Functional ability in the elderly Finnish population: time period differences and associations, 1985-99

Are Advances in Survival Among the Oldest Old Seen Across the Spectrum of Health and Functioning?

BACKGROUND

Mortality rates have been reduced by half over the last 60 years for nonagenarians, and the progress is continuing. The greater survival might be due to overtreatment of severely physically and cognitively disabled individuals, which is a big concern for societies and individuals.

METHODS

The study population comprised two Danish birth cohorts: the 1905 Cohort and the 1915 Cohort. At age 95, all from the two cohorts who were still alive and living in Denmark were invited to participate in a health survey that used the same assessment instrument. A total of 2,670 (56.8%) persons participated in the two surveys and survival was assessed through a 7.3-year follow-up period during which 2,497 (93.5%) had died, and with virtually no loss to follow-up.

RESULTS

Despite the increasing chance of surviving to age 95, the 1915 Cohort had significantly better health and functioning than the 1905 Cohort. The survival advantage in the 1915 Cohort continued in the follow-up period after age 95: Median survival length was 2.4 months longer, p = .011. This advantage was not statistically associated with different levels of activities of daily living, physical performance, cognitive functioning, self-rated health and life satisfaction. However, the advantage tended to be more pronounced among people with better health.

CONCLUSIONS

Life span and health increases among the oldest old. The improvement in survival for 95-year olds born in 1915 compared with 1905 was seen across the whole spectrum of health and functioning, with a tendency towards bigger improvement among those in good health.

Stabilized Incidence in Proximal Humeral Fractures of Elderly Women: Nationwide Statistics From Finland in 1970-2015

Background

Low-trauma fractures of elderly women are a major public health concern.

Methods

We determined the current trend in the absolute number and incidence (per 100,000 persons) of fresh low-trauma fractures of the proximal humerus among 80-year-old or older Finnish women by taking into account all women who were admitted to Finnish hospitals for primary treatment of such a fracture between 1970 and 2015.

Results

The number of low-trauma fractures of the proximal humerus among 80-year-old or older Finnish women rose continuously between 1970 (32 fractures) and 2015 (568 fractures), whereas the age-adjusted fracture rate (showing a clear rise from 87 fractures per 100,000 persons in 1970 to 304 fractures in 1995) became stabilized between 1995 and 2015 (297 fractures per 100,000 persons in 2015).

Conclusions

The clear rise in the incidence of low-trauma proximal humeral fractures in Finnish elderly women from early 1970s until mid 1990s has been followed by stabilized fracture rates. Reasons for this are largely unknown, but a cohort effect toward a healthier aging population with improved functional ability, as well as measures to prevent falls and alleviate fall severity, could partly explain the phenomenon.

Declining incidence of fall-induced ankle fractures in elderly adults: Finnish statistics between 1970 and 2014

BACKGROUND

Fall-induced fractures of older adults are a major public health concern. However, nationwide information on recent fracture trends is sparse.

METHODS

We determined the trend in the number and incidence (per 100,000 persons) of fall-induced ankle fractures among older adults in Finland by taking into account all persons 60 years of age or older who were admitted to Finnish hospitals for primary treatment of such fracture in 1970-2014.

RESULTS

The number of fall-induced ankle fractures among 60-year-old or older Finnish persons increased steadily and sharply between 1970 (369 fractures) and 1997 (1668 fractures), but since then, the increase has slowed down (1835 fractures in 2014). The raw incidence of ankle fracture, showing a clear rise from 57 fractures per 100,000 persons in 1970 to 169 fractures in 1997, declined steadily between 1997 and 2014 (to 126 fractures in 2014). Observations on the age-adjusted fracture incidence were similar. During 1970-1997, the age-adjusted incidence of fall-induced ankle fracture clearly rose in both women and men, but thereafter, the incidence declined; in women, from 199 in 1997 to 158 in 2014, and in men, from 123 in 1997 to 80 in 2014.

