BACKGROUND:Social prescribing connects NHS patients to activities, groups, and services in their community to address wider health determinants. Those living with disability may have needs for support from social prescribing, yet there is little evidence exploring this. METHODS:We examined the association between referral to social prescribing and disability, using logistic regression in 5578 individuals aged ≥50 from wave 10 of the English Longitudinal Study of Ageing (year 2021-23). RESULTS:Referral to social prescribing is significantly associated with mobility disability (OR 1.68 [95% CI: 1.26-2.23]), Instrumental Activities of Daily Living disability (1.56 [1.16-2.09]) and basic Activities of Daily Living disability (1.39 [1.03-1.86]). Our results suggest that this is driven by referrals for: (i) participants at the earlier stages of disability (i.e. with difficulty climbing stairs (1.49 [1.13-1.97]), walking ¼ mile unaided (1.83 [1.37-2.44]), and doing [heavy] housework (1.47 [1.08-1.98]), (ii) participants with difficulty managing money (1.85 [1.06-3.08]), and (iii) those with difficulty dressing (1.47 [1.08-1.99]) or using the toilet (1.72 [1.12-2.59]). CONCLUSIONS:Older adults at either end of the disability spectrum are referred to social prescribing. Further research is needed to understand whether this is meeting needs, and if benefits vary with the level or nature of the disability.

Background: The UK aimed to prolong the working lives of women by introduced a policy raising women’s state pension age (SPA) from 60 to 66. The impact of involuntary prolonged employment on individual’s health and well-being is debated. We explore how the well-being, mental and physical health of the women impacted by the policy has been affected. Methods: We used data from the first 12-waves of the longitudinal Understanding Society survey dataset. Using heterogeneous difference-in-difference models with regression adjustment we compared the outcomes of cohort of women affected by the policy born in financial years 1950/51-1955/56 to those unaffected by the policy born in 1949/50. Findings: Our sample consisted of 16,251 observations across 1,832 women. Women impacted by the policy experienced better well-being and mental functionality, compared to those unaffected by the policy. This impact was significant specifically for the 1952/53 and 1953/54 cohorts and for women in professional and managerial occupations. The policy did not impact physical functionality. A robustness check using an unaffected male sample showed no such impact. Interpretation: Women impacted by the SPA increase appeared to have better well-being and mental functionality compared to women not affected by the policy. Trends in impacts appeared similar across sub-groups defined by job type. Limited statistical power for the sub-group analysis meant findings should be interpreted with caution.

Abstract Background The gap in Disability-Free Life Expectancy between affluent and deprived areas of England is stark, at over 15 years. Successive governments have recognised the need to narrow this and extend the years of life spent without disability, but there is little evidence outlining how large an intervention must be to achieve meaningful gains. This study examines intervention scenarios to (i) extend Disability-Free Life Expectancy and (ii) reduce socioeconomic inequalities in Disability-Free Life Expectancy, among older people in England. Methods We applied multistate modelling to longitudinal data on 16 899 individuals, aged 50 + in England, incorporating disability data from three cohort studies: the English Longitudinal Study of Ageing, the Cognitive Function and Ageing Study II, and the Newcastle 85 + Study. Simulations assessed how reducing the risk of disability associated with age and area-based socioeconomic deprivation could extend Disability-Free Life Expectancy. In these simulations, deprivation-targeted interventions reduced the excess disability risk and differential recovery observed in people living in the 20% most deprived areas. Age-targeted interventions reduced the age-related increase in disability risk and the corresponding decline in recovery. Results Interventions targeted solely at the most deprived quintile yielded modest Disability-Free Life Expectancy gains (up to 2.8 years for women and 2.3 years for men, in deprived areas only). Interventions targeting age-related disability risk alone were associated with increases in Disability-Free Life Expectancy of 6.3 to 8.7 years under a 40% reduction in age-related disability risk, but exacerbated the gap between the most and least deprived populations. Interventions addressing both age- and deprivation-associated risks demonstrated the greatest potential. A 30% decrease in the age-based probability of disability, and commensurate increases in recovery from disability, alongside removal of deprivation-associated inequalities, increased Disability-Free Life Expectancy by 4.8 to 8.6 years for men and women aged 50, with women living in deprived areas benefiting most. Conclusions Extending Disability-Free Life Expectancy while reducing socioeconomic inequality is difficult, but possible by tackling both age- and deprivation-related risks. Taken on their own, age-based interventions risk increasing inequalities, as they disproportionately benefit people living in less deprived areas.

