Trends in disability-free life expectancy at age 65 in France: consistent and diverging patterns according to the underlying disability measure

Association between impairment and self-rated heath: a brazilian population study considering type, origin, and degree of limitation

BACKGROUND

Perceived health is a well-known, low-cost measure in public health, and has been used in several studies on individuals with impairment. Although many studies have related impairment to self-rated health (SRH), few have considered the origin and degree of limitation of the impairment. This study examined whether physical, hearing, or visual impairments-when analyzed according to origin (congenital or acquired) and degree of limitation (with or without)-are associated with the SRH status.

METHODS

This cross-sectional study used data of 43,681 adult individuals from the Brazilian National Health Survey (NHS, 2013). The outcome SRH was dichotomized into poor (including the regular, poor, and very poor responses) or good (including the good and very good responses). Crude and adjusted (for socio-demographic characteristics and chronic diseases history) prevalence ratios (PR) estimates were evaluated using Poisson regression models with the robust variance estimator.

RESULTS

Poor SRH prevalence was estimated at 31.8% (95%CI:31.0-33.0) among the non-impaired population, 65.6% (95%CI:60.6-70.0) among individuals with physical impairment, 50.3% (95%CI:45.0-56.0) for people with hearing impairment, and 55.3% (95%CI:51.8-59.0) for the visually impaired. Individuals with congenital physical impairment-with or without limitations-presented the strongest association with the poorest SRH status. Participants with non-limiting, congenital hearing impairment showed a protective factor to poor SRH (PR = 0.40 95%CI: 0.38-0.52). Individuals with acquired visual impairment with limitations demonstrated the strongest association with poor SRH (PR = 1.48 95%CI:1.47-1.49). Among the impaired population, middle-aged participants showed a stronger association with poor SRH than older adult participants.

CONCLUSIONS

Impairment is associated with poor SRH status, especially among people with physical impairment. The origin and degree of limitation of each type of impairment differently impacts SRH among the impaired population.

Comparison of the Physical Function Trajectories in Three Birth Cohorts of Chinese Older Adults: A 14-Year Longitudinal Study

OBJECTIVES

It remains uncertain whether the favorable trend of reduction in physical disabilities has become reversed in the recent-born cohorts of older adults. This study aimed to compare the rate of decline with time in self-reported Instrumental Activity of Daily Living (IADL) difficulties, objective measurement of gait speed and grip strength, in three birth cohorts of Chinese older adults.

DESIGN

A prospective cohort study.

SETTING AND PARTICIPANTS

Four thousand Chinese older adults aged 65 years or above in three birth cohorts (1934-1938, 1929-1933, 1905-1928) were recruited from the community in Hong Kong.

MEASUREMENTS

Grip strength, gait speed and IADL difficulties were measured between 2001 to 2017. Joint models were used to examine the trajectories of grip strength, gait speed and IADL difficulties over time, and the interaction effect of age-by-cohort (or also age2-by-cohort) was also examined.

RESULTS

The recently born cohort (1934 - 1938) had worse grip strength and more IADL difficulties at the same age than the earlier two cohorts (1929 - 1933; 1905 - 1928). Furthermore, the most recently born cohort also followed a more rapid decline longitudinally with a greater decline observed in gait speed, grip strength and IADL difficulties for women whereas a greater decline in grip strength and IADL difficulties for men.

CONCLUSIONS

The continuous improvement of physical limitations in old age may have halted and there appears to be a reversal of this favourable trend in the recent born cohort of older adults living in Hong Kong.

Contextual factors underpinning geographical inequalities in disability-free life expectancy in 100 French départements

The objectives were to estimate disability-free life expectancy (DFLE) and life expectancy with disability (DLE) by gender for the 100 French départements (administrative geographical subdivisions) and to investigate associations with socioeconomic factors, supply of healthcare and services for older persons. DFLE and DLE at age 60 are estimated using the Sullivan method and based on the GALI indicator provided by the French cross-sectional survey Vie Quotidienne et Santé 2014. In 2014, DFLE for men and women aged 60 was 14.3 years and 15.6 years, respectively. Variations across départements were considerable (5.4 years for men, 6.7 years for women). Multivariate random effects meta-regression models indicated a negative association for men between DFLE and some of the socioeconomic contextual indicators (ratio of manual workers to higher-level occupations and unemployment rate); the level of in-home nursing services (HNS) was negatively associated with DFLE and density of nurses positively associated with DLE. Among women, ratio of manual workers to higher-level occupations, unemployment rate, proportion of the population living in large urban areas, density of nurses, and level of HNS were negatively associated with DFLE; density of physiotherapy supply was associated positively with DFLE and negatively with DLE. Our results suggest that geographical inequalities in health expectancies are significantly correlated with socioeconomic status and with healthcare supply, support for older persons, and urban environments, particularly among women. These results underline the importance of monitoring these indicators and disparities at infra-national-level, and of investigating their relations with local context, particularly the supply of healthcare and services.

