Behavioral Economics and the Promotion of Health Among Aging Populations Proceedings of a Workshop—in Brief (2018) / Chapter Skim
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Behavioral Economics and the Promotion of Health Among Aging Populations: Proceedings of a Workshop - in Brief
Behavioral Economics and the Promotion of Health Among Aging Populations: Proceedings of a Workshop - in Brief
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to identify the mechanisms underlying the interventions. Specifically, there was a focus on considering in terventions that could generate long-term benefits in areas of interest to NIA, such as decreasing sedentary behavior, promoting volunteering and social engagement, improving medical regi men adherence, and reducing inappropriate use of opioids and using opioids when medically necessary.
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The behavioral economics framework is ideally suited to system change, can provide direction in terms of scalability, and can aim at large parts of the population to improve the health of aging and older adults. Eric Johnson, Columbia University, steering committee member, explained that the workshop was organized around potential new directions for applying behavioral economics research to increase understanding of inter-individual and contextual differences in intervention effectiveness, improve knowledge of mechanisms, and encourage innovation in intervention methods.
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Importantly, older participants were more likely to maintain increased step counts even after incentives were discontinued.5 Volunteering and Social Engagement in Later Life: Applications from Behavioral Economics Nancy Morrow-Howell, Washington University in St. Louis, considered social engagement in later life, providing a perspective based on gerontological social work research, which she sees as very relevant to behavioral economics concepts and methodologies.
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However, with regard to their methods, he commented that the letters were fairly low cost, and the intervention has potential for scalability because every county has a medical examiner, and 49 states have a prescription drug monitoring program. INTER-INDIVIDUAL AND CONTEXTUAL DIFFERENCES IN INTERVENTION EFFECTIVENESS Individual Differences and Context: Two Perspectives from Health Behavior Research Angela Bryan, University of Colorado Boulder, described two health behavior studies in her lab with older adults.
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On the other hand, "commitment devices" (e.g., going to restaurants that serve only salads, not hamburgers) have the potential to help people change health behaviors by restricting future choices so that short-term behaviors align better with longterm wishes.
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INNOVATIONS IN INTERVENTION METHODOLOGY Vaccination Studies Gretchen Chapman, Carnegie Mellon University, spoke about an innovative field study methodology she used in a clinic environment to increase flu vaccinations. In her opinion, ideal field studies test theoretically based interventions, use random assignment and have enough arms and power to capture the mechanism of interest, are conducted in real-life field settings with partnerships, and have concealment designs where people do not know they are being studied.
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For example, noting that a large literature has identified self-regulation as a potential causal mechanism in health behavior (and deficient regulation as a potential mechanism in health risk behavior) , Marsch reported that interventions designed to promote self-regulation have shown tremendous promise across diverse populations.
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To build knowledge of mechanisms, group members discussed ideas for a specific theory of how the expected changes in individuals, systems, or contexts could lead to the desired change in behavior; for methods to measure mechanisms of change; and for routine, postintervention qualitative research to learn why interventions worked or did not work. To foster methodological innovations, a targeted program announcement might focus on adaptive designs for behavioral economics interventions and tools for systematically examining how decisions are made and how to adapt interventions.
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They discussed social isolation as a compelling health issue and put forth research questions to advance knowledge and move in a more applied direction to study whether a formal volunteer role may confer more health benefits than other social or caregiving roles. The questions focused on the best ways to attract and keep older adults in volunteer roles -- by incentivizing, making volunteering a default option or habit, targeting those who might benefit the most, and addressing motivation changes over the course of volunteering.
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Chapman agreed that different kinds of monetary and nonmonetary incentives, as they relate to age differences, should be prioritized for future research. Adaptive Designs Volpp asserted that moving into evolutionary testing, rapid cycle innovation, and adaptive designs will provide an opportunity to apply a more nimble approach to learn who is not responding to interventions, why, and what alternative courses to take.
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Several participants expressed interest in learning more about the Way to Health platform and suggested that a call for researchers to devise ways to apply the platform in behavioral health for older adults would be of value. Measurement Morrow-Howell made the case for viewing social engagement and volunteering as health behaviors and integrating them into screening and monitoring indicators.
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Johnson, Center for Decision Sciences, Columbia University; Kevin Volpp, Center for Health Incentives and Behavioral Economics at the Leonard David Institute, University of Pennsylvania. DISCLAIMER: This Proceedings of a Workshop -- in Brief was prepared by Jeanne Rivard, rapporteur, as a factual summary of what occurred at the meeting.
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