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Gimeno L, Goisis A, Dowd JB, Ploubidis GB. Cohort Differences in Physical Health and Disability in the United States and Europe. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae113. [PMID: 38898719 PMCID: PMC11272052 DOI: 10.1093/geronb/gbae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVES Declines in mortality have historically been associated with improvements in physical health across generations. While life expectancy in most high-income countries continues to increase, there is evidence that younger generations, particularly in the United States, are less healthy than previous generations at the same age. We compared generational trends in physical health in the United States, England, and continental Europe to explore whether other regions have experienced a similar pattern of worsening health across cohorts. METHODS Using data from nationally representative studies of adults aged ≥50 years from the United States (Health and Retirement Study, n = 26,939), England (English Longitudinal Study of Ageing, n = 14,992) and 11 continental European countries (Survey of Health, Ageing and Retirement in Europe, n = 72,595), we estimated differences in the age-adjusted prevalence of self-reported chronic disease and disability and observer-measured health indicators across pseudo-birth cohorts (born <1925, 1925-1935, 1936-1945, 1946-1954, 1955-1959). RESULTS Age-adjusted prevalence of doctor-diagnosed chronic disease increased across successive cohorts in all regions. Trends in disability prevalence were more regionally varied. Still, in both the United States and Europe, we observed a structural break in disability trends, with declines observed in prewar cohorts slowing, stalling, or reversing for cohorts born since 1945. DISCUSSION In all regions, we found evidence for worsening health across cohorts, particularly for those born since 1945. While more chronic disease in younger cohorts need not necessarily translate to worse quality of life or higher rates of functional limitation, there is some suggestion that worsening chronic disease morbidity may be spilling over into worsening disability.
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Affiliation(s)
- Laura Gimeno
- Centre for Longitudinal Studies, Social Research Institute, Institute of Education, University College London, London, UK
| | - Alice Goisis
- Centre for Longitudinal Studies, Social Research Institute, Institute of Education, University College London, London, UK
| | - Jennifer B Dowd
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, Nuffield College, University of Oxford, Oxford, UK
| | - George B Ploubidis
- Centre for Longitudinal Studies, Social Research Institute, Institute of Education, University College London, London, UK
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Costi S, Pellegrini M, Braglia L, Cavuto S, Fugazzaro S. Occupational therapy improves social participation of complex patients discharged from hospital: results of a powered randomized controlled trial. Disabil Rehabil 2024; 46:2223-2233. [PMID: 37259592 DOI: 10.1080/09638288.2023.2218653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/21/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE To verify the effectiveness of experimental occupational therapy plus intensive standard rehabilitation compared to intensive standard rehabilitation alone on the reintegration to social activities of complex patients three months after hospital discharge. MATERIALS AND METHODS Patients with a score ≥ 9 on the Rehabilitation Complexity Scale at admission to an intensive rehabilitation ward were randomized to the control or experimental group. Both groups received intensive multidisciplinary rehabilitation aimed at recovering independence in the basic activities of daily life (ADL). The experimental group also received experimental occupational therapy services to address goals identified through the administration of the Canadian Occupational Performance Measure (COPM). Experimental occupational therapy began during the in-hospital phase and continued in the home-based setting. It consisted of teaching strategies, recommending aids, and providing personalized information regarding available community support. RESULTS Ninety-two individuals with a mean age of 65 years (female 44.6%) were enrolled. The experimental group significantly improved participation measured by the Reintegration to Normal Living Index (mean changes 8.61, 95% CI: 1-16.23, p = 0.027). The performance and satisfaction scores of the COPM, both during hospitalization and after discharge, and independence in ADL also improved. No differences in mood disturbances were found. CONCLUSION Early post-discharge occupational therapy integrated with multidisciplinary rehabilitation improves the social participation of complex patients. Future research should investigate the concrete feasibility of implementing this complex intervention cost-effectively and in different contexts. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03668938 (first posted date 13/09/2018).
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Affiliation(s)
- Stefania Costi
- Physiotherapist, Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia and Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Martina Pellegrini
- Occupational Therapist, Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Braglia
- Biostatistician, Clinical Trials and Statistics Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvio Cavuto
- Statistician, Clinical Trials and Statistics Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Fugazzaro
- Medical Doctor, Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Clemente D, Romano L, Zamboni E, Carrus G, Panno A. Forest therapy using virtual reality in the older population: a systematic review. Front Psychol 2024; 14:1323758. [PMID: 38298360 PMCID: PMC10828037 DOI: 10.3389/fpsyg.2023.1323758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/04/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction As life expectancy increases, more attention needs to be paid to their mental and physical condition. Many older patients are also bedridden, which makes some treatments, like in vivo exposure to natural environments, more difficult to be applied. This study aimed to systematically review articles that include interventions combining virtual reality and forest environment, targeting a sample of older people. Methods Based on PRISMA guidelines, we conducted a literature search in three databases (EBSCO, PubMed, and Scopus), plus gray literature (OpenGrey). We considered only studies that used forest settings via virtual reality and included a sample with age ≥ 65. Results After the screening and eligibility stages, 7 articles have been included. Discussion The study underlines the need to implement research in this direction to standardize effective procedures that can be used to improve the mental and physical health of the older people and caregivers, while also reducing social costs.
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Affiliation(s)
- Davide Clemente
- Experimental and Applied Psychology Laboratory, Department of Human Sciences, European University of Rome, Rome, Italy
| | - Luciano Romano
- Experimental and Applied Psychology Laboratory, Department of Human Sciences, European University of Rome, Rome, Italy
| | - Elena Zamboni
- Experimental and Applied Psychology Laboratory, Department of Human Sciences, European University of Rome, Rome, Italy
| | - Giuseppe Carrus
- Department of Education Science, Roma Tre University, Rome, Lazio, Italy
| | - Angelo Panno
- Experimental and Applied Psychology Laboratory, Department of Human Sciences, European University of Rome, Rome, Italy
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Gimeno L, Goisis A, Dowd JB, Ploubidis GB. Generational differences in physical health and disability in the United States and Europe. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.16.24301347. [PMID: 38293226 PMCID: PMC10827238 DOI: 10.1101/2024.01.16.24301347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Objectives Declines in mortality have typically been associated with improvements in physical health across generations. While life expectancy in most high-income countries continues to increase, there is evidence that younger generations, particularly in the United States (US), are less healthy than previous generations at the same age. We compared generational trends in physical health in the US, England, and continental Europe to explore whether other regions have experienced a similar pattern of worsening health across cohorts. Methods Using data from nationally representative studies of adults aged ≥50 years from the US (Health and Retirement Study, n=26,939), England (English Longitudinal Study of Ageing, n=14,992) and 11 continental European countries (Survey of Health, Ageing and Retirement in Europe, n=72,595), we estimated differences in the age-adjusted prevalence of self-reported chronic disease and disability and observer-measured health indicators across pseudo-birth cohorts (born <1925, 1925-1935, 1936-1945, 1946-1954, 1955-1959). Results Age-adjusted prevalence of doctor-diagnosed chronic disease increased across cohorts in all regions. Trends in disability prevalence were more regionally varied. Still, in both the US and Europe, we observed a structural break in disability trends, with declines observed in pre-war cohorts slowing, stalling, or reversing for cohorts born since 1945. Discussion In all regions, we found evidence for worsening health across cohorts, particularly for those born since 1945. While more chronic disease in younger cohorts need not necessarily translate to worse quality of life or higher rates of functional limitation, there is some suggestion that worsening chronic disease morbidity may be spilling over into worsening disability.
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Affiliation(s)
- Laura Gimeno
- Centre for Longitudinal Studies, Social Research Institute, Institute of Education, University College London
| | - Alice Goisis
- Centre for Longitudinal Studies, Social Research Institute, Institute of Education, University College London
| | - Jennifer B. Dowd
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, Nuffield College, University of Oxford
| | - George B. Ploubidis
- Centre for Longitudinal Studies, Social Research Institute, Institute of Education, University College London
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Moon S, Oh E, Chung D, Hong GRS. Changes in instrumental activities daily living limitations and their associated factors according to gender in community-residing older adults: A longitudinal cohort study. PLoS One 2024; 19:e0296796. [PMID: 38206920 PMCID: PMC10783775 DOI: 10.1371/journal.pone.0296796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/19/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Increases in dependence among older adults cause increases in care needs and social care burden. Instrumental activities of daily living (IADL) are often used to assess the independence of older adults residing in communities. Various factors affect IADL limitations, but few studies confirm gender differences in IADL limitations in older adults. This study explored the changes in incidence of IADL limitations across 14 years and identified the factors associated with IADL limitations according to gender among older adults in Korea. METHOD This study uses secondary data analysis with 2006-2020 data from the Korean Longitudinal Study of Aging (KLoSA), a longitudinal cohort study. Among the total 10,254 participants, 1,230 adults aged 65 years and over who met the criteria were included in the final analysis. For each IADL item, a limitation was defined when the response was partial or complete dependence. Multivariate logistic regression was performed to identify the factors (in 2006) associated with IADL limitations in 2020. RESULTS The mean age of the participants at baseline was 69.64 years (SD 3.93), and 61.0% of participants were female. Total scores for IADL limitations increased gradually across 14 years in all participants, and observed changes were statistically significant. The top three ranked items of IADL limitations differed according to gender in 2020: the top limitations in men were preparing meals, laundry, and using public transportation, and the top limitations in women were using public transportation, going out, and handling money. Factors associated with total IADL limitations were grip strength in men and age, dementia, fear of fall, and grip strength in women. Factors associated with the top three ranked items of IADL limitations differed according to gender. CONCLUSION The incidence of IADL limitations gradually increased in all participants over a 14-year period. In older adults in Korea, gender differences were confirmed in the factors associated with IADL limitations, as well as in the main limited activities. To minimize IADL limitations in community-residing older adults, it is necessary to plan tailored interventions.
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Affiliation(s)
- SeolHwa Moon
- Department of Nursing, Hoseo University, Cheonan, Republic of Korea
| | - Eunmi Oh
- Research Institute of Nursing Science, Hanyang University, Seoul, Republic of Korea
| | - Daum Chung
- College of Nursing, Hanyang University, Seoul, Republic of Korea
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Wang Y. Can adult children's education prevent parental health decline in the short term and long term? Evidence from rural China. J Biosoc Sci 2024; 56:155-181. [PMID: 37309644 DOI: 10.1017/s0021932023000111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This paper presents the first evidence of the causal relationship between adult children's schooling and changes in parental health in the short and long term. By using supply-side variation in schooling as an instrument for adult children's education and a representative dataset for rural China, we find that adult children' education has a positive influence on the long-term changes in parental health, with limited evidence of any short-term effect. Our results remain consistent after a variety of sensitivity tests. The heterogeneous analyses show differences in socio-economic status and gender, with low-educated parents and mothers being the primary beneficiaries of children's schooling. Potential mechanisms for the long-term effects of adult children's education on changes in parental health include better chronic disease management, improved access to health, sanitation, and clean fuel facilities, improved psychological well-being, and reduced smoking behaviours.
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Affiliation(s)
- Yiru Wang
- Southwestern University of Finance and Economics, Chengdu, China
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van der Steen MP. Entrepreneurship in care for elderly people with dementias: situated responses to NPM-based healthcare reforms in the Netherlands. BMC Health Serv Res 2023; 23:1349. [PMID: 38049813 PMCID: PMC10694910 DOI: 10.1186/s12913-023-10351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Despite the great confidence of Western governments in the principles of New Public Management (NPM) and its ability to stimulate "healthcare entrepreneurship", it is unclear how policies seeking to reform healthcare services provoke such entrepreneurship in individual institutions providing long-term healthcare. This study examines such situated responses in a Dutch nursing home for elderly people suffering from dementias such as Alzheimer's disease. METHODS A four-year inductive longitudinal single-case study has been conducted. During this time period, the Dutch government imposed various NPM-based healthcare reforms and this study examines how local responses unfolded in the nursing home. Through interviews conducted with managers, administrators and supporting staff, as well as the examination of a large volume of government instructions and internal documents, the paper documents how these reforms resulted in several types of entrepreneurship, which were not all conducive to the healthcare innovations the government aspired to have. RESULTS The study records three subsequent strategies deployed at the local level: elimination of healthcare services; non-healthcare related collaboration with neighboring institutions; and specialization in specific healthcare niches. These strategies were brought about by specific types of entrepreneurship - two of which were oriented towards the administrative organization rather than healthcare innovations. The study discusses the implications of having multiple variations of entrepreneurship at the local level. CONCLUSION Governmental policies for healthcare reforms may be more effective, if policymakers change output-based funding systems in recognition of the limited control by providers of long-term healthcare over the progression of clients' mental disease and ultimate passing.
