Active life expectancy among elderly Japanese

Epidemiologic Research on Healthy Life Expectancy and Proposal for Its Extension: A Revised English Version of Japanese in the Journal of the Japan Medical Association 2019;148(9):1781-4

Healthy life expectancy is an indicator that represents a composite of data on mortality and health status and is defined as the average number of years that a person can expect to live at a certain level of health. To extend people's healthy life expectancy, my colleague and I conducted a variety of epidemiologic research based upon community-based cohort studies and intervention trials. The findings from our prospective cohort studies included blood pressure reference values measured at home, green tea health benefit, Japanese dietary pattern, and feeling ikigai (a sense of life worth living) at daily life. Based upon these evidence, I have made some proposals toward extension of healthy life expectancy. In 2011, as the Chair of the Planning Committee for the Next National Health Promotion of Ministry of Health, Labor and Welfare (MHLW), I proposed that the Health Japan 21 (second term) should aim to extend healthy life expectancy to exceed the number of years extended in the total life expectancy, thus compressing the duration to be spent in an unhealthy state (compression of morbidity). In the interim evaluation of the Health Japan 21 (second term) in 2018, we were able to demonstrate that this goal is being achieved. Compared with 2010, in 2016, the increase in healthy life expectancy (1.72 years in men and 1.17 years in women) was higher than that of total life expectancy (1.43 years in men and 0.84 years in women). As a result, the duration to be spent in an unhealthy state was reduced by 0.29 years in men and by 0.33 years in women. It is important to note that Japan is the only country that has made progress in achieving compression of morbidity at the national level. We need to maintain this momentum of compressing morbidity.

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.

A Systematic Literature Review of Studies Analyzing Inequalities in Health Expectancy among the Older Population

Aim

To collect, organize and appraise evidence of socioeconomic and demographic inequalities in health and mortality among the older population using a summary measure of population health: Health Expectancy.

Methods

A systematic literature review was conducted. Literature published in English before November 2014 was searched via two possible sources: three electronic databases (Web of Science, Medline and Embase), and references in selected articles. The search was developed combining terms referring to outcome, exposure and participants, consisting in health expectancy, socioeconomic and demographic groups, and older population, respectively.

Results

Of 256 references identified, 90 met the inclusion criteria. Six references were added after searching reference lists of included articles. Thirty-three studies were focused only on gender-based inequalities; the remaining sixty-three considered gender along with other exposures. Findings were organized according to two leading perspectives: the type of inequalities considered and the health indicators chosen to measure health expectancy. Evidence of gender-based differentials and a socioeconomic gradient were found in all studies. A remarkable heterogeneity in the choice of health indicators used to compute health expectancy emerged as well as a non-uniform way of defining same health conditions.

Conclusions

Health expectancy is a useful and convenient measure to monitor and assess the quality of ageing and compare different groups and populations. This review showed a general agreement of results obtained in different studies with regard to the existence of inequalities associated with several factors, such as gender, education, behaviors, and race. However, the lack of a standardized definition of health expectancy limits its comparability across studies. The need of conceiving health expectancy as a comparable and repeatable measure was highlighted as fundamental to make it an informative instrument for policy makers.

Trends in life expectancy with care needs based on long-term care insurance data in Japan

Background

Using a previously developed method for calculating expected years of life with care needs based on data from the Japanese long-term care insurance system, we examined recent trends in expected years of life with care needs by age group and prefecture.

Methods

Information on care needs was available from the long-term care insurance system of Japan. Expected years of life with care needs by age group and prefecture in 2005–2009 were calculated.

Results

Expected years of life with care needs at age 65 increased from 1.43 years in 2005 to 1.62 years in 2009 for men, and from 2.99 to 3.44 years for women. As a proportion of total life expectancy, these values show an increase from 7.9% to 8.6% in men and from 12.9% to 14.4% in women. Expected years with care needs did not increase in the age groups of 65 to 69 and 70 to 74 years but markedly increased in the age group of 85 years or older. Expected years with care needs increased in every prefecture during the period studied. The difference in 2005 between the 25th and 75th percentiles in prefectural distributions was 0.16 years for men and 0.35 years for women. The difference remained nearly constant between 2005 and 2009.

Conclusions

Expected number of years of life with care needs increased among Japanese from 2005 to 2009, and there was a wide range in distribution among prefectures. Further studies on coverage of care needs under the long-term insurance program are necessary.

Trends in disability-free life expectancy in Japan, 1995-2004

BACKGROUND

In Japan, life expectancy at birth is currently the highest in the world. However, recent trends in disability-free life expectancy in Japan have not been examined.

METHODS

We used data from Japanese national surveys for the period 1995-2004. These surveys included information on activity status measured by common self-reported instruments. The numbers of expected years with and without activity limitation were estimated by using the Sullivan method.

RESULTS

The numbers of expected years of life without activity limitation, at birth, in 1995 and 2004 were 68.5 and 69.7, respectively, in males and 72.1 and 73.0 in females. As a proportion of total life expectancy, at birth, these values represent a decrease from 89.7% to 88.6% in males and from 87.1% to 85.3% in females. The proportion of expected years with a limitation of some activities except activities of daily living (ADL) increased in males and females. The proportion of those with an ADL limitation increased in females, but not in males.