BACKGROUND:The older population is increasingly reliant on social care, especially those who are frail. However, an estimated 1.5 million people over 65 in England have unmet care needs. The relationship between receiving care, or receiving insufficient care, and changes in frailty status remains unclear. OBJECTIVES:To investigate the associations between care receipt (paid or unpaid), unmet care needs, frailty status, and mortality. DESIGN:We used multistate models to estimate the risk of increasing or decreasing levels of frailty, using English Longitudinal Study of Ageing (ELSA) data. Covariates included age, gender, wealth, area deprivation, education, and marital status. Care status was assessed through received care and self-reported unmet care needs, while frailty status was determined using a frailty index. PARTICIPANTS:15,003 individuals aged 50+, using data collected over 18 years (2002-2019). RESULTS:Individuals who receive care are more susceptible to frailty and are less likely to recover from frailty to a less frail state. The hazard ratio of males receiving care transitioning from prefrailty to frailty was 2.1 [95 % CI: 1.7-2.6] and for females 1.8 [1.5-2.0]. Wealth is an equally influential predictor of changes in frailty status: individuals in the lowest wealth quintile who do not receive care are as likely to become frail as those in the highest wealth quintile who do receive care. As individuals receiving care (including unpaid care) are likely to be in poorer health than those who do not receive care, this highlights stark inequalities in the risk of frailty between the richest and poorest individuals. Unmet care needs were associated with transitioning from prefrailty to frailty for males (hazard ratio: 1.7 [1.2-2.4]) but not for females. CONCLUSIONS:Individuals starting to receive care (paid or unpaid) and people in the poorest wealth quintile are target groups for interventions aimed at delaying the onset of frailty.

Background and aim Unmet need for social care is linked to numerous adverse health outcomes. Understanding which unmet needs have the biggest impact on healthy ageing could help resource-stretched services prioritise care. To address this evidence gap, our analysis aimed to explore the association between selected individual unmet care needs and an indicator of healthy ageing.Design and data Cross-sectional analysis of data from the English Longitudinal Study of Ageing (Wave 9). A total of 6109 people aged 50 years or over, with complete data items, formed the basis for this analysis.Measures Absolute unmet need for help with each: walking 100 yards and climbing one flight of steps (mobility); managing money, managing medication, doing housework and shopping for groceries (instrumental activities of daily living (IADLs)); and dressing, walking across a room, bathing or showering, eating, using the toilet and getting in and out of bed (activities of daily living (ADLs)). Our outcome measure was poor self-rated health .Results Associations between poor self-rated health and most unmet ADL, IADL and mobility needs were not statistically significant. People with an unmet need for support with managing money were nine times more likely to report poor self-rated health than those whose support needs were met in this domain (OR=9.23, 95% CI: 2.12 to 40.23). In a comparison of people with met and unmet needs, individuals with met needs had higher levels of dependency than those with unmet needs.Conclusions Some unmet needs may be especially consequential for older people’s health. However, shortcomings in current data limit a clear and confident assessment of this. Our analysis highlights the importance of data on the level of need to better understand the link between unmet care needs and healthy ageing.