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Baâdoudi F, Picavet SHSJ, Hildrink HBM, Hendrikx R, Rijken M, de Bruin SR. Are older people worse off in 2040 regarding health and resources to deal with it? - Future developments in complex health problems and in the availability of resources to manage health problems in the Netherlands. Front Public Health 2023; 11:942526. [PMID: 37397729 PMCID: PMC10311544 DOI: 10.3389/fpubh.2023.942526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/09/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Developing sustainable health policy requires an understanding of the future demand for health and social care. We explored the characteristics of the 65+ population in the Netherlands in 2020 and 2040, focusing on two factors that determine care needs: (1) the occurrence of complex health problems and (2) the availability of resources to manage health and care (e.g., health literacy, social support). Methods Estimations of the occurrence of complex health problems and the availability of resources for 2020 were based on registry data and patient-reported data. Estimations for 2040 were based on (a) expected demographic developments, and (b) expert opinions using a two-stage Delphi study with 26 experts from policy making, practice and research in the field of health and social care. Results The proportion of people aged 65+ with complex health problems and limited resources is expected to increase from 10% in 2020 to 12% in 2040 based on demographic developments, and to 22% in 2040 based on expert opinions. There was high consensus (>80%) that the proportion with complex health problems would be greater in 2040, and lower consensus (50%) on an increase of the proportion of those with limited resources. Developments that are expected to drive the future changes refer to changes in multimorbidity and in psychosocial status (e.g., more loneliness). Conclusion The expected increased proportion of people aged 65+ with complex health problems and limited resources together with the expected health and social care workforce shortages represent large challenges for public health and social care policy.
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Affiliation(s)
- Fatiha Baâdoudi
- National Institute for Health and the Environment (RIVM), Bilthoven, Netherlands
| | | | - Henk B. M. Hildrink
- National Institute for Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Roy Hendrikx
- National Institute for Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Mieke Rijken
- Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands
| | - Simone R. de Bruin
- National Institute for Health and the Environment (RIVM), Bilthoven, Netherlands
- Department of Health and Wellbeing, Windesheim University of Applied Sciences, Zwolle, Netherlands
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Spijker JJA. Combining remaining life expectancy and time to death as a measure of old-age dependency related to health care needs. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2023; 23:173-187. [PMID: 35384565 PMCID: PMC8985398 DOI: 10.1007/s10754-022-09328-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 03/12/2022] [Indexed: 05/05/2023]
Abstract
Public concern about the rising number of older dependent citizens is still based mainly on standard population aging indicators. This includes the old-age dependency ratio (OADR), which divides the state pension age population by the working age population. However, the OADR counts neither the dependent elderly nor those who provide for them. This paper builds on previous research to propose several alternative indicators, including the health care (HC) need-adjusted real elderly dependency ratio and the HC need-adjusted dependent population-to-tax rate. These indicators consider improvements in old-age survival and time to death in order to better define the health care needs of the dependent old-age population and to better approximate their financial burden. We define the old-age population dependent on health care as those above the age at which remaining life expectancy is 15 years or less and are expected to die within 5 years. We use data from the US to illustrate differences between the proposed new and standard measures. Results show that, as a share of the total population, the old-age population dependent on health care has virtually not changed since 1950. Moreover, increases in GDP and state tax revenue have outstripped population aging almost continuously since 1970, irrespective of the indicator used, and they are expected to continue to do so during the coming decade. The demand for health care services is therefore not being fueled by population aging but instead by other factors such as progress in medical knowledge and technology, costs of hospitalization, and the increasing use of long-term care facilities.
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Affiliation(s)
- Jeroen J A Spijker
- Centre d'Estudis Demogràfics, Edifici E-2, Carrer de Ca n'Altayò, Campus UAB, 08193, Bellaterra, Spain.
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Jalali MT, Sarikhani Y, Askarian F, Marzaleh MA, Najibi SM, Delavari S. Factors facilitating and inhibiting the social participation of the elderly in health-oriented activities in Shiraz, Southern Iran. BMC Geriatr 2023; 23:175. [PMID: 36973677 PMCID: PMC10042408 DOI: 10.1186/s12877-023-03892-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND The social participation (SP) of the elderly is one of the factors that contribute to the improvement of their well-being. SP, one of the most important factors of active ageing, is mainly influenced by a number of facilitating or inhibiting factors. AIMS This study aimed to identify the factors that prevent and facilitate the SP of the elderly population in Iran. METHODS A cross-sectional study carried out in Shiraz, southern Iran in 2021. Participants were selected using a convenience sampling method. Shiraz is divided into 11 districts and the largest park in each district is selected for data gathering. The questionnaires were completed by 612 people aged over 60. Data were collected using the Canadian Elderly Survey Project scale and a health-related lifestyle questionnaire and were analyzed using t-test, ANOVA, Pearson's correlation, and ANCOVA. RESULTS The mean SP score of the elderly in Shiraz was 24.2 out of 60, which is below the midpoint. The results of the covariance analysis revealed that the SP had a significant relationship with the experience of physician consultation, cost barriers, age, marital status, income level, and education level (P < 0.001). Moreover, the results of Pearson correlation revealed a significant correlation between SP and different dimensions of health-oriented activities (< 0.001). CONCLUSIONS This study revealed that the main barriers to older people's participation in health-related activities are cost and access barriers, such as transportation issues. Moreover, higher income level and higher educational attainment have been recognized as the main facilitators of SP in the elderly. In this regard, it can be suggested to apply a combination of health promotion strategies, financial support programs, and development of optimal transportation infrastructure to increase the SP of the elderly.
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Affiliation(s)
- Marzie Tajik Jalali
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Yaser Sarikhani
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Fatemeh Askarian
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Milad Ahmadi Marzaleh
- Department of Health in Disasters and Emergencies, Health Human Resources Research Center, School of Health Management and Information sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyede Maryam Najibi
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Sajad Delavari
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Xue DM, Bai Q, Bian Y. How working-age population education and health of older people shape the burden of population aging: A comparative study of Macau, Hong Kong, and Singapore. Front Public Health 2022; 10:1031229. [PMID: 36408011 PMCID: PMC9669390 DOI: 10.3389/fpubh.2022.1031229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/06/2022] [Indexed: 11/05/2022] Open
Abstract
Macau, Hong Kong and Singapore are all facing increasing population aging. Those aged 65 and over make up the old-age population. The working-age population refers to the population aged 15 to 64. Conventionally, the burden of population aging is measured by the Old-Age Dependency Ratio, which is the ratio of the old-age population to the working-age population. As life expectancy rises, depending exclusively on age to calculate the burden of aging hinders the development of effective anti-aging strategies. The working-age population's education and the elderly's health affect the aging burden's support and generator, respectively. Including them in the calculation gives us a fuller view of the burden of aging. Objective To compare the population aging burden in Macau, Hong Kong, and Singapore by including working-age population education and elderly health. Methods The overall, working-age and old-age population and proportion, as well as the Old-Age Dependency Ratio of Macau, Hong Kong, and Singapore, were collected from the World Bank database. The life expectancy at 65 was extracted from the 2022 World Population Prospect. The tertiary education rate of the working-age population and the self-rated health status of the old-age population were retrieved from governments' statistical reports. We then calculated the Education-Health Adjusted Old-Age Dependency Ratio, a set of four equations showing the support of the working-age population on the old-age population, where OADRh_t and OADRuh_t represent the burden of healthy and unhealthy old-age population on the working-age population with tertiary education; similarly, OADRh_nt and OADRuh_nt indicate the burden placed on the working-age population without tertiary education by healthy and unhealthy old-age population. Lastly, for comparison with the conventional Old-Age Dependency Ratio, we generated the Weighted Education-Health Adjusted Old-Age Dependency Ratio. Results Hong Kong has the greatest old-age population proportion and Old-Age Dependency Ratio, yet its growth rates are moderate and stable, ranging from 0 to 4% and 0 to 6%, respectively. Macau and Singapore experienced sharper changes in old-age population proportion and the Old-Age Dependency Ratio, with Macau's Old-Age Dependency Ratio varying between -2.66 and 8.50% and Singapore's ranging from -1.53 to 9.70%. Three cities showed different patterns in four Education-Health Adjusted Old-Age Dependency Ratio indicators. In Macau, the OADRh_nt and OADRuh_nt increased by 0.4 and 6.2, while the OADRh_t and OADRuh_t decreased by 13.5 and 15.3 from 2004 to 2016. In Hong Kong, only the OADRuh_t fell by 9.4, and the other three increased from 2003 to 2015. In Singapore, the OADRh_nt and OADRh_t increased by 3.8 and 1.0, while OADRuh_nt and OADRuh_t decreased by 1.2 and 3.9 from 2007 to 2011. The Weighted Education-Health Adjusted Old-Age Dependency Ratios are all smaller than the conventional Old-Age Dependency Ratio in the three regions, particularly in Singapore. The Weighted Education-Health Adjusted Old-Age Dependency Ratio of Singapore was reduced by 9.5 to 30.5% compared with the conventional Old-Age Dependency Ratio, that of Hong Kong reduced by 6.2 to 22.5%, and that of Macau reduced by 4.4 to 16.1%. Conclusion This is the first study to compare the aging burden in Macau, Hong Kong, and Singapore in connection to working-age population education and elderly health. With the new assessment, the burden of population aging in three regions has been reduced, showing that improving the education of the working-age population and maintaining older people's wellbeing can assist authorities to deal with population aging, especially in Macau and Hong Kong.
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Affiliation(s)
- Dong-mei Xue
- Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China
- State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Taipa, Macau SAR, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macau SAR, China
| | - Qian Bai
- Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China
- State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Taipa, Macau SAR, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macau SAR, China
| | - Ying Bian
- Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China
- State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Taipa, Macau SAR, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macau SAR, China
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Grajek M, Gdańska A, Krupa-Kotara K, Głogowska-Ligus J, Kobza J. Global Self-Esteem, Physical Activity, and Body Composition Changes Following a 12-Week Dietary and Physical Activity Intervention in Older Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013220. [PMID: 36293799 PMCID: PMC9602821 DOI: 10.3390/ijerph192013220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 05/17/2023]
Abstract
UNLABELLED Older adults show lower physical activity. These changes altogether promote the development of overweight, obesity, and other chronic diseases. These factors substantially influence the quality of life and self-esteem of older adults. This phenomenon is especially visible after the lockdown caused by the COVID-19 pandemic. OBJECTIVES Our study aimed to evaluate the effect of a 12-week reductive diet and a 12-week physical activity plan for older adults on the global self-esteem of lifestyle in 60-70-year-old women. MATERIALS AND METHODS Our participants were 600 women with increased body mass (BMI > 25 kg/m2) aged 60-70 years. After the initial evaluation, the participants were randomly divided into three groups: CG-control group (n =200); DI-dietary group (n =200) that committed to a 12-week reductive diet; PA-physical activity group (n =200) that committed to a 12-week physical activity plan. The global self-esteem score (using the SES Rosenberg scale) and the anthropometric measurements were collected before and after the 12-week study. In the statistical analysis of data, the significance level was assumed to be 0.05. RESULTS The global self-esteem score for all groups before the study started was 30-31 points, which corresponded to average self-esteem. After a 12-week dietary or physical activity intervention, the score in the DI group was 33, which corresponded with high self-esteem. In the CG group, the self-esteem score remained unchanged (30 points). The average body mass loss was 0.5 kg/m2 for CG, 1.92 kg/m2 for DI, and 1.10 kg/m2 for the PA group. The average waist-hip ratio (WHR) change for CG, DI, and PA was 1 cm, 1 cm, and 2 cm, respectively. A decrease in body mass and body composition indicators (BMI and WHR) corresponded to participants' global self-esteem increase (p <0.05); the greater the decrease noted for BMI and WHR, the greater the global self-esteem score that was achieved. In the CG group, a negative correlation between global self-esteem and BMI value (p <0.05) was observed. CONCLUSIONS A 12-week reductive diet and a 12-week regular physical activity plan lowered participants' body mass. Adipose tissue content was reflected by decreased BMI and WHR indicators of participants from the DI and PA groups and was accompanied by higher global self-esteem scores.