CONCLUSIONS

The sharp rise in the incidence of fall-induced ankle fracture in Finnish older adults from early 1970s until late 1990s has been followed by a declining fracture rate. Despite this welcome development, the rapid aging of our population is likely to increase the absolute number of these fractures in the near future, and therefore, large-scale fracture-preventing intervention studies are urgently needed.

Low-trauma knee fractures in older Finnish women between 1970 and 2013

BACKGROUND

Fresh information on various low-trauma fractures of elderly adults is sparse.

AIM

We aimed to assess the current trends in the low-trauma knee fractures among older adults in Finland, an EU country with a well-defined white population of 5.4 million.

METHODS

The rates of elderly Finns' low-trauma fractures of the knee (distal femur, patella, and proximal tibia) were assessed by taking into account 60-year-old or older persons who were admitted to Finnish hospitals for primary treatment of such injury in 1970-2013.

RESULTS

The incidence of low-trauma knee fractures among 60-year-old or older Finnish women sharply rose between 1970 and 1997, from 55 fractures (per 100,000 persons) in 1970 to 124 fractures in 1997. Thereafter, the incidence continuously declined so that the fracture incidence was 91 in 2013. The corresponding age-adjusted fracture incidences were 60 (1970), 119 (1997), and 83 (2013). In older men, the fracture incidence was rather steady over time: the age-adjusted incidence was 30 in 1970 vs. 28 in 2013.

CONCLUSIONS

The rise in the incidence of low-trauma knee fractures in Finnish older women from early 1970s until late 1990s has been followed by a continuous decline in the fracture rate. Reasons for the decline are unknown, but a cohort effect toward a healthier aging female population with improved functionality and decreased risk of injurious slips, trips, and falls could partly explain the observation.

Fall-induced deaths among older adults: nationwide statistics in Finland between 1971 and 2009 and prediction for the future

BACKGROUND

Fall-related injuries and deaths of elderly people are a major public health concern.

METHODS

Using the Official Cause-of-Death Statistics of Finland we determined the current trends in the number and age-adjusted incidence (per 100,000 persons) of fall-induced deaths among older Finnish men and women by taking into account all persons 50 years of age or older who died because of a fall-induced injury between 1971 and 2009.

RESULTS

Among elderly Finnish men, the number of deaths due to falls increased considerably between the years 1971 and 2009, from 162 to 627 (a 287% increase). The age-adjusted incidence also increased from 43.4 (per 100,000 persons) in 1971 to 57.9 in 2000, but stabilized thereafter (57.3 in 2009). Among elderly Finnish women, the number of fall-induced deaths increased till the beginning of the new millennium (from 279 in 1971 to 499 in 2000) but stabilized thereafter (506 in 2009), and, in sharp contrast to men, women's age-adjusted incidence of fall-induced deaths declined during the entire study period, the incidence being 77.2 in 1971 while only 35.3 in 2009.

CONCLUSIONS

Between 1971 and 2009 the number of fall-induced deaths increased among elderly Finns. The changes were sex-specific so that men surpassed women in both the number and age-adjusted incidence of these fatal falls. Welcome observations were that men's age-adjusted incidence of fall-induced deaths started to stabilize during the new millennium and that in women this incidence continuously declined between 1971 and 2009.

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.

Has the prevalence of disability increased over the past decade (2000-2007) in elderly people? A Spanish population-based survey

OBJECTIVES

The main objectives of the current study were (1) to describe the prevalence of disability according to sociodemographic features, self-perceived health status, comorbidity, and lifestyle habits; (2) to determine factors associated with disability in men and women; and (3) to study the time trends prevalence of disability in the period 2000 to 2007.

METHODS

We analyzed data taken from the Spanish National Health Surveys conducted in 2001 (n = 21,058), 2003 (n = 21,650), and 2006 (n = 29,478). For the current study, we included answers from adults aged 65 years and older. The main variable was disability including basic activities of daily living (ADLs), instrumental ADLs (IADLs), and mobility disability. We stratified the adjusted models by the main variables. We analyzed sociodemographic characteristics, self-perceived health status, lifestyle habits, and comorbid conditions using multivariate logistic regression models.

