro-simulation models. Statistical modelling Multivariate analyses of sample surveys such as GHS, FRS, MRC Cognitive Function and Ageing Study (MRC CFAS) and ELSA using generalised linear models Multivariate analyses of record linkage data sources such as ONS 1% & LS Finnish Register data using generalised linear models Time series models for analysis of macro-level cause of death data Specialised statistical models used Methods used include Vectorised Generalized Additive models to model multinomial nonparametric outcomes (WP1) Trichotomous linear regression models to estimate transition probabilities to death and disability (WP2) Multi-level growth curve models for repeated spells data (WP1) Use of analytic spline models to estimate growth rates (WP1) Development of APC models (a) with log binomial link for analysing morbidity & (b) within a Relative Risks framework (WP1) Use of Bayesian and Lee-Carter models for forecasting mortality by cause of death (WP1) Combining demographic methods and statistical modelling approaches to assess data quality (WP3) Epidemiological & demographic models developed Development of proximity to death service use models for use with marital status projections data (WP1) Development of APC models for forecasting cause specific mortality (WP1) "Very high improvement mortality model to assess sensitivity of expenditure to a wider set of possibilities (WP1). Simulation modelling Most of the work was concerned with running existing models with alternative updated assumptions and latest data, but a number of methodological innovations were also made to develop and adapt: SOCSIM model to enable it to estimate wider types of kin, including cousins and nephews/nieces. CARESIM, PSSRU and PPI models to enable them to incorporate scenarios from the other work packages. CARESIM to bring in new generations of older people SIMPOP model to output gender-specific estimates and disability-free life expectancy to enable it to incorporate scenarios from the other work packages. the PSSRU model by building an informal care extension model, which makes projections of (1) household type and receipt of informal care, contingent on the 4

5 availability of living children and (2) the supply of informal care, contingent on the propensity to provide care. All models were adapted to ensure model outputs produced compatible projections of public and private expenditure on pensions, disability benefits and care services under reforms of pensions and/or long-term care funding systems, and to examine the distributional implications underlying these projections. d) Project Findings Please summarise the findings of the project, referring where appropriate to outputs recorded on ESRC Society Today. Any future research plans should also be identified. [Max 500 words] The project focussed on individual drivers of the needs and resources of older people and how they fed into modelling the final outputs in WP5. Selected key outputs include: WP1 A series of presentations and papers have been prepared on the Golden generations, those born around the early 1930s who have been identified as having experienced particularly rapid improvements; assumptions about this group dominate official projections. Using long-run data series from countries such as Sweden and Japan as well as Britain, these assumptions have been shown to be considerably less firm than often claimed, and the assumption that rates of mortality improvement will slacken may require re-consideration (published in Population and Development Review, Journal of the Royal Statistical Society and forthcoming in British Actuarial Journal). WP2 This strand concerned how changing treatments and risk factors for age-related diseases (including stroke, dementia, arthritis, diabetes) impact on the projected size of the older population with disability and disability-free life expectancy. Halving dementia-related disability could reduce the size of the disabled older population by 10% (published in Age and Ageing). Compression of disability seems attainable at the oldest ages but only through halving the prevalence of major diseases (paper in preparation). WP3 Of all demographic analyses, those concerned with kin availability are most sensitive to long-term population trends. The kinship networks of older people have been and will change in years to come. The changing demographic regime, which causes the ageing of populations, will affect availability of kin; leading to an ageing of generational relationships; and patterns of repartnering will lead to more complex partial relationships involving step-children, half sibs, and former partners (published in Continuity and Change and forthcoming in Population and Development Review). WP4 This strand investigated changes in the balance between institutional and family care for older people and how these may have been influenced by policy changes. 5

6 Despite their high mortality, 36% of women and 26% of men in institutional care in 2001 were still alive three years later, a finding relevant to both families and service providers planning financing of care (Journal of Epidemiology and Community Health). We also investigated how family status and history are associated with physical and mental health, quality of life and social interaction and receipt of help in later life (forthcoming in Social Psychiatry and Psychiatric Epidemiology and Ageing & Society). WP5 This strand undertook new modelling of informal care. A key finding is that demand for informal care by disabled older people from their adult children is projected to rise faster than its supply over the next twenty years (paper in preparation). The strand also produced projections of future expenditure on long-term care and pensions for older people. Projections were produced, drawing on the outputs of the other WPs, under a range of assumptions about future mortality, disability and household composition rates. They were also produced for a range of reforms to the current funding system for long-term care, together with analyses of distributional impacts (presented at MAP2030 seminars). e) Contributions to wider ESRC initiatives (eg Research Programmes or Networks) If your project was part of a wider ESRC initiative, please describe your contributions to the initiative s objectives and activities and note any effect on your project resulting from participation. [Max. 200 words] This was part of the New Dynamics of Ageing (NDA) programme. Members of the project participated in programme meetings and events etc. and also provided materials for meetings of Programme Director with bodies such as DWP. 3. EARLY AND ANTICIPATED IMPACTS a) Summary of Impacts to date Please summarise any impacts of the project to date, referring where appropriate to associated outputs recorded on ESRC Society Today. This should include both scientific impacts (relevant to the academic community) and economic and societal impacts (relevant to broader society). The impact can be relevant to any organisation, community or individual. [Max. 400 words] Economic and societal impacts. The project has already informed wider government thinking and policy in the areas of health, pension provision and family and long-term care, including: Submission to Department of Health Green Paper on the reform of adult social care. Paying for Long-Term Care: Potential Reforms to Funding Long-term Care Free Personal Care, Disregard of Housing Assets and Wanless Patterns of Care (Wittenberg et al. 2008) Presentation to the Chair of the All Party Parliamentary Local Government Group Enquiry into Services for Older People (Report Never Too Late for Living), (Murphy, Hancock, Pickard 2008). Technical discussions on policies for financing long-term care to Liberal 6