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Affiliation(s)
- Mateusz Grajek
- Department of Public Health, Department of Public Health Policy, Faculty of Health Sciences in Bytom, Medical University of Silesia, 40-055 Katowice, Poland
| | - Agnieszka Gdańska
- Department of Public Health, Department of Public Health Policy, Faculty of Health Sciences in Bytom, Medical University of Silesia, 40-055 Katowice, Poland
| | - Karolina Krupa-Kotara
- Department of Epidemiology, Faculty of Health Sciences in Bytom, Medical University of Silesia, 40-055 Katowice, Poland
- Correspondence:
| | - Joanna Głogowska-Ligus
- Department of Epidemiology, Faculty of Health Sciences in Bytom, Medical University of Silesia, 40-055 Katowice, Poland
| | - Joanna Kobza
- Department of Public Health, Department of Public Health Policy, Faculty of Health Sciences in Bytom, Medical University of Silesia, 40-055 Katowice, Poland
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13
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Manero A, Crawford KE, Prock‐Gibbs H, Shah N, Gandhi D, Coathup MJ. Improving disease prevention, diagnosis, and treatment using novel bionic technologies. Bioeng Transl Med 2022; 8:e10359. [PMID: 36684104 PMCID: PMC9842045 DOI: 10.1002/btm2.10359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/09/2022] [Accepted: 05/30/2022] [Indexed: 01/25/2023] Open
Abstract
Increased human life expectancy, due in part to improvements in infant and childhood survival, more active lifestyles, in combination with higher patient expectations for better health outcomes, is leading to an extensive change in the number, type and manner in which health conditions are treated. Over the next decades as the global population rapidly progresses toward a super-aging society, meeting the long-term quality of care needs is forecast to present a major healthcare challenge. The goal is to ensure longer periods of good health, a sustained sense of well-being, with extended periods of activity, social engagement, and productivity. To accomplish these goals, multifunctionalized interfaces are an indispensable component of next generation medical technologies. The development of more sophisticated materials and devices as well as an improved understanding of human disease is forecast to revolutionize the diagnosis and treatment of conditions ranging from osteoarthritis to Alzheimer's disease and will impact disease prevention. This review examines emerging cutting-edge bionic materials, devices and technologies developed to advance disease prevention, and medical care and treatment in our elderly population including developments in smart bandages, cochlear implants, and the increasing role of artificial intelligence and nanorobotics in medicine.
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Affiliation(s)
- Albert Manero
- Limbitless SolutionsUniversity of Central FloridaOrlandoFloridaUSA,Biionix ClusterUniversity of Central FloridaOrlandoFloridaUSA
| | - Kaitlyn E. Crawford
- Biionix ClusterUniversity of Central FloridaOrlandoFloridaUSA,Department of Materials Science and EngineeringUniversity of Central FloridaOrlandoFloridaUSA
| | | | - Neel Shah
- College of MedicineUniversity of Central FloridaOrlandoFloridaUSA
| | - Deep Gandhi
- College of MedicineUniversity of Central FloridaOrlandoFloridaUSA
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14
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Tynkkynen LK, Pulkki J, Tervonen-Gonçalves L, Schön P, Burström B, Keskimäki I. Health system reforms and the needs of the ageing population—an analysis of recent policy paths and reform trends in Finland and Sweden. Eur J Ageing 2022; 19:221-232. [PMID: 35465210 PMCID: PMC9012246 DOI: 10.1007/s10433-022-00699-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 01/08/2023] Open
Abstract
AbstractPopulation ageing with an increasing number of people experiencing complex health and social care needs challenges health systems. We explore whether and how health system reforms and policy measures adopted during the past two decades in Finland and Sweden reflect and address the needs of the older people. We discuss health system characteristics that are important to meet the care needs of older people and analyse how health policy agendas have highlighted these aspects in Finland and Sweden. The analysis is based on “most similar cases”. The two countries have rather similar health systems and are facing similar challenges. However, the policy paths to address these challenges are different. The Swedish health system is better resourced, and the affordability of care better ensured, but choice and market-oriented competition reforms do not address the needs of the people with complex health and social care needs, rather it has led to increased fragmentation. In Finland, the level of public funding is lower which may have negative impacts on people who need multiple services. However, in terms of integration and care coordination, Finland seems to follow a path which may pave the way for improved coordination of care for people with multiple care needs. Intensified monitoring and analysis of patterns of health care utilization among older people are warranted in both countries to ensure that care is provided equitably.
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Affiliation(s)
| | - Jutta Pulkki
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | | | - Pär Schön
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Bo Burström
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden
| | - Ilmo Keskimäki
- Finnish Institute for Health and Welfare, Helsinki, Finland
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15
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Lee JE, Kim D, Kahana E, Kahana B. Feasibility and acceptability of the community-based program: Plan Ahead. Aging Ment Health 2022; 27:811-819. [PMID: 35285774 DOI: 10.1080/13607863.2022.2046692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES In this article, we assess the feasibility and acceptability and the effect of the Plan Ahead for community dwelling older adults. In addition, we investigated the effects of the program. In addition, we aimed to examine whether the completion of the specific Future Care Planning depended on the participants' competence level. METHODS In this single group feasibility study, trained facilitators delivered the program to a sample of 234 community-residing older adults. Participants completed both pre, post assessments about the acceptability of the program and their completion of the recommended future care planning activities. RESULTS Based on participant's report on the usefulness and satisfaction of the program after the completion of the program, we found that participants reported high levels of acceptance of the program. Participation rates also confirmed the feasibility of the program. In terms of effects of program implementation, statistically significant changes were noted for several outcomes, such as resource building and FCP activities. In particular, we found that these gains were particularly robust for participants in the low competence group. CONCLUSION Pilot program results suggest the feasibility of a short community program enhancing proactive planning for future care needs among older adults residing in their community.
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Affiliation(s)
- Jeong Eun Lee
- Human Development and Family Studies, Iowa State University, Ames, IA, USA
| | - Dahee Kim
- Human Development and Family Studies, Iowa State University, Ames, IA, USA
| | - Eva Kahana
- Department of Sociology, Case Western Reserve University, Cleveland, OH, USA
| | - Boaz Kahana
- Department of Psychology, Cleveland State University, Cleveland, OH, USA
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16
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Long L, Liu W, Ruan P, Yang X, Chen X, Li L, Yuan F, He D, Huang P, Gong A, Wang K. Visualizing the Interplay of Lipid Droplets and Protein Aggregates During Aging via a Dual-Functional Fluorescent Probe. Anal Chem 2022; 94:2803-2811. [PMID: 35104110 DOI: 10.1021/acs.analchem.1c04278] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Fluorescence imaging the interplay between lipid droplets (LDs) and protein aggregates (PAs) is extremely valuable for elucidating molecular mechanisms of aging. Here, we describe the first dual-functional fluorescent probe, LW-1, for simultaneously imaging LDs and PAs in distinct fluorescence channels to dissect interplaying roles between LDs and PAs during aging. Notably, based on an intriguing mechanism of hydrogen bonds regulating single bond rotation, LW-1 selectively detected LDs in a red channel. Meanwhile, based on another mechanism of the hydrogen bond regulating intramolecular charge transfer efficiency, probe LW-1 further detected PAs in an NIR channel. Practical applications showed that LW-1 was capable of concurrently detecting LDs and PAs in living cells. Moreover, simultaneously imaging LDs and PAs in intestine tissues of mice at different aging degrees was conducted. The results denoted that the PAs level in the intestine tissue increased dramatically with aging, accompanying the buildup of LDs. Significantly, the interplay between LDs and PAs during aging was observed. These evidences demonstrated that the PAs level was closely related with aging processes in intestine tissues, while LDs were formed correspondingly to interact with PAs, suggesting that excessive PAs can be loaded into LDs and then be removed by lipophagy.
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Affiliation(s)
- Lingliang Long
- School of Chemistry and Chemical Engineering, Key Laboratory of Modern Agriculture Equipment and Technology, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P. R. China.,Guangxi Key Laboratory of Electrochemical Energy Materials, Nanning, Guangxi 530004, P. R. China
| | - Weiguo Liu
- School of Chemistry and Chemical Engineering, Key Laboratory of Modern Agriculture Equipment and Technology, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P. R. China
| | - Peng Ruan
- School of Chemistry and Chemical Engineering, Key Laboratory of Modern Agriculture Equipment and Technology, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P. R. China
| | - Xinrong Yang
- School of Chemistry and Chemical Engineering, Key Laboratory of Modern Agriculture Equipment and Technology, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P. R. China
| | - Xiaodong Chen
- School of Chemistry and Chemical Engineering, Key Laboratory of Modern Agriculture Equipment and Technology, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P. R. China
| | - LuLu Li
- School of Chemistry and Chemical Engineering, Key Laboratory of Modern Agriculture Equipment and Technology, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P. R. China
| | - Fang Yuan
- School of Chemistry and Chemical Engineering, Key Laboratory of Modern Agriculture Equipment and Technology, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P. R. China
| | - Dan He
- School of Chemistry and Chemical Engineering, Key Laboratory of Modern Agriculture Equipment and Technology, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P. R. China
| | - Pan Huang
- School of Chemistry and Chemical Engineering, Key Laboratory of Modern Agriculture Equipment and Technology, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P. R. China
| | - Aihua Gong
- School of Chemistry and Chemical Engineering, Key Laboratory of Modern Agriculture Equipment and Technology, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P. R. China
| | - Kun Wang
- School of Chemistry and Chemical Engineering, Key Laboratory of Modern Agriculture Equipment and Technology, School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212013, P. R. China
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17
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Solé-Auró A, Deeg DJH. New thinking about health expectancy: introduction to the special section. Eur J Ageing 2021; 18:439-441. [PMID: 34790083 PMCID: PMC8563872 DOI: 10.1007/s10433-021-00630-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Aïda Solé-Auró
- DemoSoc Research Group, Department of Political and Social Sciences, Universitat Pompeu Fabra, C/Ramon Trias Fargas, 25-27, 08005 Barcelona, Spain
| | - Dorly J. H. Deeg
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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18
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Kim JH, Kim S, Hong YC. Household insecticide use and urinary 3-phenoxybenzoic acid levels in an elder population: a repeated measures data. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2021; 31:1017-1031. [PMID: 33024227 PMCID: PMC8589668 DOI: 10.1038/s41370-020-00276-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 09/13/2020] [Accepted: 09/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Pyrethroids are associated with adverse health consequences, even at low-dose exposures. However, there is limited evidence on pyrethroids exposure levels among vulnerable elder population and on their exposure sources. OBJECTIVE We tried to determine pyrethroids exposure levels among Korean elders and their exposure sources. METHODS We measured levels of 3-phenoxybenzoic acid (3-PBA), a pyrethroids metabolite, in urines repeatedly collected from 1239 Korean rural and urban elders; we also explored exposure sources for pyrethroids using questionnaire data. RESULTS Our participants had high levels of 3-PBA with 446 (36.0%) of elders with 3-PBA level over 2 ng/mL of 95th percentile of the German representative populations. After adjustment for sex, age, smoking status, visit episode, and surveyed season using linear mixed effect models, household insecticide spray use was significantly associated with 3-PBA level (β = 0.03 and p = 0.02) and the association was apparent only for females (β = 0.03 and p = 0.03). In the analyses for nonlinear relationships using generalized additive mixed models, there was a J-shape change in 3-PBA level by insecticide spray use (p < 0.01 both in total population and in females). SIGNIFICANCE Household insecticide spray was a predominant exposure source for pyrethroids at community level among Korean elders, warning more stringent control for frequently exposed environmental factors for pyrethroids including insecticide spray.
