More people are living longer. Consequently the provision of healthcare for older people is increasingly important. Central to that healthcare is to help people to make good lifestyle decisions as they get older to keep themselves as healthy and happy for as long as possible. But what are those lifestyle decisions? Are they the usual suspects (exercise, diet, socialising, avoiding cigarettes and excess alcohol)? What is the evidence that they work? How can we as healthcare professionals help our patients make these good decisions? This chapter addresses these questions. It starts with some background. There is a section on the more prominent theories of ageing. Then a summary of the evidence for how to improve the physical healthcare of people with mental health problems. Seven healthy lifestyle options are discussed. There is a box summarising the outcomes of some of the major cohort studies. We hope our readers pick up some tips for their own successful ageing as well as that of their patients.

Old age psychiatry is general adult psychiatry adapted to later life, and has come into being chiefly because of the spectacular increase in the proportion of the population surviving to 65 and beyond. Many people have mental health problems for the first time in later life, partly because of vicissitudes such as bereavement and physical ill health, and partly because of pathological changes in the brain reflected in delirium and the dementias. In the 21 years since Professor Brice Pitt and I wrote the first edition of this chapter, most of the principles of good assessment are unchanged. Risk assessment has come to the fore and there is a new emphasis on measuring outcomes. The need for cultural competence is more widely recognised.

Introduction

Vulnerability is a concept that captures the dynamic interactions between complex human systems and complex environmental systems. Thus, a vulnerability assessment that produces a static view of human–environment interactions (i.e., by examining one place at one time) will likely provide only limited – and potentially misleading – insight into how the coupled system works. Of course, such static pictures are common in this research domain because it is challenging to establish the temporal evolution of vulnerability (i.e., one place or many places over time). Especially in the context of having limited resources to conduct a vulnerability assessment, a solution to this challenge is to ignore variations over time in favor of examining variations over geographic space (i.e., many places at one time; see Mendelsohn et al. 1994; Carbone 1995; Polsky 2004). We argue that executing a many-places-at-one-time approach requires that all the places adopt a common research protocol; to our knowledge such a networked vulnerability assessment has yet to be reported in the literature. In this chapter, we report results from our effort to examine vulnerabilities – using a rapidly executable and commonly executed methodology – in four distinct study sites in the United States.

As explained in Chapter 1, the HERO project sought to develop infrastructure for studying and monitoring human–environment interactions at individual sites and to enable cross-site comparisons and generalizations. To test how well these concepts and tools work in practice, the project addressed the question, “How does land-use change influence vulnerability to droughts and floods?

Introduction

As described in preceding chapters, one of the overarching HERO research activities was to establish a set of methodological protocols for vulnerability assessments. Within the methodological research plan were two principal activities, as introduced in Chapter 8: the development and testing of a Rapid Vulnerability Assessment methodology, and the development and testing of an Vulnerability Assessment Evaluation methodology, designed to validate, or assess the accuracy, of our work. Chapter 9 summarized our efforts on the former task; this chapter presents the results of the latter task. Accordingly, at the end of this chapter, we will be in a position to posit some synthetic conclusions about vulnerability in and across the four HERO sites.

Accuracy assessments are difficult to conduct in many research domains, but they are particularly challenging in the domain of vulnerability because the multidimensional nature of this concept makes it difficult for an individual researcher to observe and measure the principal variable of interest. The multi-site context, where the number of places and researchers is larger, amplifies this challenge. Clearly, then, conducting vulnerability research in a networked environment will present particular challenges to validating the research. In this light, a methodology for validating – or what we term evaluating – our research findings is needed.

Methods and data

There are two datasets involved in the application of our Vulnerability Assessment Evaluation methodology: the reference dataset and the validation dataset.