RESULTS

The total number of individuals aged 65 years and older was 18,325 (11,346 women, 6,979 men). Women were significantly older than men in all the surveys (P < .001). Women showed higher prevalence of disability (ADL, IADL, and mobility) as compared with men in all surveys. Time trends in the total disability prevalence and whole age range showed a significant increase from 2000 to 2007 in both men and women (OR 1.13, 95% CI 1.1-1.7), particularly in individuals with older age. The variables significantly associated with a higher likelihood of reporting ADL and IADL disability were age older than 84, lower educational level, 2 or more comorbid chronic conditions, obesity (only in women), sleeping more than 8 hours per day, and not practicing physical exercise. Finally, variables that increased the probability of having mobility disability were age older than 84 years, lower educational level, 2 or more comorbid chronic conditions, and not practicing physical exercise. In addition, subjects with disability had a worse self-reported health status.

CONCLUSIONS

The current study revealed an increase in disability from 2000 to 2007 in the older Spanish population. We found that age older than 84 years, lower education levels, obesity, not practicing physical activity and sleeping more than 8 hours per day were associated with higher disability. Individuals with disability reported a worse self-perceived health status and a greater number of comorbid conditions.

Changes in the Prevalence of Mobility Limitations and Mobile Life Expectancy of Older Adults in Singapore, 1995-2005

Objective: To examine changes in the prevalence of mobility limitations and mobile life expectancy of Singaporeans aged 55+. Method: Data came from the cross-sectional 1995 and 2005 National Survey of Senior Citizens (NSSC; n = 4,750 and n = 4,591, respectively). The prevalence-based Sullivan method was used to disaggregate total life expectancy into expected life time without and with mobility limitations. Results: Increases in life expectancy in the city-state were accompanied by increases in the prevalence of mobility limitations—from 3.0% to 5.7% for men and 5.1% to 9.7% for women. The impairments mostly began after age 65 and increased with age particularly at ages 85+. The proportion of life expectancy without mobility limitations declined over time, at all ages, and for both genders, with women still experiencing a higher proportion with mobility problems compared to men. Discussion: The overall results provided support for the expansion of morbidity hypothesis, and we discussed some possible reasons. From a policy perspective, the findings could suggest a need to develop infrastructures that would enable older Singaporeans to remain mobile in a highly urban setting.

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.

Rate of proximal humeral fractures in older Finnish women between 1970 and 2007

Low-trauma fractures of older women are a major public health problem. Nevertheless, nationwide information on recent trends of proximal humeral fractures is sparse. We assessed the current trend in the number and rate (per 100,000 persons) of low-trauma fractures of the proximal humerus among 80-year-old or older women in Finland, a European Union country with a well-defined white population of 5.3 million, by taking into account all women who were admitted to our hospitals for primary treatment of such fracture in 1970-2007. The number of low-trauma fractures of the proximal humerus among 80-year-old or older Finnish women rose continuously between 1970 (32 fractures) and 2007 (478 fractures), but because of a simultaneous, sharper rise in population at risk, the age-adjusted fracture rate (showing a clear rise from 88 fractures per 100,000 persons in 1970 to 304 fractures in 1995) became stabilized between 1995 and 2007 (298 fractures per 100,000 persons in 2007). In conclusion, the clear rise in the rate of low-trauma fractures of the proximal humerus in Finnish elderly women from early 1970s until mid 1990s has been followed by stabilized fracture rates. Reasons for this are largely unknown, but a cohort effect toward a healthier aging population with improved functional ability and reduced risk of injurious falls cannot be ruled out.