BACKGROUND:More evidence of socioeconomic inequalities in disability-free life expectancy (DFLE) is needed to help develop approaches to narrow the gap between the most and least socioeconomically deprived people. Activities of daily living (ADL) disability represents the most severe and expensive disablement stage. Using combined longitudinal data, we aimed to quantify area-level socioeconomic inequalities in ADL-DFLE and the total person-years lived with ADL disability, in older men and women in England. METHODS:In this modelling study, we harmonised data on ADL disability, area deprivation, age, and self-reported gender for individuals aged 50 years or older from three longitudinal studies in England: the English Longitudinal Study of Ageing (n=11 337), the Cognitive Function and Ageing Study II (n=7469), and the Newcastle 85+ Study (n=847). We used multistate modelling, and calculated the remaining life expectancy with and without ADL disability by gender and area-level socioeconomic status (<20%, 20-80%, and >80% of Index of Multiple Deprivation). From these data and Office for National Statistics population figures for the year 2024, we estimated the extra person-years lived with ADL disability by those aged 65 years from the most socioeconomically deprived areas. FINDINGS:Those living in the least deprived areas had a reduced risk of ADL disability compared with those in the most deprived areas (hazard ratio [HR] 0·61 [95% CI 0·55-0·69]; p<0·0001), as did those in the middle area-level socioeconomic group (HR 0·76 [0·69-0·84]; p<0·0001). Increasing area-level socioeconomic disadvantage was associated with reduced life expectancy and more time spent with ADL disability, particularly for women. Living in the most disadvantaged areas was associated with people having ADL disability 11·0 years earlier for men and 12·0 years earlier for women, compared with living in the least deprived areas. An extra 59 000 person-years for men and 88 000 person-years for women were lived with ADL disability by those in the most deprived areas, at the population level, compared with the least deprived areas. INTERPRETATION:Targeted policies to address underlying socioeconomic inequalities in health are likely to be the long-term definitive solution. FUNDING:National Institute for Health and Care Research Policy Research Unit in Healthy Ageing.

INTRODUCTION:Studies examining the risk of dementia in people with multimorbidity are commonly conducted in research cohorts or outside the UK. Multimorbidity has historically been associated with aging, but recent research suggests that more than half of incidence cases occur in adults < 50. METHODS:Using UK primary care data, adjusted Cox regressions and competing risk of death models were used to determine risk of dementia in people with multimorbidity overall and by body system. RESULTS:People with multimorbidity had a greater risk of dementia that those without multimorbidity (hazard ratio [HR] = 4.01, 95% confidence interval [CI] 3.94-4.07). Among people with multimorbidity, the risk was highest for those when a neurological condition was included (HR = 2.19, 95% CI 2.15-2.23). DISCUSSION:Managing multimorbidity, particularly neurological conditions, is key and could delay or reduce the risk of dementia. Highlights:People with multimorbidity experienced a greater risk of dementia than those without.Neurological multimorbidity presented the highest risk of dementia.Risk of dementia increased progressively with younger-onset multimorbidity.Preventing or managing multimorbidity effectively could reduce or delay dementia.

Frailty is more prevalent in socio-economically disadvantaged groups; however, little is known about how this translates to differences in the number of years people live with and without frailty. We investigate differences in frailty-free and frail life expectancies among population groups stratified by wealth, area deprivation, education and marital status. The English Longitudinal Study of Ageing cohort study was used to follow the frailty trajectories of 15,003 individuals over 18 years. A multi-state model assessed the risk of transitioning between frailty states and death based on socio-economic characteristics. These risks were translated into state-specific life expectancies. Wealth had the strongest association with frailty-free and frail life expectancies. Increased wealth, reduced deprivation, higher educational attainment and marriage all correlate with increased frailty-free life expectancies and reduced frail life expectancies. At age 50, the wealthiest population quintile can expect to live 11.1 [10.1–12.1] years (women) and 9.8 [8.8–10.8] years (men) longer frailty-free than the poorest population quintile. The wealthiest quintile live less than half the number of years with frailty than the poorest quintile. There is no difference in frailty-free life expectancy between the poorest men and women; however, the wealthiest women have longer frailty-free life expectancies than the wealthiest men. Large inequalities in frailty-free and frail life expectancies exist across socio-economic groups, with wealth and area deprivation the most important socio-economic determinants. Narrowing these inequalities may extend frailty-free life expectancies more for women than men, suggesting strategies to reduce disparities should consider both socio-economic factors and gender. Care policies should account for the geographical clustering of socio-economically disadvantaged populations. Reducing socio-economic inequalities could increase frailty-free life expectancies and reduce health and social care costs.