Disability-Free Life Expectancy among People Over 60 Years Old by Sex, Urban and Rural Areas in Jiangxi Province, China

OBJECTIVE

To estimate and compare age trends and the disability-free life expectancy (DFLE) of the population over 60 years old in 2018 in Jiangxi Province, China, by sex and urban-rural areas.

METHODS

The model life table was employed to estimate the age-specific mortality rate by sex and urban-rural areas, based on the Summary of Health Statistics of Jiangxi Province in 2018 and the Sixth National Health Service survey of Jiangxi Province. DFLE and its ratio to life expectancy (LE) were obtained by the Sullivan method.

RESULTS

In 2018, the DFLE among people over 60 is 17.157 years for men and is 19.055 years for women, accounting for 89.7% and 86.5% of their LE respectively. The DFLE/LE of men is higher than that of women at all ages. LE and DFLE are higher for the population in urban areas than in rural areas. For women, DFLE/LE is higher in urban areas than in rural areas (except at ages 75 and 80). Urban men have a higher DFLE/LE than rural men (except at age 85). The difference in DFLE between men and women over 60 years is 1.898 years, of which 2.260 years are attributable to the mortality rate, and 0.362 years are due to the disability-free prevalence. In addition, the difference in DFLE between urban-rural elderly over 60 years old is mostly attributed to the mortality rate by gender (male: 0.902/1.637; female: 0.893/1.454), but the impact of the disability-free rate cannot be ignored either (male: 0.735/1.637; female: 0.561/1.454).

CONCLUSIONS

The increase in DFLE is accompanied by the increase in LE, but with increased age, DFLE/LE gradually decreases. With advancing age, the effect of disability on elderly people becomes more severe. The government administration must implement some preventive actions to improve health awareness and the life quality of the elderly. Rural elderly; rural women in particular, need to be paid more attention and acquire more health care.

Are We Living Longer and Healthier?

Objective: To examine whether we live healthier as we live longer in Hong Kong, which has one of the highest life expectancies in the world. Methods: Sullivan's method was used to evaluate the chronic disease-free life expectancy (CDFLE), life expectancy in good self-perceived health (GPHLE), and impairment-free life expectancy (IFLE) among population aged 50 years and older in Hong Kong in 2007-2016. Results: In spite of the marked improvement in life expectancy in Hong Kong, the increase in GPHLE was much smaller, while CDFLE and IFLE even declined for both genders. The situation was more severe among older population. Discussion: People in Hong Kong live longer but with worsening health. The expansion of chronic diseases, self-perceived poor health, and impairments among older adults calls for more fiscal investments, government attention, and public health policies.

Are younger cohorts in the USA and England ageing better?

BACKGROUND

Whether worldwide increases in life expectancy are accompanied by a better health status is still a debate. People age differently, and there is a need to disentangle whether healthy-ageing pathways can be shaped by cohort effects. This study aims to analyse trends in health status in two large nationally representative samples of older adults from England and the USA.

METHODS

The sample comprised 55 684 participants from the first seven waves of the English Longitudinal Study of Ageing (ELSA), and the first 11 waves of the Health and Retirement Study (HRS). A common latent health score based on Bayesian multilevel item response theory was used. Two Bayesian mixed-effects multilevel models were used to assess cohort effects on health in ELSA and HRS separately, controlling for the effect of household wealth and educational attainment.

RESULTS

Similar ageing trends were found in ELSA (β = -0.311; p < 0.001) and HRS (β = -0.393; p < 0.001). The level of education moderated the life-course effect on health in both ELSA (β = -0.082; p < 0.05) and HRS (β = -0.084; p < 0.05). A birth-year effect was found for those belonging to the highest quintiles of household wealth in both ELSA (β = 0.125; p < 0.001) and HRS (β = 0.170; p < 0.001).

CONCLUSIONS

Health inequalities have increased in recent cohorts, with the wealthiest participants presenting a better health status in both the USA and English populations. Actions to promote health in the ageing population should consider the increasing inequality scenario, not only by applying highly effective interventions, but also by making them accessible to all members of society.

Post-war (1946-2017) population health change in the United Kingdom: A systematic review

We systematically reviewed the evidence on secular trends in main chronic conditions, disability and self-assessed general health among adults in the United Kingdom, as reported in primary/secondary care databases and population-based surveys. Searches were conducted separately for: (1) trends in age-standardised or age-specific prevalence of major non-communicable diseases, disability, and self-reported general health; (2) trends in health expectancy. The databases searched were MEDLINE, EMBASE/EMBASE Classic and Web of Science (all from 1946/7). The evidence was synthesised narratively. There were 39 studies reporting trends in prevalence of health conditions and 15 studies in health expectancy. We did not find evidence for improvement in the age-standardised or age-specific prevalence of any of the studied major chronic conditions over the last few decades, apart from Alzheimer's disease and other dementias. Both increasing or stable prevalence rates with simultaneous rising life expectancy support the expansion of morbidity theory, meaning that people are expected to spend a greater number of years with chronic condition(s). The evidence on disability-expressed as prevalence or health expectancy-was mixed, but also appeared to support the expansion of morbidity among those aged 65 or over. The evidence on trends in disability for younger age is lacking. Across the studied period (1946-2017), the UK population endured more years with chronic morbidity and disability, which may place a serious strain on the health care system, the economy and the society.

