A pilot of Healthy Ageing In Scotland (HAGIS) is needed before moving on to rolling out a full scaled version. Conducting the pilot first will allow the HAGIS team to test the sampling approach, the survey material and also the data linkage aspect of the study. The methodology for the pilot follows closely, in all aspects, to the other longitudinal studies of ageing in the UK who have successfully carried out full scale versions of their surveys. As such, the pilot is well informed and any issues which arise will be highlighted and can then be controlled for in the full version of HAGIS.
There are a number of motivations which point to the need for a longitudinal study of ageing in Scotland:-
Since there isn’t one in Scotland, HAGIS will both be a key research resource for understanding health and ageing in Scotland, and provide a powerful international comparator in respect of similarities and differences in health status, health policy and in the economic and social wellbeing of older people. This gap in research will be filled by HAGIS and the primary benefits will accrue to the elderly population in Scotland.
Scotland has a relatively poor health record. Additionally, its high levels of income inequality have lead to large variations in health status across the country. HAGIS will allow researchers to investigate the possible explanations for Scotland’s poor health record and make comparisons between Scotland and other countries.
There is historically low life expectancy in Scotland compared to the rest of the UK and the US. The extent to which this outcome reflects differences in health behaviours and/or in the organisation and policies of the respective health systems are clearly important research questions that could be answered using comparable surveys of ageing in Scotland, the rest of the UK and the US. Furthermore, there is huge variation in average life expectancy within Scotland itself. A longitudinal survey of ageing would provide analysts with the tools to conduct effective causal inference on differential life expectancy within Scotland.
There are existing and growing differences between health and social care delivery in Scotland and England. The National Health Service (NHS) in Scotland is controlled by the Scottish Parliament and follows different policies from the NHS in England. There is almost no private sector involvement in healthcare in Scotland, while the English NHS is increasingly dependent on private sector provision. Differences between the two systems have increased over the last decade, with England moving closer to the US model based on choice and competition, while the Scottish NHS continues to rely on state-directed provision. Social care policies between Scotland and England have also increasingly diverged with Scotland providing for free personal care for those aged 65+. This policy has been accompanied by a general shift towards long-term care provision in the client’s home for reasons both of cost and client satisfaction. This required a greater degree of joint planning by health boards and local authorities than occurs in England. As a result, the relative importance of care home provision has diminished. The policy framework for health and social care of older people in Scotland thus differs substantially from England and also from the US. Given the similarities in their social, economic and institutional settings, comparisons between Scotland and England based on policy divergences can therefore reasonably be described as tests based on “natural experiments” in policy. HAGIS would allow such comparisons and tests to be carried out.
HAGIS could provide important methodological advances for the international community of ageing studies, based on Scotland’s unparalleled ability to link survey data with administrative datasets in domains such as health and health care, social care, welfare benefits, taxation and education. Scotland has an advanced data linkage infrastructure and is developing policies to provide safe access to these data. Scotland also takes the lead on administrative data linkage within the UK nations. HAGIS therefore has the potential to act as an exemplar to all of the longitudinal ageing studies on the benefits of data linkage.
The benefits of HAGIS will not be limited to the people and policy makers in Scotland, but will also provide insights for other countries who experience similar levels of ageing, health, life expectancy, mortality and income. HAGIS will deepen our understanding on a number of health and wellbeing issues concerning our elderly population, as well as help to guide policy makers in designing policy which meet the objectives of the Scottish
2000 households will randomly be selected from the Post Code Address File (PAF). The PAF is the Royal Mail database of 29.5million addresses in the UK, constantly updated to keep in line with evolving businesses and new properties. After selection, the addresses will be sent on to the NHS Central Register who will cross check the addresses and confirm to the HAGIS team, whether or not there is someone living in the household who is aged 50 or over. At this point the HAGIS team will send out letters to eligible households explaining the purpose and scope of HAGIS, and give individuals the option to opt out of further participation in the study. All opt outs will immediately be removed from the sample.
Around two weeks after the letters have been sent to households, the fieldwork agency* will then visit the address, explain the purpose of the study, and invite individuals to participate in an interview. At this point potential participants will again have the option to opt out of the study, in which case they will be removed from the sample. Participants who consent to participate will then undertake an interview in their own home lasting around 60- 75 minutes at a time convenient to them. Interviews (with informed consent) will be undertaken with all eligible adults in the household.
The interview will consist of respondents answering questions relating to demographic characteristics of household members; social circumstances; physical health; cognitive health; education; employment; financial literacy; social networks; care and future expectations and retirement planning. The questionnaire design is well aligned to that of other ageing surveys in the UK to ensure valid data harmonisation can be carried out, in turn, easing and strengthening comparisons of Scotland to other countries.
Following the interview, participants will be asked to fill in a self-completion questionnaire in their own time. This should take around 15 minutes to complete. The self-completion questionnaire will cover topics such as: risk and time preference; life satisfaction; social activities; use of internet; family relationships; alcohol consumption; wellbeing. After finishing the self-completion questionnaire, participants are asked to post it back to the HAGIS team using the pre-paid envelope which is provided.
*Appointment of fieldwork agency is subject to a competitive tender process to be carried out in August 2015.
Following the interview, participants will be asked if they will consent to linkage of their personal data to other administrative data. Participants will be individually free to opt in or out of linkage of their various records:-
Permission to link respondents to their health records in the Scottish Morbidity Register has been sought from the Privacy Advisory Committee (PAC). This will include access to health episodes and prescription data.
As for social care data, the Scottish Government and ISD have a pilot dataset which links individual health records to social care data. The dataset is being analysed in detail and a report is due to be released in the near future which will outline the findings and benefits of the linked data. This initiative would permit us to add links to social care records for respondents in the HAGIS pilot. This will include details of personal and nursing care provided in the home, contact with social work, and time spent in residential care. This data will be available from 2010, giving the HAGIS pilot a 5-year social care history for each linked respondent.
Permission will be sought from the National Archives of Scotland and the Scottish Qualifications Authority to set up procedures to link respondents to their historical educational qualifications with informed consent. Initial discussions have been held to establish that this is possible in principle, and that an application for linking would be welcomed.
Anonymous HAGIS pilot survey data will be made available on the UK Data Archive after the fieldwork has been carried out. Fieldwork is expected to commence in mid-Febuary 2016.
The HAGIS pilot interviews are planned to take place in mid-Febuary 2016.