Declining incidence of low-trauma knee fractures in elderly women: nationwide statistics in Finland between 1970 and 2006

The study assessed the recent secular trend in the incidence of low-trauma knee fractures among older Finns in the years 1970-2006. The clear rise in women's fracture incidence from early 1970s until the late 1990s was followed by a declining fracture rate. Exact reasons for the decline are unknown, but a cohort effect toward a healthier female population with improved functionality and reduced risk of injurious slips, trips and falls could partly explain the phenomenon.

INTRODUCTION

Although low-trauma fractures of elderly adults have been recognized as a major public health concern in modern societies with aging populations, fresh nationwide information on their secular trends is sparse.

METHODS

We determined the current trend in the number and incidence (per 100,000 persons) of low-trauma knee fractures among elderly people in Finland, an EU country with a well-defined white population of 5.3 million, by taking into account all persons 60 years of age or older who were admitted to our hospitals for primary treatment of such fractures from 1970 to 2006.

RESULTS

The number and incidence of low-trauma knee fractures among 60-year-old or older Finnish women sharply rose between 1970 and 1997, from 218 (number) and 55 (incidence) in 1970 to 733 and 124 in 1997. However, thereafter both the number and incidence of fractures have continuously declined so that there were only 626 fractures in these women in 2006 (incidence 94). In the age-adjusted fracture incidence, the findings were similar. During 1970-1997, the age-adjusted incidence of low-trauma knee fractures in our elderly women clearly rose (from 60 to 118), but thereafter, this incidence declined to 85 in 2006. In men, the fracture incidence did not show consistent trend changes over time (30 in 1970 and 36 in 2006).

CONCLUSIONS

The sharp rise in the incidence of low-trauma knee fractures in Finnish elderly women from early 1970s until late 1990s has been followed by a declining fracture rate. Exact reasons for this are unknown, but a cohort effect toward a healthier aging female population with improved functional ability and reduced risk of injurious slips, trips and falls cannot be excluded.

Stabilizing incidence of low-trauma ankle fractures in elderly people Finnish statistics in 1970-2006 and prediction for the future

INTRODUCTION

Low-trauma fractures of older adults have been recognized as a major public health problem in developed societies with aging populations. However, nationwide information on recent fracture trends is rather scarce.

METHODS

We determined the trend in the number and incidence (per 100,000 persons) of low-trauma ankle fracture among elderly people in Finland by taking into account all persons 60 years of age or older who were admitted to our hospitals for primary treatment of such fracture in 1970-2006.

RESULTS

The number of low-trauma ankle fractures among 60-year-old or older Finnish persons increased steadily and sharply between 1970 (369 fractures) and 1997 (1668 fractures), but since then, the increase has leveled off (1670 fractures in 2006). The raw incidence of low-trauma ankle fracture, showing a clear rise from 57 fractures per 100,000 persons in 1970 to 169 fractures in 1997, somewhat decreased between 1997 and 2006 (to 144 fractures in 2006). Observations on the age-adjusted fracture incidence were similar. During 1970-1997, the age-adjusted incidence of low-trauma ankle fracture clearly rose in both women and men, but thereafter, the incidence declined; in women, from 199 in 1997 to 173 in 2006, and in men, from 123 in 1997 to 100 in 2006.

CONCLUSIONS

The sharp increase in the incidence of low-trauma ankle fracture in Finnish older adults from early 1970s until late 1990s has been followed by stabilized, slightly declining fracture rates. Reasons for this are not known, but a cohort effect toward a healthier aging population with improved functional ability and reduced risk of injurious slips, trips and falls could partly explain the phenomenon.

Educational differences in mobility: the contribution of physical workload, obesity, smoking and chronic conditions

BACKGROUND

In earlier studies, determinants of socioeconomic gradient in mobility have not been measured comprehensively.

AIM

To assess the contribution of chronic morbidity, obesity, smoking and physical workload to inequalities in mobility.

METHODS

This was a cross-sectional study on 2572 persons (76% of a nationally representative sample of the Finnish population aged > or = 55 years). Mobility limitations were measured by self-reports and performance rates.