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Affiliation(s)
- Jin Hee Kim
- Department of Integrative Bioscience and Biotechnology, Sejong University, Seoul, 05006, Republic of Korea.
| | - Sungroul Kim
- Department of Environmental Health Sciences, Soonchunhyang University, Asan, 336-745, Republic of Korea
| | - Yun-Chul Hong
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, 110-799, Republic of Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, 110-799, Republic of Korea
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19
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Lindberg T, Sandström B, Andersson EK, Borg C, Hjelm M, Nilsson L, Olsson A, Skär L. Older persons’ experience of eHealth services in home health care: A meta-ethnography eHealth services in home health care. Health Informatics J 2021; 27:14604582211059370. [DOI: 10.1177/14604582211059370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to describe older persons’ experiences of eHealth services in home health care. A meta-ethnographic approach was applied, and a systematic literature search was conducted in three databases. In total, 11 articles were included and analysed, which resulted in two themes and six sub-themes. The results show that for older persons to use the eHealth services, they must provide some additional value compared to current contacts with healthcare professionals. Those with regular healthcare contact do not experience the eHealth service as adding anything to the care they already receive. The introduction of eHealth services involves learning how to use the new technology, and some older persons experience the technology as motivating and inspiring. The eHealth service makes some feel safer while some do not trust the technology. In order to make the best use of eHealth services, it is important that the services are adjusted not only to each person’s needs but also to their personal capabilities and resources, while the older person must feel valued as an active partner in the care process. Thus, when using eHealth services, the older person’s perspective needs to be given priority and decisions should not only be based on organizational considerations.
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Affiliation(s)
| | | | | | | | - Markus Hjelm
- Blekinge Institute of Technology, Karlskrona Sweden
| | - Lina Nilsson
- Blekinge Institute of Technology, Karlskrona Sweden
| | - Anki Olsson
- Blekinge Institute of Technology, Karlskrona Sweden
| | - Lisa Skär
- Blekinge Institute of Technology, Karlskrona Sweden
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20
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Jackson H, Young NAE, Taylor D. Beyond question wording: How survey design and administration shape estimates of disability. Disabil Health J 2021; 14:101115. [PMID: 34154971 PMCID: PMC10237032 DOI: 10.1016/j.dhjo.2021.101115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Between 2008 and 2014, annual estimates of disability prevalence among U.S. adults varied somewhat across federal surveys that use a standardized measure of disability, but trends over-time were relatively stable and consistent. In 2014, however, estimates of disability from the Survey of Income and Program Participation (SIPP) increased markedly relative to previous years and were much higher than disability estimates from other federal surveys. OBJECTIVE To examine why disability prevalence among adults aged 40 and older substantially increased in the first wave of the 2014 SIPP Panel. METHODS We consider three factors that may have contributed to the rise in disability: data processing, context effects linked to question order, and sampling. To do so, we compare estimates with and without survey weights and imputed data, analyze supplemental disability-related data collected among SIPP participants, and employ decomposition analysis to assess what proportion of the increase in disability can be attributed to changes in sample composition. RESULTS We find evidence that differences in sample composition contributed to the observed rise in disability prevalence in SIPP between 2011 and 2014. There is less evidence that weighting and imputation or context effects played a role. CONCLUSIONS Previous studies emphasize differences in operationalization and conceptualization of disability as the major factor driving discrepancies in disability estimates. This study suggests that other factors related to survey design and administration may influence disability measurement. Such aspects of surveys, like question order and sampling, may be difficult to standardize, leading to meaningful cross-survey differences in disability estimates.
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Affiliation(s)
- Heide Jackson
- Social, Economic, And Housing Statistics Division, U.S. Census Bureau, 4600 Silver Hill Rd., Suitland, MD 20746, USA
| | - Natalie A E Young
- Social, Economic, And Housing Statistics Division, U.S. Census Bureau, 4600 Silver Hill Rd., Suitland, MD 20746, USA.
| | - Danielle Taylor
- Social, Economic, And Housing Statistics Division, U.S. Census Bureau, 4600 Silver Hill Rd., Suitland, MD 20746, USA
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21
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Arnadottir SA, Jonsson BG. Outpatient physical therapy population has been aging faster than the general population: a total population register-based study. BMC Health Serv Res 2021; 21:708. [PMID: 34275439 PMCID: PMC8286556 DOI: 10.1186/s12913-021-06738-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/05/2021] [Indexed: 11/26/2022] Open
Abstract
Background The Icelandic population is aging like other populations in the world, the life expectancy is high, and the national focus is to help people to age in their own homes. The objectives of this research was to describe 17 years of demographic changes among outpatient physical therapy (OPT) clients and to determine if these changes reflect aging in the total population. Methods Data was obtained from a national registry with information on all OPT clients reimbursed by Icelandic Health Insurance from 1999 to 2015, and general population data from the Statistics Iceland registry covering the same 17 years. Simple counts, proportions, Rate Ratios (RR) and 95 % Confidence Intervals (CI) were used to describe and compare the two time-points (1999 and 2015) in both populations, and regression analyses were used to estimate linear changes for each of these 17 years. Results Comparing the endpoints of the 17-year period, the proportion of older adults within the total OPT clientele increased by 23 % (from 18.3 % to 1999 to 23.5 % in 2015; RR 1.23; 95 %CI 1.19–1.27).) while in the general Icelandic population, the proportion of older adults increased by 15 % (from 11.6 % to 1999 to 13.5 % in 2015; RR 1.15; 95 % CI 1.1–1.21). For each of these 17 years, there was an overall 5 % yearly increase in the rate of older adults from the general older Icelandic population who used an OPT (accounting for population aging), and an overall 3.5 % yearly increase in the proportional contribution of older adults to the total OPT clientele. Adjusting for sex and older age group revealed that this increase in rate and proportion was most pronounced among ≥ 85-year-old men. Conclusions This case of Iceland is an example of how health-related and population-based registers may potentially be used to routinely inform and facilitate optimal planning of future health care services for older adults.
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Affiliation(s)
- Solveig A Arnadottir
- Department of Physical Therapy, Faculty of Medicine, School of Health Sciences, University of Iceland, Stapi v/Hringbraut, 102, Reykjavik, Iceland.
| | - Brynjolfur Gauti Jonsson
- Statistical Consulting Center, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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22
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Hoogendijk EO, Stolz E, Oude Voshaar RC, Deeg DJH, Huisman M, Jeuring HW. Trends in Frailty and Its Association With Mortality: Results From the Longitudinal Aging Study Amsterdam, 1995-2016. Am J Epidemiol 2021; 190:1316-1323. [PMID: 33534876 PMCID: PMC8245891 DOI: 10.1093/aje/kwab018] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to investigate trends in frailty and its relationship with mortality among older adults aged 64–84 years across a period of 21 years. We used data from 1995 to 2016 from the Longitudinal Aging Study Amsterdam. A total of 7,742 observations of 2,874 respondents in the same age range (64–84 years) across 6 measurement waves were included. Frailty was measured with a 32-item frailty index, with a cutpoint of ≥0.25 to indicate frailty. The outcome measure was 4-year mortality. Generalized estimating equation analyses showed that among older adults aged 64–84 years the 4-year mortality rate declined between 1995 and 2016, while the prevalence of frailty increased. Across all measurement waves, frailty was associated with 4-year mortality (odds ratio = 2.79, 95% confidence interval: 2.39, 3.26). There was no statistically significant interaction effect between frailty and time on 4-year mortality, indicating a stable association between frailty and mortality. In more recent generations of older adults, frailty prevalence rates were higher, while excess mortality rates of frailty remained the same. This is important information for health policy-makers and clinical practitioners, showing that continued efforts are needed to reduce frailty and its negative health consequences.
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Affiliation(s)
- Emiel O Hoogendijk
- Correspondence to Dr. Emiel O. Hoogendijk, Department of Epidemiology & Data Science, Amsterdam UMC, VU University Medical Center, P.O. Box 7057, 1007MB Amsterdam, the Netherlands (e-mail: )
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23
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Storeng SH, Øverland S, Skirbekk V, Hopstock LA, Sund ER, Krokstad S, Strand BH. Trends in Disability-Free Life Expectancy (DFLE) from 1995 to 2017 in the older Norwegian population by sex and education: The HUNT Study. Scand J Public Health 2021; 50:542-551. [PMID: 33908292 DOI: 10.1177/14034948211011796] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM Understanding whether increasing Life Expectancy (LE) translates to improved health and function among older adults is essential, but results are inconclusive. We aimed to estimate trends in Disability-Free Life Expectancy (DFLE) in the older Norwegian population by sex and education from 1995 to 2017. METHOD National life table data were combined with cross-sectional data on functional ability for 70+ year-olds from the population-based Trøndelag Health Surveys 2-4 (1995-1997, 2006-2008 and 2017-2019) (n=24,733). Self-reported functional ability was assessed on a graded scale by a combination of Instrumental Activities of Daily Living (IADL) such as paying bills, going out or shopping (mild disability) and Personal Activities of Daily Living (PADL) such as washing, dressing or eating (severe disability). LE, DFLE, Mild-Disability LE and Severe-Disability LE at age 70 were estimated by the Sullivan method. RESULTS From 1995 to 2017 DFLE at age 70 increased from 8.4 to 13.0 years in women, and from 8.0 to 12.1 years in men. DFLE increased in the basic and high educational groups, but more so in the high educational group among men. Educational inequalities in years spent with disability however, remained low. CONCLUSIONS From the mid-1990s and over the past three decades both LE and DFLE at 70 years increased in the older Norwegian population, for both men and women, and across basic and high educational levels. Educational inequalities in DFLE increased, especially in men, but years spent with disability were similar across the three decades.
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Affiliation(s)
- Siri H Storeng
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Norway
| | - Simon Øverland
- Center for Disease Burden, Norwegian Institute of Public Health, Norway.,Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway
| | - Vegard Skirbekk
- Centre for Fertility and Health, Norwegian Institute of Public Health, Norway.,Columbia Aging Center, Mailman School of Public Health, Columbia University, US.,Department of Psychology, University of Oslo, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Norway
| | - Laila Arnesdatter Hopstock
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Norway
| | - Erik R Sund
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Norway.,Faculty of Nursing and Health Sciences, Nord University, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Norway
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Norway
| | - Bjørn H Strand
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway
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Öhman HR, Karppinen H, Lehti TE, Knuutila MT, Tilvis R, Strandberg T, Kautiainen H, Pitkala KH. Secular trends in functional abilities, health and psychological well-being among community-dwelling 75- to 95-year-old cohorts over three decades in Helsinki, Finland. Scand J Public Health 2021; 50:524-531. [PMID: 33899588 PMCID: PMC9152590 DOI: 10.1177/14034948211007688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Life expectancy has increased markedly in the past
decades. Thus, it is of great importance to understand how people are ageing and
if the trajectories of health and disability are changing over time. This study
aimed to examine trends in functional abilities and health in independent
cohorts of people aged 75–95 over three decades. Methods: This
Helsinki Ageing Study consists of repeated cross-sectional postal surveys
examining independent cohorts of old people (75, 80, 85 and 90+ years old). This
study combined data from four waves (1989, 1999, 2009 and 2019).
Results: In the most recent wave, there was an increase in
the portion of participants who were able to walk outdoors easily (75-year-olds
p=0.03, 80-year-olds p=0.002, 85-year-olds
p<0.001; p for linearity for the study
year effect, all adjusted for sex). Fewer people in the youngest age group
(75-year-olds) needed daily help from another person in 2019 compared to the
earlier waves (p=0.02 for linearity for the study year). Over
the past three decades, the proportions of self-reported good mobility have
risen 8.7% (95% confidence interval (CI) 2.3–15.1) in 75-year-olds, 11.7% (95%
CI 3.9–19.6) in 80-year-olds and 20.1% (95% CI 10.7–29.4) in 85-year-olds, after
adjusting for sex. Furthermore, in 2019, more people rated their health as good
and scored better in psychological well-being than in the previous waves among
75-, 80- and 85-year-olds. However, no improvements were found among
90+-year-olds in any of these variables. Conclusions: People between 75
and 85 years old are presently feeling and functioning better than their
predecessors. This may be an important objective for both economics and
health policy.