CONCLUSIONS

The trends in expected years with and without activity limitation suggest that the duration of life with a light or moderate disability increased in Japanese males and females during the period 1995-2004.

Functional status and active life expectancy among senior citizens in a small town in Japan

The objectives of this study were to understand transition patterns and mechanisms of functional status, and to estimate active life expectancy (ALE) among senior citizens in a small town in Japan. With data drawn from surveys conducted annually from 1998 to 2002 (n=638 at baseline), prevalence and incidence of functional disability in activities of daily living (ADL) and instrumental activities of daily living (IADL) were described and compared between the sexes. Then relationships between potential predictors and functional decline through a 4-year follow-up were examined using logistic regression. Finally, active and disabled life expectancy was estimated by Katz's method. At baseline, 9 and 12% of subjects were dependent in performing ADL and IADL, respectively. Prevalence and incidence rates increased with age. The risk of mortality increased by 2.2-5.0-fold when the subject was functionally dependent at the previous year. Advanced age, difficulty in walking and poor interest were shown to be significant predictors of loss of independence in ADL. Mean durations with disability in ADL and IADL among women were longer than among men by around 1 year. Population-specific preventive care programs considering physical, cognitive and social aspects are needed not only to maximize ALE but also to improve quality of life during survival period with disability especially in old women.

Gender differences in life expectancy free of impairment at older ages

This article uses data from the United Kingdom Medical Research Council Cognitive Function and Ageing study (MRC CFAS) to analyze morbidity associated with three areas of impairment. We use cognitive status, functional status, and physical illness to examine differences in the proportion of time that older women and men will spend with co-morbidity. We also analyze differences among various impairments, and investigate the relationship between missing data and sex. Women have a larger burden of impairment than men, and, by including cognitive impairment together with functional impairment, a very large impairment burden is highlighted at all ages. Policy implications of the findings from the perspective of older women in the United Kingdom are discussed.

Health expectancies in Japan: gender differences and policy implications for women

Based on prospective observation of elderly people in the community in Japan, we compared the time-course of development and progression of physical disability between women and men. Men experienced disability at a younger age and at a faster rate than did women. The duration of time spent with disability in women was twice as long as in men. Consequently, women consume about two-thirds of the total resources of formal caregiving services in Japan. Women in Japan are increasingly educated, postponing marriage to higher ages, and less likely to care for parents in the home. Given these changes in family structure and social norms, the capacity for informal family caregiving has decreased dramatically. A recently enacted national long-term care insurance system may further change the picture of caregiving.

Functional transitions and active life expectancy for older Japanese living in a community

We examined functional transitions in both the activities of daily living (ADL), and instrumental activities of daily living (IADL), over a 1-year interval among older Japanese living in a community, then estimated their physically active life expectancy (PALE) and instrumentally active life expectancy (IALE). In 1992, all residents aged 65 or older who lived in Saku City, Nagano, Japan, were followed-up over the 1-year interval. A self-administrated questionnaire, which involved age, sex, five ADL items, and five IADL items, was used for each survey in both 1992 and 1993. Of the baseline cohort (n=10,098), we received 9533 analyzable questionnaires at the follow-up survey in 1993. During the follow-up, 92 and 87% of subjects who were initially independent in ADL and IADL remained independent, respectively. PALE for men and women were estimated to be 16.0 and 18.9 at 65 years of age, respectively. IALE for men and for women were estimated to be 12.8 and 14.6 at the age of 65, respectively. Proportions of the PALE to total life expectancy (TLE) at any age did not greatly differ between men and women; however, men had a slightly larger proportion of IALE to TLE at any given age than women.

Active life expectancy for people over 65 years old in a local city in the northern part of Tohoku district

Life expectancy does not necessarily match quality of life (QOL). A cohort study involving a population of 10,107 in a certain city of Japan was conducted to evaluate active life expectancy (ALE), which has a direct relationship with QOL. The ALE that took functional recovery rates into account was 17.20 and 19.08 years for males and females respectively, at the age of 65. These values increased by 2.98 and 3.87 years for men and women, respectively, compared with when functional recovery rates were not considered. ALE may serve as an indicator for the objective evaluation of various public health services provided by local governments.

Health-life expectancy according to various functional levels

OBJECTIVES

To estimate disability-free life expectancy according to three functional levels.

DESIGN

A 2-year prospective study of older residents in a rural Japanese community. The functional ability of each individual was determined with self-completed questionnaires at baseline (1994) and at follow-up (1996).

SETTING AND PARTICIPANTS

All residents of Wakuya Town, Japan, who were aged 65 years or older at the start of the study in 1994 (n = 3590).

MEASUREMENTS

Single-year increment-decrement life tables were constructed from mortality rates and incidence of disability rates. Independent life expectancies in three functional areas: basic activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility, were estimated for each sex and each year of age.

RESULTS

The incidence and prevalence of disability were similar in men and women. For both sexes, independent life in IADL was shorter than independent life in ADL and mobility. The development and progression of disability were different between sexes: men experienced disability at a younger age and at a faster rate than women.

CONCLUSIONS

The slow progress of disability, with a longer duration in a disabled state among women, induces a heavy burden on health and welfare resources. Interventions to delay the onset of disability in women should reduce the economic burden to society as well as improve the quality of life. Prospective studies to look at the process of disablement, based on direct observation, are needed to confirm the gender differences.