RESULTS

According to a wide array of self-reported and test-based indicators, persons with a lower level of education showed more mobility limitations than those with a higher level. The age-adjusted ORs for limitations in stair climbing were threefold in the lowest-educational category compared with the highest one (OR 3.3 in men and 2.9 in women for self-reported limitations, and 3.5 in men and 2.2 in women for test-based limitations). When obesity, smoking, work-related physical loading and clinically diagnosed chronic diseases were simultaneously accounted for, the educational differences in stair-climbing limitations vanished or were greatly diminished. In women, obesity contributed most to the differences, followed by a history of physically strenuous work, knee and hip osteoarthritis and cardiovascular diseases. In men, diabetes, work-related physical loading, musculoskeletal diseases, obesity and smoking contributed substantially to the inequalities.

CONCLUSIONS

Great educational inequalities exist in various measures of mobility. Common chronic diseases, obesity, smoking and workload appeared to be the main pathways from low education to mobility limitations. General health promotion using methods that also yield good results in the lowest-educational groups is thus a good strategy to reduce the disparities in mobility.

Health Trends in the Elderly Population: Getting Better and Getting Worse

Health trends in the fastest growing sector of the population, the oldest old, have received much attention during the past decade because of the rising costs of medical and long-term care. Many studies have suggested a compression of morbidity in this sector, implying that the future care needs of elderly people will not follow the demographic prognoses. Most of these studies have used health indicators based on disability, a concept that is contextually embedded. We have taken a closer look at health-trend surveys with a focus on the health indicator used. Our findings reveal that although disability measures often show improvement, there is a simultaneous increase in chronic disease and functional impairments-health components that require care resources. That is, an expansion of other health problems may accompany a compression of disability. Therefore, a concept of general morbidity is not sufficient when discussing health trends and the need for care services in the elderly population. Because different indicators do not show the same trends over time, we suggest a more refined discussion that distinguishes between different health components. In addition, different components have different implications for the amount and kind of care resources needed. If the current positive trends in disability continue, future need for social services and long-term care may not parallel demographic projections. Trends in disease and functional limitations seem to have taken a different direction, suggesting a parallel or increased need for resources in medical care, rehabilitation, and compensatory interventions such as assistive technology.

Nationwide decline in incidence of hip fracture

This epidemiologic study determined the trend in the number and incidence (per 100,000 persons) of hip fracture among older adults in Finland, an EU country with a well-defined white population of 5.2 million, between 1970 and 2004. The results show that the alarming rise in the fracture incidence from early 1970s until late 1990s has been now followed by declining fracture rates. Reasons for this are largely unknown, but a cohort effect toward a healthier aging population and increased average body weight and improved functional ability among elderly Finns could partly explain the phenomenon.

INTRODUCTION

Although osteoporotic fractures of older adults are said to be a major public health concern in modern societies with aging populations, fresh nationwide information on their secular trends is limited.

MATERIALS AND METHODS

This epidemiologic study determined the current trend in the number and incidence (per 100,000 persons) of hip fracture among older adults in Finland, an EU country with a well-defined white population of 5.2 million, by taking into account all persons >or= 50 years of age who were admitted to our hospitals for primary treatment of such fracture in 1970-2004.

RESULTS

The number of hip fractures among >or= 50-year-old Finns rose very constantly between 1970 (1857 fractures) and 1997 (7122 fractures), but since then, the rise has leveled off (7083 fractures in 2004). After this and because of a continuous rise in population at risk, the crude incidence of hip fracture (showing a clear rise in 1970-1997) decreased between 1997 and 2004, from 438 (per 100,000 persons) in 1997 to 374 in 2004. Concerning the age-adjusted fracture incidence, findings were similar. Until 1997, the age-adjusted incidence of hip fracture clearly increased in both women and men, but thereafter, this incidence declined in both sexes: in women, from 494 in 1997 to 412 in 2004, and in men, from 238 in 1997 to 223 in 2004.