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Affiliation(s)
- Hanna R Öhman
- Geriatric Medicine, University of Helsinki and Helsinki University Hospital, Finland
| | - Helena Karppinen
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
| | - Tuuli E Lehti
- Department of General Practice and Primary Health Care, University of Helsinki, Finland.,Social Services and Health Care, City of Helsinki, Finland
| | - Mia T Knuutila
- Department of General Practice and Primary Health Care, University of Helsinki, Finland.,Social Services and Health Care, City of Helsinki, Finland
| | - Reijo Tilvis
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
| | - Timo Strandberg
- Geriatric Medicine, University of Helsinki and Helsinki University Hospital, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
| | - Kaisu H Pitkala
- Department of General Practice and Primary Health Care, University of Helsinki, Finland
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Schouten B, Merten H, Spreeuwenberg PMM, Nanayakkara PWB, Wagner C. The Incidence and Preventability of Adverse Events in Older Acutely Admitted Patients: A Longitudinal Study With 4292 Patient Records. J Patient Saf 2021; 17:166-173. [PMID: 33734205 DOI: 10.1097/pts.0000000000000727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Acute care crowding is a global issue, jeopardizing patient safety. An important cause of crowding is the growing number of older, vulnerable, and complex patients. This group is at higher risk of experiencing (preventable) adverse events (AEs) than younger patients.This study aimed to identify the incidence, preventability, nature, and prevention strategies of AEs in older patients during an acute hospital admission and to assess changes over time. METHODS We analyzed data of 4292 acutely admitted patients (70+) who died in the hospital, using data of a multicenter Dutch AE record review study (2008, 2012, 2016). Multilevel logistic regression analyses were performed to adjust for patient-mix differences and clustering on department/hospital level per year. RESULTS The incidence of AEs in this group declined significantly (χ2(1) = 8.78, P = 0.003) from 10.7% (95% confidence interval [CI] =8.2-13.9) in 2008, 7.4% (95% CI = 5.6-9.7) in 2012, to 7.2% (95% CI = 5.5-9.3) in 2016. The relative preventability showed a significant parabolic trend (χ2(1) = 4.86, P = 0.027), from 46.2% (95% CI = 34.1-58.7), to 32.4% (95% CI = 21.1-46.1), to 44.6% (95% CI = 32-58). Adverse events were often related to medication (26.3% in 2008, 35.1% in 2012, and 39.5% in 2016), and the preventability in AEs related to diagnosis was highest (88.3%, 70.8%, and 79.9%). CONCLUSIONS The incidence of AEs in older acutely admitted patients declined over the years; however, the preventability increased again after an initial decline. This could be related to crowding or increasing complexity in the acute care chain. Further monitoring and improvement in (preventable) AE rates are necessary to pinpoint areas of improvement to make hospital care for this vulnerable group safer.
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Affiliation(s)
- Bo Schouten
- From the Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam
| | - Hanneke Merten
- From the Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam
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26
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Sperlich S, Klar MK, Safieddine B, Tetzlaff F, Tetzlaff J, Geyer S. Life stage-specific trends in educational inequalities in health-related quality of life and self-rated health between 2002 and 2016 in Germany: findings from the German Socio-Economic Panel Study (GSOEP). BMJ Open 2021; 11:e042017. [PMID: 33664070 PMCID: PMC7934728 DOI: 10.1136/bmjopen-2020-042017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/30/2020] [Accepted: 01/21/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES While evidence suggests persisting health inequalities, research on whether these trends may vary according to different stages of life has rarely been considered. Against this backdrop, we analysed life stage-specific trends in educational inequalities in health-related quality of life (HRQOL) and poor self-rated health (SRH) for individuals in 'later working life' (50-64 years), 'young seniors' (65-79 years) and persons of 'old age' (80+ years). METHODS We used survey data from the German Socio-Economic Panel Study comprising the period from 2002 to 2016. The sample consists of 26 074 respondents (160 888 person-years) aged 50 years and older. Health was assessed using the mental and physical component summary scale (MCS/PCS) of the HRQOL questionnaire (12-Item Short Form Health Survey V.2) and the single item SRH. To estimate educational health inequalities, we calculated the regression-based Slope Index of Inequality (SII) and Relative Index of Inequality (RII). Time trends in inequalities were assessed by the inclusion of a two-way interaction term between school education and time. RESULTS With increasing age, educational inequalities in PCS and poor SRH decreased whereas they rose in MCS. Over time, health inequalities decreased in men aged 65-79 years (MCSSII=2.76, 95% CI 0.41 to 5.11; MCSRII=1.05, 95% CI 1.01 to 1.10; PCSSII=2.12, 95% CI -0.27to 4.51; PCSRII=1.05, 95% CI 1.00 to 1.11; poor SRHSII=-0.10, 95% CI -0.19 to 0.01; poor SRHRII=0.73, 95% CI 0.48 to 1.13) and among women of that age for MCS (MCSSII=2.82, 95% CI 0.16 to 5.50; MCSRII=1.06, 95% CI 1.01 to 1.12). In contrast, health inequalities widened in the 'later working life' among women (PCSSII=-2.98, 95% CI -4.86 to -1.11; PCSRII=0.94, 95% CI 0.90 to 0.98; poor SRHSII=0.07, 95% CI 0.00 to 0.14) while remained largely stable at old age for both genders. CONCLUSIONS We found distinctive patterns of health inequality trends depending on gender and life stage. Our findings suggest to adopt a differentiated view on health inequality trends and to pursue research that explores their underlying determinants.
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Affiliation(s)
| | | | | | - Fabian Tetzlaff
- Medical Sociology, Hannover Medical School, Hannover, Germany
| | | | - Siegfried Geyer
- Medical Sociology, Hannover Medical School, Hannover, Germany
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27
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Gondek D, Ploubidis GB, Hossin MZ, Gao M, Bann D, Koupil I. Inequality in hospitalization due to non-communicable diseases in Sweden: Age-cohort analysis of the Uppsala Birth Cohort Multigenerational Study. SSM Popul Health 2021; 13:100741. [PMID: 33537404 PMCID: PMC7841359 DOI: 10.1016/j.ssmph.2021.100741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 08/24/2020] [Accepted: 01/18/2021] [Indexed: 11/30/2022] Open
Abstract
We aimed to investigate cohort differences in age trajectories of hospitalization due to non-communicable conditions, and if these varied by paternal socioeconomic position. We used the Uppsala Birth Cohort Multigenerational Study—including virtually complete information on medical diagnoses. Our sample constituted 28,448 individuals (103,262 observations). The outcome was five-year prevalence of hospitalization due to major non-communicable conditions in 1989–2008. The exposures were age (19–91), year-of-birth (1915–1929; 1938–1972), gender (man vs woman), and parental socioeconomic position (low, medium, and high). We used multilevel logit models to examine associations between exposures and the hospitalization outcome. Younger cohorts had a higher prevalence of hospitalization at overlapping ages than those born earlier, with inter-cohort differences emerging from early-adulthood and increasing with age. For instance, at age 40 predicted probability of hospitalization increased across birth-cohorts—from 1.2% (born in 1948-52) to 2.0% (born in 1963-67)—whereas at age 50 it was 2.9% for those born in 1938-42 compared with 4.6% among participants born in 1953-57. Those with medium and low socioeconomic position had 13.0% and 20.0% higher odds of experiencing hospitalization during the observation period, respectively—when age, year-of-birth and gender were accounted for. We found that no progress was made in reducing the socioeconomic inequalities in hospitalization across cohorts born between 1915 and 1972. Hence, more effective policies and interventions are needed to reduce the overall burden of morbidity—particularly among the most vulnerable. What is already known on this subject? The evidence on trends in morbidity in Sweden is mainly cross-sectional and focused on individual conditions. Rates of various indicators of morbidity (e.g. poor mobility, psychological distress, disability) have increased over time. What this study adds. Successively younger birth cohorts had a higher prevalence of hospitalization, with differences emerging in early-adulthood. Those in medium and low parental socioeconomic position (vs high) had 13% and 20% higher odds of hospitalization. No progress was made in reducing the socioeconomic inequalities across cohorts born between 1915 and 1972.
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Affiliation(s)
- Dawid Gondek
- Centre for Longitudinal Studies, UCL Institute of Education, University College London, United Kingdom
| | - George B Ploubidis
- Centre for Longitudinal Studies, UCL Institute of Education, University College London, United Kingdom
| | | | - Menghan Gao
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - David Bann
- Centre for Longitudinal Studies, UCL Institute of Education, University College London, United Kingdom
| | - Ilona Koupil
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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28
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Tavares J, Santinha G, Rocha NP. Age-Friendly Health Care: A Systematic Review. Healthcare (Basel) 2021; 9:healthcare9010083. [PMID: 33561084 PMCID: PMC7830866 DOI: 10.3390/healthcare9010083] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Health care provided to older adults must take into account the characteristics of chronic diseases and the comorbidities resulting from ageing. However, health services are still too oriented towards acute situations. To overcome this problem, the World Health Organization (WHO) proposed a set of Age-Friendly Principles that seek to optimize the provision of health care for this population. This article aims to understand how such Principles are considered in the implementation of age-friendly health care worldwide. Methods: A systematic review was conducted to synthesize the literature on age-friendly health care in accordance with the PRISMA recommendations in the PubMed, Web of Science, and Scopus databases. Results: The research identified 34 articles, with only seven recognizing the WHO Principles and only four using the implementation toolkit. In addition, in the context of primary care, three studies recognize the WHO Principles, but only two use the toolkit. Conclusions: The WHO Principles are being implemented in health care, but in a smaller scale than desired, which reveals possible flaws in their dissemination and standardization. Thus, a greater scientific investment in age-friendly health care should be considered, which represents a greater operationalization of the Principles and an evaluation of their effectiveness and impacts.
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Affiliation(s)
- Jéssica Tavares
- GOVCOPP, Department of Social, Political and Territorial Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
- Correspondence:
| | - Gonçalo Santinha
- GOVCOPP, Department of Social, Political and Territorial Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Nelson P. Rocha
- IEETA, Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
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29
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Wetzel M, Vanhoutte B. Putting cumulative (dis)advantages in context: Comparing the role of educational inequality in later-life functional health trajectories in England and Germany. PLoS One 2020; 15:e0244371. [PMID: 33378335 PMCID: PMC7773250 DOI: 10.1371/journal.pone.0244371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The cumulative (dis)advantage (CAD) perspective more and more is examined in a comparative way, to highlight the role of context in generating inequality over the life course. This study adds to this field of research by examining trajectories of activities of daily living (ADL) in later life by educational level in a country comparison of England and Germany, emphasizing differing institutional conditions. METHOD Data used are the English Longitudinal Study of Ageing (ELSA; 11,352 individuals) and the German subsample of the Survey of Health and Retirement in Europe (SHARE; 5,573 individuals). Using population averaged Poisson panel regression models, 12-year trajectories of six birth cohorts are investigated, covering the age range of 50 to 90 years. RESULTS Respondents in England have a higher level of limitations at age 50, and more limited increases over age than in Germany. An educational gradient exists in both countries at age 50. Notably, the educational gradient increases for more recently born cohorts, but declines with increasing age in England, while in Germany educational differences increase for more recently born cohort only. DISCUSSION The current study indicates that CAD processes between educational groups are context sensitive. While England showed convergence of disparities with increasing age, in Germany no differential development was found.