Digital technologies are crucial to drive the needed improvement in NHS primary care delivery and access. The impact of these digital interventions on health inequalities remains a critical area of concern and uncertainty. Transition to digital primary care services was rapidly accelerated during the COVID-19 pandemic. We explored what can be learnt from this transition to digital access by examining the patterns of remote general practice consultation before and after the pandemic and the influence of age, gender, social deprivation, and ethnicity on these patterns. This is a longitudinal study in primary care settings involving data from19 million men and women aged 18 + years registered with general practices in England between January 2019 and February 2022 using the OpenSAFELY platform. The main outcome was remote consultation (telephone, video, or electronic) of all appointments recorded by GPs. Binomial regression models including marginal effect probabilities were used to analyse the proportion of remote consultations in all appointments. Covariates including age, gender, deprivation, and ethnicity were adjusted for in the models. Remote consultations increased from 10.1 million per annum (March 2019 to March 2020) to 32.7 million per annum during the pandemic (March 2020 to March 2022). Pre-pandemic, 85 + year olds had the highest probability of remote consultation (0.133, 95

Objective To understand how area deprivation inequalities in COVID-19 mortality changed during the national vaccination programme in England and to identify the extent to which these inequalities might be explained by unequal vaccination uptake.Design Ecological study.Setting 307 Lower Tier Local Authorities in England, March 2020 – December 2022.Main outcome measure Inequality in age-standardised mortality rates 28 days after a positive COVID-19 test by area-level deprivation from March 2020 to December 2022. We employ three different measures of this inequality: the disparity index, the concentration and generalised concentration index, and absolute and relative measures of inequality. We use the 2019 edition of the Index of Multiple Deprivation, transformed into quintiles.Results Relative inequalities in age-standardised mortality rates 28 days after a positive COVID-19 test reduced substantially (from around 6.9 times higher in most deprived to least deprived to 1.2 times higher) in the 25 months after the national vaccination rollout began. Vaccination uptake between the most and least deprived quintiles widened with each dose. Inequalities in cumulative mortality rates developed quickly, and while they stabilised and reduced, they did not disappear. We estimate that if vaccination rates in the most deprived areas had been the same as those in the least deprived, absolute disparity inequality would have been reduced from 118.9 per 100 000 (95% CI 117.0 to 120.7) to 40.2 (95% CI 3.7 to 76.7) at the end of 2022.Conclusions National COVID-19 vaccination strategies offer the potential to significantly reduce inequalities in COVID-19 mortality rates. However, more could be achieved if barriers to vaccination uptake in the most deprived areas are overcome.

Heart failure (HF) affects over 64 million individuals worldwide and is a major cause of hospitalization and mortality, particularly among older adults. In Europe, HF imposes a significant and growing economic burden. This systematic review aimed to evaluate the economic impact of HF diagnosis, treatment and management across European healthcare systems. A systematic literature search was conducted using PubMed, Cochrane Library and Econlit databases including the terms 'heart failure' AND 'costs' OR 'cost of illness' OR 'cost analysis' OR 'economic burden' OR 'cost effectiveness' OR 'primary care' OR 'secondary care'. Studies published between January 2000 and January 2024 were included. A total of 49 studies were included: 17 on resource use, 11 on costs, 15 on resource use and costs, 1 on costs and cost-effectiveness, and 5 on resource use, costs and cost-effectiveness. Hospitalizations and medication use were the most frequently reported resource parameters. Annual HF-related costs varied widely across countries, ranging from €613 to €22,647 per patient. Hospitalizations represented the primary cost driver, accounting for 15% to 92% of total HF costs. Cost-reduction strategies included multidisciplinary care, telemonitoring and pharmacologic interventions. Several disease management programmes reduced hospital admissions and emergency visits. Cost-effectiveness analyses supported the use of certain HF therapies, with incremental cost-effectiveness ratios ranging from €1490 to €9406 per QALY gained. F imposes a substantial economic burden in Europe, largely driven by hospitalizations. Cost-effective interventions such as remote monitoring and integrated care programmes can reduce this burden. Broader adoption of these strategies may improve outcomes and optimize resource allocation across healthcare systems.