Secular trends of mortality and dementia-free life expectancy over a 10-year period in France

The aim of this paper was to investigate the evolution of mortality and life expectancy according to dementia in two French populations 10 years apart. Two different populations of subjects aged 65 or older included in PAQUID from 1988 to 1989 (n = 1342) and 3C from 1999 to 2000 (n = 1996) and initially not demented were followed over 10 years. Dementia was assessed using an algorithmic approach, and participants were considered to have dementia if they had an MMSE score < 24 AND a 4IADL score > 1. Illness-death models were used to compare mortality with and without dementia and to provide total life expectancy (LE), dementia-free life expectancy (DemFreeLE), life expectancy with dementia (DemLE), and survival with dementia. Mortality without dementia has decreased between the two populations among men [HR = 0.63 (0.49-0.81)] and women [HR = 0.67 (0.50-0.90)], whereas mortality with dementia has decreased for women only [HR = 0.59 (0.41-0.87)]. Total LE and DemFreeLE have increased between the 1990s and the 2000s populations (total LE: + 2.5 years; DemFreeLE: + 2.2 years); DemLE only slightly increased between the populations (DemLE: + 0.3 years). For survival with dementia, an increase in survival has been evidenced (mean survival: + 1.3 years) for women only. The improvement in DemFreeLE is promising. However, as the duration of life with dementia tends to increase for women, efforts to delay the onset of dementia should be reinforced.

Variation in the Gender Gap in Inactive and Active Life Expectancy by the Definition of Inactivity Among Older Adults

OBJECTIVE

To assess variation in gender gap (female-male) in inactive life expectancy (IALE) and active life expectancy (ALE) by definition of inactivity.

METHOD

Inactivity, among older Singaporeans, was defined as follows: Scenario 1-health-related difficulty in activities of daily living (ADLs); Scenario 2-health-related difficulty in ADLs/instrumental ADLs (IADLs); Scenario 3-health-related difficulty in ADLs/IADLs or non-health-related non-performance of IADLs. Multistate life tables computed IALE and ALE at age 60, testing three hypotheses: In all scenarios, life expectancy, absolute and relative IALE, and absolute ALE are higher for females (Hypothesis 1 [H1]); gender gap in absolute and relative IALE expands, and in absolute ALE, it contracts in Scenario 2 versus 1 (Hypothesis 2 [H2]); gender gap in absolute and relative IALE decreases, and in absolute ALE, it increases in Scenario 3 versus 2 (Hypothesis 3 [H3]).

RESULTS

H1 was supported in Scenarios 1 and 3 but not Scenario 2. Both H2 and H3 were supported.

DISCUSSION

Definition of inactivity influences gender gap in IALE and ALE.

What is the duration of life expectancy in the state of frailty? Estimates in the SIPAF study

The screening of frailty can trigger interventions aiming to delay disability in older people. Whereas the prevalence, the consequences, and the factors associated with frailty are well described, little is known about the duration of the state of frailty. This study aimed to estimate the time spent in the state of frailty in men and women using the Sullivan method. Data used were the age- and sex-specific prevalence of frailty found in SIPAF study ("Système d'Information sur la Perte d'Autonomie Fonctionnelle de la personne âgée") and statistics of mortality from the Human Mortality Database. The SIPAF study included 2350 individuals aged 70 and over and living in France. Participants were interviewed at home by trained nurses. Frailty was defined as impairment in three domains or more among nutrition, energy, physical activity, strength, and mobility. People requiring assistance in basic activities of daily living were considered in a separate category. Mean age of the study sample was 83.3 ± 7.5 years, with 59.4% of women. Overall, the prevalence of pre-frailty, frailty, and dependency was 39.1, 17.0, and 15.4%, respectively. Life expectancy at age 70 was 18.3 years for women, of which 7.4 years (95% CI 6.9-7.9) were pre-frail, 3.4 years (95% CI 3.0-3.8) frail, and 2.4 (95% CI 2.1-2.7) with disability. In contrast, LE for men at 70 was 14.8 years, of which pre-frail, frail, and disabled years were 6.0 years (95% CI 5.5-6.5), 1.2 years (95% CI 1.0-1.5), and 1.2 (95% CI 1.0-1.5), respectively. In conclusion, frailty is a transition state that is relatively limited in time compared to pre-frailty that may represent a larger time window for prevention.

Influence of Socioeconomic Factors on Daily Life Activities and Quality of Life of Thai Elderly

Background

The increasing number of older people is a significant issue in Thailand, resulted in growing demands of health and social welfare services. The study aim was to explore the influence of socioeconomic factors on activities of daily living and quality of life of Thai seniors.