CONCLUSIONS

The rise in the incidence of hip fracture in Finland from the early 1970s until the late 1990s has been followed by declining fracture rates. Exact reasons for this are unknown, but a cohort effect toward a healthier aging population and increased average body weight and improved functional ability among elderly Finns cannot be ruled out.

Trends and educational disparities in functional capacity among people aged 65-84 years

BACKGROUND

This study examined 10 year trends in functional capacity by gender, age, and education among elderly Finns aged 65-84 years, focusing on difficulties in basic activities of daily living (BADL). Educational disparities and their trends in the prevalence of these difficulties were also assessed.

METHODS

Data were derived from nationally representative monitoring surveys conducted biennially from 1993 to 2003 by the National Public Health Institute (KTL). A total of 5740 men and 5746 women were included in the study (response rate 80%). Activities of daily living (ADL) measures were used to assess levels of functional capacity. Education was divided into two groups: low (0-8 years) and high (9+ years). Age-adjusted trends and logistic regression analyses were computed.

RESULTS

A clear downward trend in BADL difficulties was observed in all age groups in both genders. 80-84 year olds had clearly poorer functional ability than 65-69 year olds, even when adjusted for chronic diseases. Despite the overall improvement in functional capacity in both educational groups, low educational status persistently predicted poorer functional capacity. When chronic diseases and survey period were controlled for, the educational disparities attenuated slightly but remained significant.

CONCLUSIONS

The number of Finnish elderly with BADL difficulties has declined markedly over the past 10 years. However, persistent educational disparities continue to present a challenge to public health initiatives for reducing inequalities in health.

Associations of functional ability with health-related behavior and body mass index among the elderly

The main purpose of this study was to determine whether functional ability among the elderly associates with body mass index (BMI) and health-related behavior. The secondary aim was to examine whether health behavior and BMI can be seen as mechanisms explaining sociodemographic disparities in functional ability. Cross-sectional biennial surveys from 1985 to 2001 were used to study 11,793 Finnish people aged 65-79 years. Associations of activities of daily living (ADL) with BMI, health behaviors (smoking, alcohol consumption, diet, physical activity), time period, previous occupation, marital status and certain diseases were tested using an ordinal regression model. Current and ex-smoking, heavy and non-alcohol use, unhealthy diet, physical inactivity and obesity were associated with inferior ADL. Alcohol consumption among men showed a U-shaped relation to functional ability. Most of the differences in ADL by occupation and marital status vanished after adjustment of multiple factors. The results showed clear associations of ADL with health-related behaviors and BMI when adjusted for multiple factors. The findings suggesting a U-shaped relation between ADL and alcohol consumption among men and the association between diet and ADL add to our previous knowledge of factors related to functional ability.

Smoking and alcohol consumption among the elderly: trends and associations, 1985-2001

BACKGROUND

Despite their clear association with health, smoking and alcohol consumption among elderly people have not been extensively researched. This study examined changes in smoking and alcohol consumption and their sociodemographic patterning among the Finnish population aged 65-79 years over the period 1985-2001.

METHODS

Population-based monitoring surveys conducted biennially from 1985 to 2001 were pooled into three time periods. Trends in smoking and alcohol consumption and their sociodemographic variations among 5870 men and 5923 women were calculated. Logistic regression was used as the main method of analysis.

RESULTS

Smoking declined slightly among men, and consumption of higher levels of alcohol rose in both genders from the mid-1980s to the early 2000s. Smoking among women remained at a very low level throughout the study period. Smoking and higher level of alcohol consumption were more prevalent among the younger elderly and among the men than among their counterparts. Higher alcohol use was more common among retired office workers than other former employees. Smoking was clearly more prevalent among unmarried than married people.

CONCLUSIONS

Declining numbers of male smokers and remarkably few female smokers, together with positive changes already noted in diet and functional ability, suggest healthier senior years ahead. On the other hand, the rising trend of alcohol use poses a challenge to future public health.