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Affiliation(s)
| | - Bram Vanhoutte
- École de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
- Department of Sociology, University of Manchester, Manchester, United Kingdom
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30
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Bakhtiari A, Pourali M, Omidvar S. Nutrition assessment and geriatric associated conditions among community dwelling Iranian elderly people. BMC Geriatr 2020; 20:278. [PMID: 32762725 PMCID: PMC7409695 DOI: 10.1186/s12877-020-01668-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 07/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Although malnutrition risk is well documented in elderly care institutions, few studies have been conducted to address concerns regarding community-dwelling elderly people. This study has been aimed to describe the nutritional status and its related socioeconomic and geriatric factors in community-dwelling elders with malnutrition. Method For this study, a randomized sampling among people aged 60 has been done (n = 326). Information on nutrition status (full MNA) and health information, like cognitive status (MMSE), daily functional status (ADL and IADL scales) and frailty was obtained. Multiple logistic regression analyses have been carried out, in order to identify the association of demographical and clinical factors with malnutrition. Results 28.1% of the participants suffered from poor nutrition. In the binary analysis, low MNA scores were associated with increasing age, female gender, lower education level, financial dependence, solitary life, poor self-rated health, multiple physical disabilities and chronic disease, polypharmacy, smoking, functional and cognitive decrease and frailty. In the final model of the multivariate analysis, living alone (OR:1.249,CI:1.105–2.620), multiple physical disabilities (OR:2.183,CI:1.246 ± 3..250) and chronic disease (OR: 2.148,CI:1.167–2.879) were independently associated with malnutrition. Also financial independency (OR:0.625,CI:0.233–0.938), functional ability on ADL (OR:0.536,CI:0.327–0.976) and IADL (OR:0.319,CI:0.194–0.856), normal cognitive (OR:0.456,CI:0.293–0.934) and no frailty (OR:0.253,CI:0.117–0.729) independently were inversely associated with malnutrition. The model was adjusted for all socio- demographic and health variables that were significantly related in the previous models. Conclusions Our results indicated a strong correlation between malnutrition and health status. Identifying predictive factors can potentially improve prevention and management strategies used for malnutrition in elderly.
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Affiliation(s)
- Afsaneh Bakhtiari
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R., Iran
| | - Mahbobeh Pourali
- Department of Nursing, Babol School of Midwifery Nursing, Babol University of Medical Sciences, Babol, Iran
| | - Shabnam Omidvar
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R., Iran.
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Abstract
Objetivos: verificar o número e as causas de hospitalizações por quedas em idosos brasileiros, além dos gastos federais do Sistema Único de Saúde (SUS), no período de 2000 a 2018.Métodos: trata-se de um estudo ecológico, utilizando informações disponíveis na base de dados do Departamento de Informática do SUS. Foram coletados dados de idosos (≥60 anos) que internaram no SUS devido às quedas no período de 2000 a 2018 no Brasil. Extraíram-se o número de hospitalizações no País e nas regiões (Norte, Nordeste, Sul, Sudeste e Centro-Oeste), as causas das quedas (Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde – 10) e o valor de gastos federais. Para fins estatísticos, utilizou-se análise descritiva.Resultados: totalizaram-se 1,48 milhões de hospitalizações por quedas em idosos no Brasil, com uma taxa de 38,6 a cada 10 mil. As principais causas desses registros no DATASUS foram as “quedas sem especificações”, as “outras quedas no mesmo nível” e as “quedas no mesmo nível por escorregão, tropeção ou passos em falsos”. Em relação às localidades, os idosos pertencentes às regiões Sudeste (47,1), Sul (44,1) e Centro-Oeste (40,4) foram aqueles que apresentaram maiores medianas das taxas de hospitalizações por quedas no período analisado. Entretanto, o Nordeste (variação%=0,4), o Sul (variação%=0,2) e o Centro-Oeste (variação%=0,2) demonstraram maiores elevações desse indicador ao longo dos 18 anos, enquanto apenas a região Norte apresentou redução (variação%=-0,5). A mediana de gastos hospitalares federais (milhões) foi de R$135,58, variando de R$112,89 até R$194,98.Conclusões: houve aumento das taxas de hospitalizações por quedas em idosos no SUS em quase todas as unidades federativas. As causas mais frequentes foram as “quedas sem especificações”, as “outras quedas no mesmo nível” e as “quedas no mesmo nível por escorregão, tropeção ou passos em falsos”. Além disso, ocorreu elevação dos gastos hospitalares federais ao longo do período no País.
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32
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Hossin MZ, Östergren O, Fors S. Is the Association Between Late Life Morbidity and Disability Attenuated Over Time? Exploring the Dynamic Equilibrium of Morbidity Hypothesis. J Gerontol B Psychol Sci Soc Sci 2020; 74:e97-e106. [PMID: 28575329 DOI: 10.1093/geronb/gbx067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 05/09/2017] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE There is evidence suggesting that the prevalence of disability in late life has declined over time while the prevalence of chronic diseases has increased. The dynamic equilibrium of morbidity hypothesis suggests that these patterns are due to the attenuation of the morbidity-disability link over time. This study aimed to test this assumption empirically. METHODS Data were drawn from three repeated cross-sections of SWEOLD, a nationally representative survey of the Swedish population aged 77 years and older. Poisson regression models were fitted to assess the trends in the prevalence of Activities of Daily Living (ADL) disability, Instrumental ADL (IADL) disability, and selected groups of chronic conditions. The changes in the associations between chronic conditions and disabilities were examined on both multiplicative and additive scales. RESULTS Between 1992 and 2011, the prevalence of both ADL and IADL disabilities decreased whereas the prevalence of nearly all chronic morbidities increased. Significant attenuations of the morbidity-disability associations were found for cardiovascular diseases, metabolic disorders, poor lung function, and psychological distress. DISCUSSION In agreement with the dynamic equilibrium of morbidity hypothesis, this study concludes that the morbidity-disability associations among the Swedish older adults largely waned between 1992 and 2011.
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Affiliation(s)
| | | | - Stefan Fors
- Aging Research Center, Karolinska Institute/Stockholm University, Stockholm, Sweden
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33
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Wang YQ, Jia RX, Liang JH, Li J, Qian S, Li JY, Xu Y. Effects of non-pharmacological therapies for people with mild cognitive impairment. A Bayesian network meta-analysis. Int J Geriatr Psychiatry 2020; 35:591-600. [PMID: 32119152 DOI: 10.1002/gps.5289] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare the effects of non-pharmacological therapies (NPTs) on improving the cognition of people with mild cognitive impairment (MCI) by performing a Bayesian network meta-analysis (NMA). METHODS We searched eight databases for potentially eligible studies. Physical exercise (PE), cognitive stimulation (CS), cognitive training (CT), cognitive rehabilitation (CR), musical therapy (MT) and multi-domain interventions (MI). Pairwise meta-analyses were performed by estimating the weighted mean differences with 95% confidence interval (CI) for mini-mental state examination. The NMA was undertaken to compare different interventions. RESULTS CS, PE, MI, MT and CT may all be effective in improving the cognition of patients with MCI. CR was unable to show a significant efficacy. Our NMA ranking results suggest the effectiveness of the six NPTs to be ranked from best to worst as follows: CS, PE, MI, MT, CT and CR. CONCLUSIONS NPT has great potential to improve the cognition of the elderly with MCI. CS has the highest probability of being the optimal NPT. However, the result should be interpreted with cautions given the limited number and small samples of included randomized controlled trials (RCTs) in this field, large diversity existing in different study designs and potential risk of bias. Future RCTs with high quality and large sample sizes are required to confirm our results. SUMMARY NPT, as a whole definition, has great potential to improve the cognition of the elderly with MCI. Our NMA ranking results suggest the effectiveness of the six NPTs to be ranked from best to worst as follows: CS, PE, MI, MT, CT and CR.
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Affiliation(s)
- Ying-Quan Wang
- Department of Social Medicine, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, Suzhou, China
| | - Rui-Xia Jia
- Department of Social Medicine, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, Suzhou, China
| | - Jing-Hong Liang
- Department of Social Medicine, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, Suzhou, China
| | - Jing Li
- Department of Social Medicine, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, Suzhou, China
| | - Sheng Qian
- Department of Social Medicine, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, Suzhou, China
| | - Jia-Yu Li
- Department of Social Medicine, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, Suzhou, China
| | - Yong Xu
- Department of Social Medicine, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, Suzhou, China
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Seaman R, Höhn A, Lindahl-Jacobsen R, Martikainen P, van Raalte A, Christensen K. Rethinking morbidity compression. Eur J Epidemiol 2020; 35:381-388. [PMID: 32418023 PMCID: PMC7250949 DOI: 10.1007/s10654-020-00642-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/29/2020] [Indexed: 11/30/2022]
Abstract
Studies of morbidity compression routinely report the average number of years spent in an unhealthy state but do not report variation in age at morbidity onset. Variation was highlighted by Fries (1980) as crucial for identifying disease postponement. Using incidence of first hospitalization after age 60, as one working example, we estimate variation in morbidity onset over a 27-year period in Denmark. Annual estimates of first hospitalization and the population at risk for 1987 to 2014 were identified using population-based registers. Sex-specific life tables were constructed, and the average age, the threshold age, and the coefficient of variation in age at first hospitalization were calculated. On average, first admissions lasting two or more days shifted towards older ages between 1987 and 2014. The average age at hospitalization increased from 67.8 years (95% CI 67.7-67.9) to 69.5 years (95% CI 69.4-69.6) in men, and 69.1 (95% CI 69.1-69.2) to 70.5 years (95% CI 70.4-70.6) in women. Variation in age at first admission increased slightly as the coefficient of variation increased from 9.1 (95% CI 9.0-9.1) to 9.9% (95% CI 9.8-10.0) among men, and from 10.3% (95% CI 10.2-10.4) to 10.6% (95% CI 10.5-10.6) among women. Our results suggest populations are ageing with better health today than in the past, but experience increasing diversity in healthy ageing. Pensions, social care, and health services will have to adapt to increasingly heterogeneous ageing populations, a phenomenon that average measures of morbidity do not capture.
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Affiliation(s)
- Rosie Seaman
- Max Planck Institute for Demographic Research, Konrad-Zuse Str. 1, Rostock, Germany. .,Faculty of Social Sciences, University of Stirling, Stirling, UK.
| | - Andreas Höhn
- Max Planck Institute for Demographic Research, Konrad-Zuse Str. 1, Rostock, Germany.,Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.,Department of Epidemiology, Biostatistics, and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Rune Lindahl-Jacobsen
- Department of Epidemiology, Biostatistics, and Biodemography, University of Southern Denmark, Odense, Denmark.,Interdisciplinary Centre On Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Pekka Martikainen
- Max Planck Institute for Demographic Research, Konrad-Zuse Str. 1, Rostock, Germany.,Population Research Unit, University of Helsinki, Helsinki, Finland
| | - Alyson van Raalte
- Max Planck Institute for Demographic Research, Konrad-Zuse Str. 1, Rostock, Germany
| | - Kaare Christensen
- Department of Epidemiology, Biostatistics, and Biodemography, University of Southern Denmark, Odense, Denmark.,Danish Aging Research Centre, University of Southern Denmark, Odense, Denmark
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Bezdicek O, Červenková M, Georgi H, Schmand B, Hladká A, Rulseh A, Kopeček M. Long-term cognitive trajectory and activities of daily living in healthy aging. Clin Neuropsychol 2020; 35:1381-1397. [PMID: 32306891 DOI: 10.1080/13854046.2020.1745895] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective: The purpose of the present study was to investigate if participants in NANOK study (National Normative Study of Cognitive Determinants of Healthy Ageing) who show no cognitive decline throughout five years (successful healthy agers; SHA) will show less age-related differences in instrumental activities of daily living (IADL) based on Functional Activities Questionnaire in comparison to participants who show subtle cognitive decline (Decliners) over time.Method: We used two different classifications of SHA: Rogalski (N = 25 SHA and N = 15 Decliners) based on cross-sectional neuropsychology measures and linear mixed model (LMEM; 20 SHA and 20 Decliners) based on the Montreal Cognitive Assessment longitudinal 5-years follow-up. Whole-brain T1- and T2-weighted images were corrected for distortions and segmented using Freesurfer. Whole-brain volumetry was performed using FSL's voxel-based morphometry tool.Results: The cognitive decline after four years follow-up but not age predicts subtle impairment in IADL in healthy ageing participants. We found brain volumetric differences between SHA and Decliners based on Rogalski but not LMEM classification especially in bilateral insular cortices and ventrolateral frontal cortex. The logistic regression model achieved an accuracy of 75% for the Rogalski in comparison to 67.5% for the LMEM classification.Conclusions: Slight restrictions in IADL seem to be a useful tool for screening healthy ageing participants at risk of developing subtle cognitive decline over a period of five years and the cross-sectional Rogalski criteria based on standardized neuropsychological measures were superior for tapping age-related brain changes to longitudinal LMEM classification based on screening (Montreal Cognitive Assessment).