Design and methods

Using randomised cluster sampling, one province was sampled from each of the Central, North, Northeast and South regions, then one subdistrict sampled in each province, and a household survey used to identify the sample of 1678 seniors aged 60 years and over. The Mann-Whitney U-test and binary logistic regression were used to compare and determine the association of socioeconomic variables on quality of life and activities of daily living.

Results

The findings showed that sociodemographic and socioeconomic factors were significantly related to functional capacity of daily living. Education levels were strongly associated with daily life activities, with 3.55 adjusted ORs for respondents with secondary school education. Gender was important, with females comprising 61% of dependent respondents but only 47% of independent respondents. Seniors with low incomes were more likely to be anxious in the past, present and future and less likely to accept death in the late stage, with 1.40 Adjusted ORs (95%CI: 1.02-1.92), and 0.72 (95%CI: 0.53-0.98), respectively. However, they were more likely to engage in social activities.

Conclusions

While socioeconomic factors strongly indicated the functional capacity to live independently, a good quality of life also required other factors leading to happiness and life satisfaction.

Evaluating compression or expansion of morbidity in Canada: trends in life expectancy and health-adjusted life expectancy from 1994 to 2010

INTRODUCTION

The objective of this study was to investigate whether morbidity in Canada, at the national and provincial levels, is compressing or expanding by tracking trends in life expectancy (LE) and health-adjusted life expectancy (HALE) from 1994 to 2010. "Compression" refers to a decrease in the proportion of life spent in an unhealthy state over time. It happens when HALE increases faster than LE. "Expansion" refers to an increase in the proportion of life spent in an unhealthy state that happens when HALE is stable or increases more slowly than LE.

METHODS

We estimated LE using mortality and population data from Statistics Canada. We took health-related quality of life (i.e. morbidity) data used to calculate HALE from the National Population Health Survey (1994-1999) and the Canadian Community Health Survey (2000-2010). We built abridged life tables for seven time intervals, covering the period 1994 to 2010 and corresponding to the year of each available survey cycle, for females and males, and for each of the 10 Canadian provinces. National and provincial trends were assessed at birth, and at ages 20 years and 65 years.

RESULTS

We observed an overall average annual increase in HALE that was statistically significant in both Canadian females and males at each of the three ages assessed, with the exception of females at birth. At birth, HALE increased an average of 0.2% (p = .08) and 0.3% (p < .001) annually for females and males respectively over the 1994 to 2010 period. At the national level for all three age groups, we observed a statistically non-significant average annual increase in the proportion of life spent in an unhealthy state, with the exception of men at age 65, who experienced a non-significant decrease. At the provincial level at birth, we observed a significant increase in proportion of life spent in an unhealthy state for Newfoundland and Labrador (NL) and Prince Edward Island (PEI).

CONCLUSION

Our study did not detect a clear overall trend in compression or expansion of morbidity from 1994 to 2010 at the national level in Canada. However, our results suggested an expansion of morbidity in NL and PEI. Our study indicates the importance of continued tracking of the secular trends of life expectancy and HALE in Canada in order to verify the presence of compression or expansion of morbidity. Further study should be undertaken to understand what is driving the observed expansion of morbidity in NL and in PEI.

Disability trends among older adults in ten European countries over 2004–2013, using various indicators and Survey of Health, Ageing and Retirement in Europe (SHARE) data

In the context of the prospective increase in the numbers of older adults in Europe and of conflicting findings regarding recent disability trends, the present study uses cross-sectional data from four waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), covering the period 2004–2013, and aims at the assessment of trends in disability by sex and broad age group (50–64 and 65 and over) for the ten countries participating in all waves, based on four different measures: limitations in activities of daily living (ADLs), limitations in instrumental ADLs, mobility difficulties and the Global Activity Limitation Indicator. The analysis uses logistic regression models adjusted for age and, subsequently, also for chronic conditions. The findings indicate improvements both in mild/moderate activity restrictions and in functional limitations for several countries, especially among men and women aged 65 and over. Regarding severe disability (ADLs) there is mostly a lack of any significant trend and only a few declines. In several instances, the observed trends are linked to changes in chronic conditions; significant improvements net of chronic conditions are found mainly in Sweden but also in the Netherlands, Austria, Germany, Italy and France. Overall, the estimated trends often differentiate by country, age group and sex while they depend upon the specificities of the measures used in the analysis.

A comparison of health expectancies over two decades in England: results of the Cognitive Function and Ageing Study I and II

BACKGROUND

Whether rises in life expectancy are increases in good-quality years is of profound importance worldwide, with population ageing. We investigate how various health expectancies have changed in England between 1991 and 2011, with identical study design and methods in each decade.