Introduction Heart failure (HF) is a complex clinical syndrome. Accurate risk stratification and early diagnosis of HF are challenging as its signs and symptoms are non-specific. We propose to address this global challenge by developing the STRATIFYHF artificial intelligence-driven decision support system (DSS), which uses novel analytical methods in determining the risk, diagnosis and prognosis of HF. The primary aim of the present study is to collect prospective clinical data to validate the STRATIFYHF DSS (in terms of diagnostic accuracy, sensitivity and specificity) as a tool to predict the risk, diagnosis and progression of HF. The secondary outcomes are the demographic and clinical predictors of risk, diagnosis and progression of HF.Methods and analysis STRATIFYHF is a prospective, multicentre, longitudinal study that will recruit up to 1600 individuals (n=800 suspected/at risk of HF and n=800 diagnosed with HF) aged ≥45 years old, with up to 24 months of follow-up observations. Individuals suspected of HF will be divided into two categories based on current definitions and predefined inclusion criteria. All participants will have their medical history recorded, along with data on physical examination (signs and symptoms), blood tests including serum natriuretic peptides levels, ECG and echocardiogram results, as well as demographic, socioeconomic and lifestyle data, and use of complete novel technologies (cardiac output response to stress test and voice recognition biomarkers). All measurements will be recorded at baseline and at 12-month follow-up, with medical history and hospitalisation also recorded at 24-month follow-up. Cardiovascular MRI assessment will be completed in a subset of participants (n=20–40) from eligible clinical centres only at baseline. Each clinical centre will recruit a subset of participants (n=30) who will complete a 6-month home-based monitoring of clinical characteristics and accelerometry (wrist-worn monitor) to determine the feasibility and acceptability of the STRATIFYHF mobile application. Focus groups and semistructured interviews will be conducted with up to 15 healthcare professionals and up to 20 study participants (10 at risk of HF and 10 diagnosed with HF) to explore the needs of patients and healthcare professionals prior to the development of the STRATIFYHF DSS and to evaluate the acceptability of this mobile application.Ethics and dissemination Ethical approval has been granted by the East Midlands - Leicester Central Research Ethics Committee (24/EM/0101). Dissemination activities will include journal publications and presentations at conferences, as well as development of training materials and delivery of focused training on the STRATIFYHF DSS and mobile application. We will develop and propose policy guidelines for integration of the STRATIFYHF DSS and mobile application into the standard of care in the HF care pathway.Trial registration number NCT06377319.

BACKGROUND:frailty is a condition of reduced function and health due to ageing processes and is associated with a higher risk of falls, hospitalisation, disability and mortality. OBJECTIVE:to determine the relationship between household wealth and neighbourhood deprivation with frailty status, independently of demographic factors, educational attainment and health behaviours. DESIGN:population-based cohort study. SETTING:communities in England. SUBJECTS:in total 17,438 adults aged 50+ from the English Longitudinal Study of Ageing. METHODS:multilevel mixed-effects ordered logistic regression was used in this study. Frailty was measured using a frailty index. We defined small geographic areas (neighbourhoods) using English Lower layer Super Output Areas. Neighbourhood deprivation was measured by the English Index of Multiple Deprivation, grouped into quintiles. Health behaviours included in this study are smoking and frequency of alcohol consumption. RESULTS:the proportion of respondents who were prefrail and frail were 33.8% [95% confidence interval (CI) 33.0-34.6%] and 11.7 (11.1-12.2)%, respectively. Participants in the lowest wealth quintile and living in the most deprived neighbourhood quintile had 1.3 (95% CI = 1.2-1.3) and 2.2 (95% CI = 2.1-2.4) times higher odds of being prefrail and frail, respectively, than the wealthiest participants living in the least deprived neighbourhoods Living in more deprived neighbourhood and poorer wealth was associated with an increased risk of becoming frail. Those inequalities did not change over time. CONCLUSIONS:in this population-based sample, living in a deprived area or having low wealth was associated with frailty in middle-aged and older adults. This relationship was independent of the effects of individual demographic characteristics and health behaviours.