7 Democrats (WP5) and Norman Lamb MP (Hancock 2009) Oral evidence (Jagger, Wittenberg) and two sets of written evidence (Hancock et al, and Pickard) to the House of Commons Health Committee Inquiry on Social Care. df Member of expert group briefing the Chancellor of the Exchequer, George Osborne, about changes to the long-term care system (Murphy 2010) Estimation of numbers of grandparents in England since the 1850s for Chief Medical Officer s Report (Murphy 2010) Advice on informal care policy to the Québec Ministry for Families and the Elderly (Pickard 2009) Professional impact was achieved by, for example, meetings held by the International Longevity Centre and Actuarial Profession ( Funding Long-Term Care Finding a Fair Solution across the Generations 2008, Choosing Population Projections for Public Policy 2008, Public Spending and the Effect of Changes in Life Expectancy 2009), the Institute of Actuaries Annual Pensions Convention 2008, regional and local government though the British Irish Council seminar 2008 and Independent Healthy Ageing Conference hosted by Scottish Government (2008). Scientific impact. Impact on other academic researchers was mainly by publications and a series of seminars hosted by MAP2030 in 2009 and a day meeting of the British Society for Population Studies (2008). At a workshop on the Future of Family Care in Europe organised jointly by MAP2030 and the European Association for Population Studies in 2009, 24 papers were presented and over 60 people from 16 different countries participated. Papers were also presented at UK and international conferences such as those hosted by: International Microsimulation Association, the International Network on Health Expectancy and the Disability Process (REVES), Population Association of America, British Society of Gerontology, British Society for Population Studies, Royal Statistical Society, IAGG, IUSSP and European Association for Population Studies. b) Anticipated/Potential Future Impacts Please outline any anticipated or potential impacts (scientific or economic and societal) that you believe your project might have in future. [Max. 200 words] In the context of on-going debate on financing long-term care, some members of WP5 have secured a grant from AXA to examine how private long-term care insurance can supplement state systems. They are close to submitting an ESRC application for a small grant for further analysis of the impact of fiscal constraints on long-term care financing. They are in touch with the new Care Commission to ensure that the Commission know of the findings from this NDA project, are aware of future research plans and can feed into them. A new simulation model for WP5 incorporating uncertainty is included in a bid to the Wellcome Trust for 4 Year PhD studentships from Newcastle University. 7

8 Methods developed in WP1 are being used with Finnish data and a cross-national project is being developed to assess the impact of smoking on old age morality. Work on data quality in Official Statistics from WP3 is continuing with the Centre for Population Change at Southampton University and is being fed into the ONS system so that substantial errors in the key demographic childlessness series may be rectified. You will be asked to complete an ESRC Impact Report 12 months after the end date of your award. The Impact Report will ask for details of any impacts that have arisen since the completion of the End of Award Report. 4. DECLARATIONS Please ensure that sections A, B and C below are completed and signed by the appropriate individuals. The End of Award Report will not be accepted unless all sections are signed. Please note hard copies are NOT required; electronic signatures are accepted and should be used. A: To be completed by Grant Holder Please read the following statements. Tick ONE statement under ii) and iii), then sign with an electronic signature at the end of the section. i) The Project This Report is an accurate overview of the project, its findings and impacts. All co-investigators named in the proposal to ESRC or appointed subsequently have seen and approved the Report. ii) Submissions to ESRC Society Today Output and impact information has been submitted to ESRC Society Today. Details of any future outputs and impacts will be submitted as soon as they become available. OR This grant has not yet produced any outputs or impacts. Details of any future outputs and impacts will be submitted to ESRC Society Today as soon as they become available. OR This grant is not listed on ESRC Society Today. iii) Submission of Datasets Datasets arising from this grant have been offered for deposit with the Economic and Social Data Service. OR Datasets that were anticipated in the grant proposal have not been produced and the Economic and Social Data Service has been notified. OR No datasets were proposed or produced from this grant. 8