METHODS

Baseline data from the Cognitive Function and Ageing Studies in populations aged 65 years or older in three geographically defined centres in England (Cambridgeshire, Newcastle, and Nottingham) provided prevalence estimates for three health measures: self-perceived health (defined as excellent-good, fair, or poor); cognitive impairment (defined as moderate-severe, mild, or none, as assessed by Mini-Mental State Examination score); and disability in activities of daily living (defined as none, mild, or moderate-severe). Health expectancies for the three regions combined were calculated by the Sullivan method, which applies the age-specific and sex-specific prevalence of the health measure to a standard life table for the same period.

FINDINGS

Between 1991 and 2011, gains in life expectancy at age 65 years (4·5 years for men and 3·6 years for women) were accompanied by equivalent gains in years free of any cognitive impairment (4·2 years [95% CI 4·2-4·3] for men and 4·4 years [4·3-4·5] for women) and decreased years with mild or moderate-severe cognitive impairment. Gains were also identified in years in excellent or good self-perceived health (3·8 years [95% CI 3·5-4·1] for men and 3·1 years [2·7-3·4] for women). Gains in disability-free years were much smaller than those in excellent-good self-perceived health or those free from cognitive impairment, especially for women (0·5 years [0·2-0·9] compared with 2·6 years [2·3-2·9] for men), mostly because of increased mild disability.

INTERPRETATION

During the past two decades in England, we report an absolute compression (ie, reduction) of cognitive impairment, a relative compression of self-perceived health (ie, proportion of life spent healthy is increasing), and dynamic equilibrium of disability (ie, less severe disability is increasing but more severe disability is not). Reasons for these patterns are unknown but might include increasing obesity during previous decades. Our findings have wide-ranging implications for health services and for extension of working life.

FUNDING

UK Medical Research Council.

Population Aging at Cross-Roads: Diverging Secular Trends in Average Cognitive Functioning and Physical Health in the Older Population of Germany

This paper uses individual-level data from the German Socio-Economic Panel to model trends in population health in terms of cognition, physical fitness, and mental health between 2006 and 2012. The focus is on the population aged 50–90. We use a repeated population-based cross-sectional design. As outcome measures, we use SF-12 measures of physical and mental health and the Symbol-Digit Test (SDT) that captures cognitive processing speed. In line with previous research we find a highly significant Flynn effect on cognition; i.e., SDT scores are higher among those who were tested more recently (at the same age). This result holds for men and women, all age groups, and across all levels of education. While we observe a secular improvement in terms of cognitive functioning, at the same time, average physical and mental health has declined. The decline in average physical health is shown to be stronger for men than for women and found to be strongest for low-educated, young-old men aged 50–64: the decline over the 6-year interval in average physical health is estimated to amount to about 0.37 SD, whereas average fluid cognition improved by about 0.29 SD. This pattern of results at the population-level (trends in average population health) stands in interesting contrast to the positive association of physical health and cognitive functioning at the individual-level. The findings underscore the multi-dimensionality of health and the aging process.

Economics of the Iceberg: Informal Care Provided to French Elderly with Dementia

OBJECTIVES

Dementia has a substantial effect on patients and their relatives, who have to cope with medical, social, and economic changes. In France, most elderly people with dementia live in the community and receive informal care, which has not been well characterized.

METHODS

Using a sample of 4680 people aged 75 years and older collected in 2008 through a national comprehensive survey on health and disability, we compared the economic value of the care received by 513 elderly people with dementia to that received by a propensity score- matched set of older people without dementia.

RESULTS

More than 85% of elderly people with dementia receive informal care; the estimation of its economic value ranges from €4.9 billion (proxy good method) to €6.7 billion (opportunity cost method) per year.

CONCLUSIONS

The informal care provided to people with dementia has substantial annual costs; further work should be done to examine the social and economic roles foregone as a result of this care.

Are we living longer but less healthy? Trends in mortality and morbidity in Catalonia (Spain), 1994-2011

Evidence on trends in prevalence of disease and disability can clarify whether countries are experiencing a compression or expansion of morbidity. An expansion of morbidity, as indicated by disease, has appeared in Europe and other developed regions. It is likely that better treatment, preventive measures, and increases in education levels have contributed to the declines in mortality and increments in life expectancy. This paper examines whether there has been an expansion of morbidity in Catalonia (Spain). It uses trends in mortality and morbidity and links these with survival to provide estimates of life expectancy with and without diseases and mobility limitations. We use a repeated cross-sectional health survey carried out in 1994 and 2011 for measures of morbidity, and information from the Spanish National Statistics Institute for mortality. Our findings show that at age 65 the percentage of life with disease increased from 52 to 70 % for men, and from 56 to 72 % for women; the expectation of life with mobility limitations increased from 24 to 30 % for men and from 40 to 47 % for women between 1994 and 2011. These changes were attributable to increases in the prevalence of diseases and moderate mobility limitation. Overall, we find an expansion of morbidity along the period. Increasing survival among people with diseases can lead to a higher prevalence of diseases in the older population. Higher prevalence of health problems can lead to greater pressure on the health care system and a growing burden of disease for individuals.