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Affiliation(s)
- Ondrej Bezdicek
- National Institute of Mental Health, Klecany, Czech Republic.,Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Markéta Červenková
- National Institute of Mental Health, Klecany, Czech Republic.,Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | | | - Ben Schmand
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Adéla Hladká
- National Institute of Mental Health, Klecany, Czech Republic.,Institute of Computer Science of the Czech Academy of Sciences, Prague, Czech Republic
| | - Aaron Rulseh
- National Institute of Mental Health, Klecany, Czech Republic.,Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Miloslav Kopeček
- National Institute of Mental Health, Klecany, Czech Republic.,Department of Psychiatry, Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Gontijo Guerra S, Berbiche D, Vasiliadis HM. Changes in instrumental activities of daily living functioning associated with concurrent common mental disorders and physical multimorbidity in older adults. Disabil Rehabil 2020; 43:3663-3671. [PMID: 32255362 DOI: 10.1080/09638288.2020.1745303] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction: Instrumental activities of daily living (IADL) are key indicators of general functional status that are frequently used to assess the autonomy of older adults living in the community.Aims: To evaluate the changes in IADL in community-living older adults and the role of common mental disorders and physical multimorbidity in predicting these changes.Method: A secondary analysis including participants from the Longitudinal Survey on Senior's Health and Health Services. Self-reported sociodemographic and clinical information on chronic conditions were obtained at baseline interview (n = 1615). Measures of IADL were obtained at two time points, 3 years apart. Administrative data on physician diagnoses of chronic diseases were linked to self-reported information. Logistic and multinomial regression models were used to study the outcomes of interest.Results: More than one-third of participants reported disability. Significant increase in global and specific IADL tasks disability were observed over time. Concurrent mental and physical chronic conditions predicted persistent and future incidence of disability.Conclusions: We draw attention to the synergistic effect of mental and physical co-morbidities on IADL functioning and to the importance of the simultaneous management of these conditions in order to prevent disability, future decline and the associated health and societal burden.Implications for RehabilitationBy establishing the prevalence of global and specific IADL disability, we can better recognize the needs of older adults and inform health and social care planning.Influenced by the morbidity profile, older adults may experience decline, improvement or maintenance of autonomy in IADL over time.The presence of synergistic effect of physical and mental chronic conditions on functioning suggests that their simultaneous management is crucial in delaying or preventing disability.Reports of significant impairment in tasks such as taking medication calls attention to the need for increased accessibility to programs on medication management.The progressive loss of ability to take medication among multimorbid patients emphasize the need for therapeutic plans that circumvent polypharmacy.
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Affiliation(s)
- Samantha Gontijo Guerra
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Longueuil, QC, Canada.,Faculty of Medicine and Health Sciences, Université de Sherbrooke, Campus Longueuil, Longueuil, QC, Canada
| | - Djamal Berbiche
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Longueuil, QC, Canada.,Faculty of Medicine and Health Sciences, Department of Community Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
| | - Helen-Maria Vasiliadis
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Longueuil, QC, Canada.,Faculty of Medicine and Health Sciences, Department of Community Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
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Zawisza K, Galas A, Tobiasz-Adamczyk B. Factors associated with patient satisfaction with health care among Polish older people: results from the polish part of the COURAGE in Europe. Public Health 2020; 179:169-177. [DOI: 10.1016/j.puhe.2019.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/12/2019] [Accepted: 10/17/2019] [Indexed: 11/29/2022]
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Sperlich S, Beller J, Epping J, Tetzlaff J, Geyer S. Trends in self-rated health among the elderly population in Germany from 1995 to 2015 - the influence of temporal change in leisure time physical activity. BMC Public Health 2020; 20:113. [PMID: 31992257 PMCID: PMC6988275 DOI: 10.1186/s12889-020-8218-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Against the backdrop of rising statutory retirement age in Germany, we analyzed time trends in self-rated health (SRH) among the elderly population between 50 and 70 years of age and explored the mediating role of leisure time physical activity (LTPA) on the relationship between time period and self-rated health (SRH). METHODS We used longitudinal survey data (n = 23,161) from a national panel study (GSOEP) to analyze time trends in SRH and regular LTPA (at least once a week) by means of Generalized Estimation Equation (GEE) analysis for logistic regression. The Karlson-Holm-Breen (KHB) method was applied for decomposing trend effects into direct and indirect parts via LTPA. In addition to odds ratios (OR), we illustrated the results by means of predicted probabilities and average partial effects (APE). RESULTS Over time, the predicted probabilities of good SRH and regular LTPA increased while those of poor SRH decreased. After adjusting for socioeconomic status (SES) 53.4% of the trend in good SRH in women (OR = 1.34 / APE = 6.8%-points) could be attributed to the rise in regular LTPA. In men, the remaining smaller effect (OR = 1.13 / APE = 2.7%) could be fully assigned to temporal changes in regular LTPA. With respect to poor health we found a suppression effect of LTPA in the adjusted model, indicating that without improvements in regular LTPA over time an increase in poor SRH would have occurred. CONCLUSIONS The increase of regular LTPA accounted for improved SRH from 1995 to 2015 among the elderly, indicating that promoting LTPA might be a key factor to raise healthy working life expectancy.
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Affiliation(s)
- Stefanie Sperlich
- Hannover Medical School, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Johannes Beller
- Hannover Medical School, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jelena Epping
- Hannover Medical School, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Juliane Tetzlaff
- Hannover Medical School, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Siegfried Geyer
- Hannover Medical School, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Self-Rated Health: When and How to Use It in Studies Among Older People? INTERNATIONAL HANDBOOK OF HEALTH EXPECTANCIES 2020. [DOI: 10.1007/978-3-030-37668-0_12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Timmermans EJ, Hoogendijk EO, Broese van Groenou MI, Comijs HC, van Schoor NM, Thomése FCF, Visser M, Deeg DJH, Huisman M. Trends across 20 years in multiple indicators of functioning among older adults in the Netherlands. Eur J Public Health 2019; 29:1096-1102. [PMID: 31008512 PMCID: PMC6896978 DOI: 10.1093/eurpub/ckz065] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Monitoring of trends in functioning of older adults provides indispensable information for health care policy. This study examined trends in multiple indicators of functioning among Dutch older adults across a period of 20 years. METHODS Data from the Longitudinal Aging Study Amsterdam were used. We included 10 870 observations of 3803 respondents aged 64-84 years across seven waves (1992-12) and 931 observations of 603 respondents aged 85-94 years across four waves (2001-12). At each wave, 8 indicators of functioning were measured: multimorbidity, severe functional limitations, depression, anxiety, cognitive impairment, physical inactivity, loneliness and social isolation. In addition, a sum score (range: 0-8) of these indicators was calculated, with a score of ≥5 indicating 'multiple problems.' Trends in functioning over time were assessed using Generalized Estimating Equation analyses. RESULTS In the 64-84-years-olds, the prevalence of multimorbidity increased over time [OR(year) = 1.06, 95% CI = 1.05-1.06], whereas the prevalence of the other indicators decreased [i.e. cognitive impairment, physical inactivity (in women) and loneliness (in women)] or remained stable [i.e. severe functional limitations, depression, anxiety, physical inactivity (in men), loneliness (in men) and social isolation]. In the 85-94-year-olds, the prevalence of severe functional limitations increased over time [OR(year) = 1.08, 95% CI = 1.02-1.13], whereas the prevalence of the other indicators remained stable. In both age groups, the prevalence of 'multiple problems' remained stable. CONCLUSION Unfavorable trends were observed in multimorbidity among 64-84-years-olds and in severe functional limitations among 85-94-year-olds. Favorable trends were found in cognitive impairment, physical inactivity (in women) and loneliness (in women) among 64-84-years-olds.
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Affiliation(s)
- Erik J Timmermans
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC – Location VU University Medical Center, Amsterdam, The Netherlands
| | - Emiel O Hoogendijk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC – Location VU University Medical Center, Amsterdam, The Netherlands
| | | | - Hannie C Comijs
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC – Location VU University Medical Center/GGZ inGeest, Amsterdam, The Netherlands
| | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC – Location VU University Medical Center, Amsterdam, The Netherlands
| | - Fleur C F Thomése
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dorly J H Deeg
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC – Location VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC – Location VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Ran L, Kong H, Du M, He J, Zhong Q, Ran Y, Si Y, Zhang J, Yao C, Luo H, Ye Q. Comparison of health-related quality of life between the Han and Yi ethnicity elderly in the Yi autonomous areas of Yunnan Province. BMC Geriatr 2019; 19:326. [PMID: 31766992 PMCID: PMC6878633 DOI: 10.1186/s12877-019-1257-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 08/25/2019] [Indexed: 11/28/2022] Open
Abstract
Background The purpose of this research was to assess the health-related quality of life (HRQOL) and functional abilities of Yi and Han elderly who resided in Yi Autonomous prefecture or Counties in Yunnan Province, as well as to compare their differences in HRQOL, functional abilities and other factors. Methods A total of 1636 older subjects, which included 863 Han and 773 Yi, were recruited from 10 Yi Autonomous regions. Their HRQOL and functional capabilities were assessed by the MOS 36-Item Short Form Health Survey (SF-36), activities of daily living (ADL), and instrumental activities of daily living (IADL) scales. Results The Han elderly performed better in every domain of SF-36 than the Yi elderly. Both of the two ethnic groups could perform their ADL independently but the Yi elderly showed greater dependency in IADL abilities. The HRQOL was positively associated with their ADL, IADL, and education levels. Moreover, age, health insurance status, and living arrangement were negatively correlated with HRQOL. Conclusion The HRQOL and IADL capabilities of the Han elderly were higher than that of the Yi counterparts in the Yi Autonomous regions. The HRQOL of both the two ethnic groups was positively connected with ADL, IADL abilities as well as education levels, whereas it was negatively correlated with age and health insurance. The elderly-care policy on the Yi autonomous areas should focus more on the HRQOL, ADL improvement, education background, age needs, and health insurance, etc.
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Affiliation(s)
- Lingyun Ran
- Nursing School of Kunming Medical University, Kunming, Yunnan, China.
| | - Hongqian Kong
- Qujing Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Mengqi Du
- Steinhardt School of New York University, New York, USA
| | - Jianhui He
- Public Health School of Kunming Medical University, Kunming, China.
| | - Qiong Zhong
- The Sixth Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Yuanyuan Ran
- Hunan University of Finance and Economics, Changsha, China
| | - Yanping Si
- Nursing School of Kunming Medical University, Kunming, Yunnan, China
| | - Jiang Zhang
- The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Cheng Yao
- Nursing School of Kunming Medical University, Kunming, Yunnan, China
| | - Huineng Luo
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Qin Ye
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
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Zhang Y, Xu Y, Si G, Ran L, Xie Y, Yang J, Tan X. Physical and behavioural factors, negative emotion and cognitive function among near-centenarians and centenarians in China. Australas J Ageing 2019; 39:e344-e351. [PMID: 31663256 DOI: 10.1111/ajag.12740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To investigate the association among demographic, physical, behavioural parameters, psychosocial and cognitive function in near-centenarians and centenarians. METHODS The present study data originated from the 2014 wave of the largest nationwide longitudinal survey of the population aged 95 and above in China (N = 175). The aim of this study was to systematically identify the relationship among physical and behavioural variables, negative emotions and cognitive function. Cognitive function was evaluated by the modified Mini-Mental State Examination (mMMSE) Chinese version. Structured responses were obtained for the analysis of physical and behavioural factors and negative emotions. RESULTS The average age of the sample was 98.78 years (SD = 4.00, range: 95-112 years). The average score of the mMMSE was 20.71 (SD = 3.48), average activities of daily living (ADL) total score was 17.21 (SD = 1.72), average instrumental activities of daily living (IADL) total score was 17.90 (SD = 5.57), and average negative emotion score was 8.77 (SD = 2.69). In the combined multiple linear regression model, the quality of sleep, IADL and negative emotion of centenarians were significantly associated with cognitive function (P < 0.05). CONCLUSION The cognitive function of centenarians was significantly associated with the quality of sleep, IADL and negative emotion. Improving physical functioning and social resources can help emotional health and improve the overall cognition of centenarians.