Abstract There is a growing role for digital technologies in society, but concerns that older adults may be disadvantaged and excluded with the growth of use of these technologies. The COVID-19 pandemic led governments across the world to mandate lockdowns and social restrictions. This was accompanied by rapid implementation of many digitalized services, including to access health and social care. This paper reports on a project to advance our understanding of how health and social care services for older adults (65+) have been digitalized during the COVID-19 pandemic, and to learn what has worked well and what has not, with a specific lens on health inequalities. We report main findings from three workstreams: (i) a mapping review, to identify (a) the types of evidence available on the digitalization of health and social care services for older adults during the COVID-19 pandemic, and (b) the extent to which factors related to health inequalities have been considered in this evidence; (ii) quantitative analysis of health care records to examine the impact of digitalization on access to primary care for older people in England during the COVID-19 pandemic, with a focus on incidence rate of consultation types (face-to-face, telephone and video) examined against age, gender, ethnicity and socioeconomic status; (iii) qualitative work to explore the experiences of UK older adults of South Asian and Black African or Caribbean descent of using digital technologies to access primary care. We consider how digitalization of health and social care services relates to health inequalities for older people.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

Abstract Understanding how the onset of frailty differs between socio-economic groups will help health and care providers plan for increasing demand from an ageing population and highlight population groups to target interventions to reduce frailty. We aimed to calculate the frailty-free, frail and total life expectancies of adults aged over 50 using data from the English Longitudinal Study of Ageing (ELSA), and analyse associations with socio-economic characteristics. Survey data from ELSA waves 1-9 (2002-2019) was used to follow the frailty trajectories of individuals (n=11,423 at wave 1). Individuals were categorised into non-frail and frail states using a frailty index. A multistate model assessed the risk of individuals transitioning between states or dying. Transitions were associated with the participants’ socio-economic characteristics and converted to life expectancies. Increased wealth, reduced deprivation, more education, and marriage are all associated with increased frailty-free and total life expectancies, and reduced frail life expectancies. Wealth is the most important socio-economic indicator of frailty-free life expectancy. At age 50, large inequalities in frailty-free life expectancies exist between the wealthiest, least deprived population (females: 36.1 [35.1-37.0], males: 34.6 [33.7-35.4] years) and the least wealthy, most deprived population (females: 22.1 [21.3-22.7], males: 21.3 [20.4-22.0] years). This is the first study to investigate the associations between frailty-free life expectancies and socio-economic characteristics in Europe. Large inequalities in frailty-free and frail life expectancies exist between those with different socio-economic characteristics. This highlights the people most at risk of early frailty at younger ages.

Abstract Understanding the role of socio-economic factors in the number of medications an individual is prescribed, can help healthcare practitioners target medication reviews and safer prescribing, improving quality of life. We aimed to understand the association between socio-economic factors and polypharmacy - defined as the use of five or more medications at any given time. Data was used from the Cognitive Function and Ageing Study (CFAS), focusing on adults aged 65 years and over. Data from CFAS I and CFAS II, was used to understand the relationship between education (a marker of socio-economic status) and polypharmacy. Individuals were categorised on the number of years in full time education, and baseline cohorts (wave 1) from each study were compared, to identify the longitudinal effect. Logistic regression was used to assess the association between polypharmacy and education. Increased number of years of full-time education was associated with a decreased likelihood in polypharmacy, in CFAS II - those with <10 years of full-time education showed higher odds of polypharmacy, when compared to individuals with 10-11 years of full-time education, OR 1.61 (95 % CI 1.44-1.80). However, similar odds were displayed across each education category and polypharmacy in CFAS I. Results have showcased growing inequalities in healthcare, particularly through the influence of education on polypharmacy. Socio-economic factors could be used to trigger for medication related review services.