Health, functioning, and disability in older adults--present status and future implications

Ageing is a dynamic process, and trends in the health status of older adults aged at least 60 years vary over time because of several factors. We examined reported trends in morbidity and mortality in older adults during the past two decades to identify patterns of ageing across the world. We showed some evidence for compression of morbidity (ie, a reduced amount of time spent in worse health), in four types of studies: 1) of good quality based on assessment criteria scores; 2) those in which a disability-related or impairment-related measure of morbidity was used; 3) longitudinal studies; or 4) studies undertaken in the USA and other high-income countries. Many studies, however, reported contrasting evidence (ie, for an expansion of morbidity), but with different methods, these measures are not directly comparable. Expansion of morbidity was more common when trends in chronic disease prevalence were studied. Our secondary analysis of data from longitudinal ageing surveys presents similar results. However, patterns of limitations in functioning vary substantially between countries and within countries over time, with no discernible explanation. Data from low-income countries are very sparse, and efforts to obtain information about the health of older adults in less-developed regions of the world are urgently needed. We especially need studies that focus on refining measurements of health, functioning, and disability in older people, with a core set of domains of functioning, that investigate the effects of these evolving patterns on the health-care system and their economic implications.

Trends in inequalities in health, risk and preventive behaviour among the advanced-age population in Austria: 1983-2007

Background

Although a number of previous research studies have focused on the long-term analysis of the health and health behaviour of the elderly, there is still a shortage of information in relation to the long-term trends regarding health or risk and preventive behaviour in the elderly population taking into account gender differences and differences in educational level.

Methods

The database comprised subsamples of the Austrian Micro-Census, including individuals aged 65 years and older, for the years 1983, 1991, 1999, and subsamples of the ATHIS (Austrian Health Interview Survey) 2007. A trend analysis was conducted for four health-related variables with the year of the survey and education as predictors. The analysis was stratified by sex.

Results

We found a general trend towards better self-rated health, better preventive and less risk behaviour among the elderly, while the body mass index has been increasing over the years. There are indeed gender differences regarding the trend in smoking behaviour. While the prevalence of male smoking has been steadily decreasing, female smoking prevalence has not changed. At all points in time, individuals with higher education had significantly better self-rated health than those with lower education but the association between education and preventive behaviour significantly decreased over the years.

Conclusion

We agree with previous research in concluding that preventive action and health promotion should aim in particular to support older women and men with lower education.

Healthy life expectancy changes in Thailand, 2002-2007

We investigate links between increasing longevity and health status in Thailand. Using data from 2002 and 2007 national surveys of the elderly, healthy life expectancies at older ages were estimated. Change depended on health indicator, gender and age. Self-reported health and self-care disability showed expansion of morbidity. Mobility disability change indicated compression but a wording change means this may be an artefact. We compare these findings with the 1990 and 2010 results of the Global Burden of Disease study. Using HLE based on disease prevalence, the GBD found that Thailand experienced small longevity gains and morbidity compression. Our findings suggest these results should be treated with caution, as, since 2000, Thailand has introduced universal health care.

Aging and health in France: an unexpected expansion of disability in mid-adulthood over recent years

OBJECTIVES

The study presents new disability-free life expectancies (DFLE) estimates for France and discusses recent trends in the framework of the three 'health and aging' theories of compression, dynamic equilibrium and expansion of disability. The objectives are to update information for France and to compare two methods to analyse recent trends.

METHODS

DFLE at ages 50, 65 and in the 50-65 age group are computed for several disability dimensions, using data from five French surveys over the 2000s. Owing to scarce time series, we used two methods to assess trends and consolidate our conclusions: (i) decomposition of the DFLE changes using the available time series; (ii) linear regression using all the available estimates, classified by disability dimensions.

RESULTS

Trends in DFLE65 prolonged the dynamic equilibrium of the previous decades: increasing life expectancy with functional limitations but not with activity restrictions. Meanwhile, partial DFLE50-65 has decreased for various disability dimensions, including some activity restrictions, especially for women.

CONCLUSION

France has recently experienced an unexpected expansion of disability in mid-adulthood while it is still on a trend of dynamic equilibrium at older ages. The study highlights the importance of monitoring trends in DFLE for various disability dimensions and broadens the scope of interest to the mid-adulthood.

Critical role of prostate biopsy mortality in the number of years of life gained and lost within a prostate cancer screening programme

Study Type--Therapy (data synthesis) Level of Evidence 2b. What's known on the subject? and What does the study add? The efficacy of prostate cancer screening using PSA testing is still being debated, with conflicting results in randomized trials. The study shows that, even using the hypothesis most favourable to prostate cancer screening with PSA, the net number of years of life does not favour screening.

OBJECTIVE

• To evaluate the impact of the implementation a prostate-specific antigen (PSA) screening programme using the European Randomized Study of Screening for Prostate Cancer (ERSPC) results and taking into account the impact of prostate biopsy and over-treatment on mortality.