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Affiliation(s)
- Yuting Zhang
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Yi Xu
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Guanglin Si
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Li Ran
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Yaofei Xie
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Jinru Yang
- College of Clinical Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Xiaodong Tan
- Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan, China
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Ye L, Luo J, Shia BC, Fang Y. Heterogeneous health classes for older adults and their regional disparities in China: based on multidimensional health. Public Health 2019; 178:15-22. [PMID: 31605804 DOI: 10.1016/j.puhe.2019.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/13/2019] [Accepted: 08/24/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES China is currently facing an unprecedented complex health demand from a rapidly aging population. Based on multidimensional health, this study aimed to identify heterogeneous latent health classes for older Chinese people, and assess regional disparities and associated sociodemographic factors. STUDY DESIGN Chinese Longitudinal Healthy Longevity Survey in 2014 was adopted. METHODS For 2886 participants aged 65 years and more without missing health indicators in physical, psychological, and social dimensions, latent class analysis was used to identify heterogeneous health. For 2128 participants with complete information, logistic regressions were used to examine how regional divisions and sociodemographic factors impact each identified class. RESULTS Four classes were identified and labeled as 'Lacking Socialization' (17.4%), 'High Comorbidity' (13.7%), 'Functional Impairment' (7.1%), and 'Relative Health' (61.8%). When the Relative Health class was the reference, the likelihoods of the High Comorbidity and Functional Impairment classes were higher for older adults in eastern and central regions than in western regions. Those in eastern regions also tended to be in the Lacking Socialization class than in western regions. The effects of regional divisions on the different classes were significantly impacted by sociodemographic characteristics. CONCLUSIONS Four health classes identified by multidimensional health have enhanced our understanding of heterogeneity among older Chinese people. By examining regional disparities in China, our study provided evidence for health policies addressing the issue of aging with respect to regional disparities.
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Affiliation(s)
- L Ye
- School of Public Health, Xiamen University, Xiamen, Fujian, 361102, China; School of Economics, Xiamen University, Xiamen, Fujian, 361005, China
| | - J Luo
- School of Public Health, Xiamen University, Xiamen, Fujian, 361102, China
| | - B-C Shia
- School of Management, Taipei Medical University, Taipei, 10675, Taiwan
| | - Y Fang
- School of Public Health, Xiamen University, Xiamen, Fujian, 361102, China.
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Ravensbergen W, Drewes Y, Hilderink H, Verschuuren M, Gussekloo J, Vonk R. Combined impact of future trends on healthcare utilisation of older people: A Delphi study. Health Policy 2019; 123:947-954. [DOI: 10.1016/j.healthpol.2019.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/22/2019] [Accepted: 07/07/2019] [Indexed: 11/30/2022]
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Gondek D, Bann D, Ning K, Grundy E, Ploubidis GB. Post-war (1946-2017) population health change in the United Kingdom: A systematic review. PLoS One 2019; 14:e0218991. [PMID: 31269039 PMCID: PMC6608959 DOI: 10.1371/journal.pone.0218991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 06/10/2019] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Dawid Gondek
- Centre for Longitudinal Studies, Department of Social Science, UCL Institute of Education, University College London, London, United Kingdom
| | - David Bann
- Centre for Longitudinal Studies, Department of Social Science, UCL Institute of Education, University College London, London, United Kingdom
| | - Ke Ning
- Centre for Longitudinal Studies, Department of Social Science, UCL Institute of Education, University College London, London, United Kingdom
| | - Emily Grundy
- Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom
| | - George B. Ploubidis
- Centre for Longitudinal Studies, Department of Social Science, UCL Institute of Education, University College London, London, United Kingdom
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Linderholm M, Törnvall E, Yngman-Uhlin P, Hjelm K. Self-rated health, lifestyle habits and risk assessment in 75-year-old persons attending preventive clinic visits with a nurse in primary health care: a cross-sectional study. Prim Health Care Res Dev 2019; 20:e88. [PMID: 32799984 PMCID: PMC6609977 DOI: 10.1017/s1463423619000136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/29/2018] [Accepted: 02/25/2019] [Indexed: 11/05/2022] Open
Abstract
AIM To describe self-rated health in relation to lifestyle and illnesses and to identify risk factors for ill health such as pressure ulcers, falls and malnutrition among 75-year-old participants in a new clinical routine involving health assessment followed by tailored one-to-one health promotion at preventive clinic visits to a nurse at primary health care centres (PHCC). BACKGROUND There is a rapidly growing ageing population worldwide. It is central to health policy to promote active and healthy ageing. Preventive clinic visits to a nurse in primary health care were introduced as a new clinical intervention in a region in Sweden to improve the quality of health for the older adults. DESIGN A quantitative cross-sectional population-based study. METHODS The sample consisted of 306 individuals in six primary health care centres in Sweden aged 75 years who attended preventive clinic visits to a nurse. Data were collected from March 2014 to May 2015 during structured conversations with a nurse based on self-administered questionnaires, clinical examinations, risk assessments and after the clinic visit existing register data were collected by the researcher. FINDINGS Participants experienced good self-rated health despite being overweight and having chronic illnesses. Daily exercise such as walking and housework was more common than aerobic physical training. The majority had no problems with mobility but reported anxiety, pain and discomfort and had increased risk of falls. CONCLUSION It is important to encourage the older adults to live actively and independently for as long as possible. The healthy older adults may benefit from the clinical intervention described here to support the individual's ability to maintain control over their health. Such supportive assessments might help the healthy older adult to achieve active ageing, reducing morbidity and preventing functional decline.
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Affiliation(s)
- Märit Linderholm
- Primary Health Care Centre Valdemarsvik, Region of Östergötland, Valdemarsvik, Sweden
- Doctoral student, Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Eva Törnvall
- Management Department, Region of Östergötland, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Pia Yngman-Uhlin
- The Research and Development Unit, Region of Östergötland, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Katarina Hjelm
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
- Departement of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Liu E, Feng Y, Yue Z, Zhang Q, Han T. Differences in the health behaviors of elderly individuals and influencing factors: Evidence from the Chinese Longitudinal Healthy Longevity Survey. Int J Health Plann Manage 2019; 34:e1520-e1532. [PMID: 31149759 DOI: 10.1002/hpm.2824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Health behaviors play an important role in determining individual health status; thus, understanding differences in the health behaviors of elderly individuals and their influencing factors is a prerequisite for the formulation and implementation of health behavior promotion policies for elderly individuals. The objectives of this study were to explore differences in health behaviors among Chinese elderly people and their influencing factors. METHODS Based on data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2014, this paper applied latent class analysis (LCA) to explore differences in the health behaviors of elderly individuals in China and employed a multinomial logit model to identify the influencing factors that cause these differences. RESULTS Results showed that there are five classes of health behaviors among elderly individuals in China: passive, relatively passive, general, relatively positive, and positive, the proportions of which were 31.07%, 15.86%, 24.06%, 17.24%, and 11.76%, respectively. Community medical and health services, pension, living arrangements, and family income were the primary factors explaining differences in the health behaviors of elderly individuals. In addition, there were significant demographic differences in the health behaviors of elderly individuals in China, including gender, age, education, marital status, census register, region, and others. CONCLUSION There are significant differences in the behaviors of elderly individuals in China, and the behaviors of the majority of elderly people are not healthy. China is expected to invest more medical and health resources to tackle health prevention and management and to provide targeted education, guidance, and intervention in elderly health behaviors, urging them to control and correct risky health behaviors with a focus on elderly individuals that are the oldest, are females, have low education levels, and live in the countryside and in towns.
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Affiliation(s)
- Erpeng Liu
- Center for Social Security Studies, Wuhan University, Wuhan, China
| | - Yan Feng
- School of Business, Guizhou Minzu University, Guiyang, China
| | - Zhang Yue
- Department of Social Security, Zhongnan University of Economics and Law, Wuhan, China
| | - Qilin Zhang
- Center for Social Security Studies, Wuhan University, Wuhan, China
| | - Tiankuo Han
- Center for Social Security Studies, Wuhan University, Wuhan, China
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Abstract
AbstractIn recent years, several authors have drawn attention to signs of growing inequalities in the ageing populations of the developed economies. Such formulations have employed the concept of precariousness to suggest that a ‘new’ precarity has emerged in old age. Questioning this position and drawing on data reported over the last two decades on income and health inequalities between and within retired and working-age households, the present paper argues that evidence of this ‘precarity’ is speculative at most and relates more to imagined futures than to empirically observed trends in the present. The ageing of ageing societies – that is the growing agedness of the older population – might imply an increase in precarity or vulnerability at older ages, but this is not a result of changes in the underlying economic and social relations of society. Instead, we would contend that it is the corporeal consequences of living longer. By conflating the various meanings of ‘precarity’ there is a corresponding danger that the very real changes brought about by population ageing will be underplayed, which may be to the detriment of the most vulnerable. The idea of a new precarity in later life may thus not serve the ends to which it is intended.
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Ye L, Shia BC, Fang Y, Lee TS. Heterogeneous health profiles and healthcare utilization of the middle-aged and elderly with multiple health insurance schemes in China. Public Health 2019; 170:61-69. [PMID: 30954778 DOI: 10.1016/j.puhe.2019.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/03/2019] [Accepted: 01/15/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES China is facing an escalating demand of healthcare services from the middle-aged and elderly. Compared with the traditional view of health on symptoms and diseases, this study aimed to assess the heterogeneous health profiles of middle-aged and elderly Chinese by a person-centered approach. Furthermore, this study examined the effects of health profiles and associated factors on healthcare utilization within the context of China's multiple health insurance schemes. STUDY DESIGN The study used the 2015 data of China Health and Retirement Longitudinal Study, a nationwide population-based sample of people aged 45 years and older. METHODS Latent class analysis (LCA) was adopted to identify the heterogeneous health profiles. Two-part models were adopted to assess the effects of associated factors on healthcare utilization. RESULTS Among 15,250 Chinese aged 45 years and older, six heterogeneous health profiles were identified and labeled as 'Quite Healthy', 'Relatively Healthy', 'Comprehensive Comorbidities', 'Functional Impairment', 'Severe Disability', and 'Relatively Frail'. The Relatively Frail profile was the heaviest healthcare user. The Severe Disability profile took the least use of outpatient services but had relatively high utilization of inpatient services and outpatient expenditure. The Comprehensive Comorbidities profile tended to have the smallest effect on the frequency of visits for both inpatient and outpatient services, but its effect on outpatient expenditure was high. After controlling for health profiles, the significant effects of different health insurance programs on healthcare utilization were discussed. CONCLUSIONS Introducing health profiles by the person-centered approach of LCA has provided a holistic understanding of complex healthcare demands for middle-aged and elderly Chinese. It is valuable for policy makers to improve healthcare resource allocation targeted for the middle-aged and elderly.
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Affiliation(s)
- L Ye
- School of Public Health, Xiamen University, Xiamen, Fujian, 361102 China; School of Economics, Xiamen University, Xiamen, Fujian, 361005 China
| | - B-C Shia
- School of Management, Taipei Medical University, Taipei City, 10675 Taiwan
| | - Y Fang
- School of Public Health, Xiamen University, Xiamen, Fujian, 361102 China
| | - T-S Lee
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, 24205 Taiwan.
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Trends in good self-rated health in Germany between 1995 and 2014: do age and gender matter? Int J Public Health 2019; 64:921-933. [PMID: 30918976 DOI: 10.1007/s00038-019-01235-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES This study analyzes longitudinal trends in self-rated health (SRH) by taking age- and gender-specific differences into account. METHODS Data of 29,251 women and 26,967 men were obtained from the German Socio-Economic Panel between 1995 and 2014. Generalized Estimation Equation analysis for logistic regression was used to estimate changes in odds of (very) good SRH over time. Development of (un)healthy life expectancy was calculated by applying the Sullivan method. RESULTS While in women, the odds of good SRH increased significantly over time for the ages 41-50 to 71-80 years, improvements among men were most apparent for the ages 61-70 and 71-80 years. By contrast, for both genders, no improvements in SRH were found in the youngest (31-40 years) and eldest age group (81-90 years) and in men aging 51-60 years. Over time, healthy life expectancy at age 31 increased by 3 years in women and 2 years in men, leading to a reduced but not eliminated gender gap in SRH. CONCLUSIONS Our findings support the hypothesis of relative compression of morbidity. However, trends in SRH differed according to age and gender, calling for health promotion efforts that meet diverse needs at different stages of life.
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