MATERIALS AND METHODS

• We used a model based on the number of years of life gained and lost owing to screening, using data reported in the ERSPC. • We conducted a critical evaluation of the ERSPC results and of the Swedish arm of the study.

RESULTS

•  Accounting for biopsy-specific mortality and for over-treatment, the balance of number of years of life was negative in the ERSPC study, with an estimated loss of 3.6 years of life per avoided death. • The number of years of life becomes positive (real gain) only when fewer than 666 screened individuals are required to avoid one death. • We found that in the Swedish arm of the ERSPC there was a biopsy rate of 40% compared with 27% in the ERSPC overall. The over-treatment rate was also greater with 4.1% compared with 3.4% overall. • For the last 20 years, there has been a marked difference in prostate cancer-specific mortality between Sweden and the rest of Europe: in 2005, for the age group 65-74 the rate was 140 per 100,000 person years in Sweden and ~80 per 100,000 for the rest of Europe.

CONCLUSION

• Overall, PSA testing in Europe is associated with a loss in years of life and should thus not be recommended.

Healthy ageing: the role of health care services

The implications of the imminent surge in population ageing for the work of health care services in high-income countries remain unclear. It is widely expected, however, that the prevention and management of chronic disease will increasingly dominate their workload, and that this is likely to require a major shift in the way that care is delivered. This paper argues that the central contribution of health care services to a healthy ageing strategy is to drive improvements in the prevention and management of chronic disease, and it explores some of the implications of this view in the light of evidence mainly from the UK.

Trends and variation in mild disability and functional limitations among older adults in Norway, 1986-2008

An increase in the number of older adults may raise the demand for health and care services, whereas decreasing prevalence of disability and functional limitations among them might counteract this demographic effect. However, the trends in health are inconsistent between studies and countries. In this article, we estimated the trends in mild disability and functional limitations among older Norwegians and analyzed whether they differ between socio-demographic groups. Data were obtained from repeated cross-sectional surveys conducted in 1987, 1991, 1995, 2002, 2005, and 2008, in total 4,036 non-institutionalized persons aged 67 years or older. We analyzed trends using multivariate logistic regression. On average, the age-adjusted trend in functional limitations was −3.3% per year, and in disability 3.4% per year. The risk for functional limitations or disability was elevated for women compared to men, for married compared to non-married, and was inversely associated with educational level The trends were significantly weaker with increasing age for disabilities, whereas none of the trends differed significantly between subgroups of sexes, educational level or marital status. Both functional limitations free and disability-free life expectancy appeared to have increased more than total life expectancy at age 67 during this period. The analysis suggests downward trends in the prevalence of mild disability and functional limitations among older Norwegians between 1987 and 2008 and a compression of lifetime in such health states. The reduced numbers of older people with disability and functional limitations may have restrained the demand for health and care services caused by the increase in the number of older adults.

Mortality and morbidity trends: is there compression of morbidity?

OBJECTIVE

This paper reviews trends in mortality and morbidity to evaluate whether there has been a compression of morbidity.

METHODS

Review of recent research and analysis of recent data for the United States relating mortality change to the length of life without 1 of 4 major diseases or loss of mobility functioning.

RESULTS

Mortality declines have slowed down in the United States in recent years, especially for women. The prevalence of disease has increased. Age-specific prevalence of a number of risk factors representing physiological status has stayed relatively constant; where risks decline, increased usage of effective drugs is responsible. Mobility functioning has deteriorated. Length of life with disease and mobility functioning loss has increased between 1998 and 2008.

DISCUSSION

Empirical findings do not support recent compression of morbidity when morbidity is defined as major disease and mobility functioning loss.

Longevity, genes and efforts: an optimal taxation approach to prevention

This paper applies the analytical tools of optimal taxation theory to the design of the optimal subsidy on preventive behaviours, in an economy where longevity varies across agents, and depends on preventive expenditures and on longevity genes. Public intervention can be here justified on three grounds: corrections for misperceptions of the survival process and for externalities related to individual preventive behaviour, and redistribution across both earnings and genetic dimensions. The optimal subsidy on preventive expenditures is shown to depend on the combined impacts of misperception, externalities and self-selection. It is generally optimal to subsidize preventive efforts to an extent depending on the degree of individual myopia, on how productivity and genes are correlated, and on the complementarity of genes and preventive efforts in the survival function.

Trends in healthy life expectancy in Hong Kong SAR 1996-2008

Although Hong Kong has one of the best life expectancy (LE) records in the world, second only to Japan for women, we know very little about the changes in the health status of the older adult population. Our article aims to provide a better understanding of trends in both chronic morbidity and disability for older men and women. The authors compute chronic morbidity-free and disability-free life expectancy and the proportion of both in relation to total LE using the Sullivan method to examine whether Hong Kong older adults are experiencing a compression of morbidity and disability and whether there is any gender difference in relation to mortality and morbidity. The results of this study show that Hong Kong women tend to outlive Hong Kong men but are also more likely to suffer from a ‘double disadvantage’, namely more years of life with more chronic morbidity and disability. There has also been a significant expansion of chronic morbidity, as chronic morbidity-free life expectancy (CMFLE) decreased substantially for both genders from 1996 to 2008. Although disability-free life expectancy (DFLE) increased during this period, it increased at a slower pace compared to LE. The proportion of life without chronic morbidity also declined remarkably during these 12 years. Among the advanced ages, the proportion of remaining life in good health without disability has decreased since 1996, indicating a relative expansion of disability.

Gender gap in health expectancy

Men have higher death rates than women, but women do worse with regard to physical strength, disability, and other health outcomes, the so called male-female health-survival paradox. The paradox is likely to be due to multiple causes that include biological, behavioral, and social differences between the sexes. Despite decades of research on the male-female health-survival paradox, we still do not fully recognize whether behavioral factors explain most of the gender gap or whether biological and social differences contribute more substantially to the explanation of the sex differences in health and mortality. Little work has been done to investigate the magnitude of sex differences in healthy life expectancy and unhealthy life expectancy, as well as to examine the contribution of mortality and disability levels to the sex gap in health expectancy. The five selected works presented at the Réseau Espérance de Vie en Santé (REVES) Meeting 2009 in Copenhagen, and published in this issue, provide new insights into sex differences in health expectancy. The papers examine sex differences in health expectancy indicators in the EU countries, as well as trends in health expectancy in Hong Kong and in the US. They go beyond description of sex differences in health expectancy and assess the contributions of mortality and disability to gender differences in healthy life years and unhealthy life years, investigate temporal changes in sex differential health expectancy, as well as analyze contributions of time and age dimensions to the gender gap. They also show that there is still work to be done to indentify and quantify mechanisms underlying sex differences in longevity, health, and aging.

Use of formal and informal care services among older people in Ireland and France

This paper focuses on current use of elderly care services in Ireland and France. In light of health care resource allocation problems, it is important to know the level of current use of home care on which future projections may be based. With the availability of SHARE (Survey of Health Ageing and Retirement in Europe) data, it is now possible to analyse this process and estimate the relationship between formal and informal care, and our econometric model tests for endogeneity of informal care. Previous research has not included Ireland into the analysis. Given that Ireland has a younger population base, lessons could be learned from countries with older populations, such as France. Results suggest informal care is endogenous and negatively linked with formal care in the pooled (France and Ireland) model. There is a higher unmet need for care in Ireland. These results have important policy implications for Ireland as the demographic makeup will change from 11 per cent to 15 per cent of older people over the next 10 years.

Decreasing the aging velocity in industry workers

We carried out physiological and ergonomic studies in industry from 1965 to 2000. Participants (2147) were workers in different jobs, such as light industry and the dairy, automotive, and building materials industries. Most of the groups studied included 30-50 male and female workers. In the studies we used a combination of methods and paid much attention to the quantitative assessment of discomfort during working hours. One of the aims was to avoid or postpone various age-related diseases (cardiovascular, musculoskeletal, etc.) of workers. We provided recommendations to managers and individuals: changing the technology, work organization, corrective measures of ergonomics, self-care procedures or doctor visits, correct diet, preventive exercises, and improving labor productivity. Changes based on our studies postponed age-related changes up to 20 years and pointed to close connections between the environment and aging peculiarities in the human organism.

Ageing populations: the challenges ahead

If the pace of increase in life expectancy in developed countries over the past two centuries continues through the 21st century, most babies born since 2000 in France, Germany, Italy, the UK, the USA, Canada, Japan, and other countries with long life expectancies will celebrate their 100th birthdays. Although trends differ between countries, populations of nearly all such countries are ageing as a result of low fertility, low immigration, and long lives. A key question is: are increases in life expectancy accompanied by a concurrent postponement of functional limitations and disability? The answer is still open, but research suggests that ageing processes are modifiable and that people are living longer without severe disability. This finding, together with technological and medical development and redistribution of work, will be important for our chances to meet the challenges of ageing populations.

The relationship between longevity and healthy life expectancy

What is the relationship between longevity and health? Health expectancies were developed more than 30 years ago specifically to answer this question. It may therefore be the time to try to answer this question, though it is worth noting that the question implies a unidirectional relationship. Almost no one questions the positive association between health and longevity. It is expected that healthy, robust people will live, on average, longer than frail people. This heterogeneity in terms of robustness/frailty may explain the shape of the mortality trajectory with age, ie. the oldest old seem to follow a lower mortality schedule (Vaupel et al, 1979). On the other hand, many people wonder about the relationship between longevity and health. Are we living longer because we are in better health? Are we living longer in good health? Or are we merely surviving longer whatever our health status? In other words, can we live in good health as long as we can survive? And this is exactly the purpose of health expectancies: monitoring how long people live in various health statuses (Sanders, 1964; Sullivan, 1971; Robine et al, 2003a).