Towards a postponement of activities of daily living dependence and mobility limitations: Trends in healthy life years in old age in Sweden

Trends over two decades in life expectancy with complex health problems among older Swedes: implications for the provision of integrated health care and social care

BACKGROUND

Due to population aging, it is essential to examine to what extent rises in life expectancy (LE) consist of healthy or unhealthy years. Most health expectancy studies have been based on single health measures and have shown divergent trends. We used a multi-domain indicator, complex health problems (CHP), indicative of the need for integrated medical and social care, to investigate how LE with and without CHP developed in Sweden between 1992 and 2011. We also addressed whether individuals with CHP more commonly lived in the community in 2011 compared to earlier years.

METHODS

CHP were defined as having severe problems in at least two of three health domains related to the need for medical and/or social care: symptoms/diseases, cognition/communication, and mobility. The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), a nationally representative survey of the Swedish population aged ≥ 77 years with waves in 1992, 2002 and 2011 (n≈2000), was used to estimate the prevalence of CHP. Age- and gender-specific death rates were obtained from the Human Mortality Database. The Sullivan method was deployed to calculate the remaining life expectancy with and without CHP. The estimates were decomposed to calculate the contribution of changes from morbidity and mortality to the overall trends in LE without CHP.

RESULTS

Between 1992 and 2011, both total LE (+ 1.69 years [95% CI 1.56;1.83] and LE without CHP (+ 0.84 years [-0,87;2.55]) at age 77 increased for men, whereas LE at age 77 increased for women (+ 1.33 [1.21;1.47]) but not LE without CHP (-0.06 years [-1.39;1.26]). When decomposing the trend, we found that the increase in LE with CHP was mainly driven by an increase in the prevalence of CHP. Among individuals with CHP the proportion residing in care homes was lower in 2011 (37%) compared to 2002 (58%) and 1992 (53%).

CONCLUSIONS

The findings, that an increasing number of older people are expected to live more years with CHP, and increasingly live in the community, point towards a challenge for individuals and families, as well as for society in financing and organizing coordinated and coherent medical and social services.

Evaluation of the Oxford Hip Score: Does it still have content validity? Interviews of total hip arthroplasty patients

Background

The Oxford Hip Score is used to evaluate the outcome after total hip arthroplasty. The Oxford Hip Score was developed more than 20 years ago with only some degree of patient involvement. We question if the Oxford Hip Score is still relevant for the present-day total hip artrhoplasty patients. We aimed to determine whether the Oxford Hip Score contains items that are relevant for present-day patients with osteoarthritis undergoing total hip arthroplasty, thus investigating the content validity.

Methods

Patients aged 60–75 years, undergoing total hip arthroplasty for primary osteoarthritis were recruited to participate in focus group interviews preoperatively and at 3 and 12 months after primary total hip arthroplasty. We conducted 6 focus group interviews in which 30 patients participated. The interviews were audio-recorded and transcribed verbatim. Using Interpretative Phenomenological Analysis, we inductively organised the interview transcripts into particular items/themes which we then compared to items in the Oxford Hip Score.

Results

We identified 6 general items with 41 sub-items. The 6 general items were pain, walking, physical activities, functional abilities, quality of life and psychological health. We found that items in the Oxford Hip Score were all in some way relevant to the patients but that the Oxford Hip Score lacks several important items relevant for present-day total hip artrhoplasty patients, including several physical activities, functional abilities and certain aspects of quality of life and psychological health.

Conclusion

We found that the Oxford Hip Score lacks important items for present-day patients in our population. Due to findings regarding several additional items that are not present in the Oxford Hip Score, particularly concerning physical activities and quality of life, we question the content validity of the Oxford Hip Score for a present-day population. Our findings indicate a need for a revision of the Oxford Hip Score.

Trends in health expectancies: a systematic review of international evidence

OBJECTIVES

A clear understanding of whether increases in longevity are spent in good health is necessary to support ageing, health and care-related policy.

DESIGN

We conducted a systematic review to update and summarise evidence on trends in health expectancies, in Organisation for Economic Co-operation and Development (OECD) high-income countries.

DATA SOURCES

Four electronic databases (MEDLINE, 1946-19 September 2019; Embase 1980-2019 week 38; Scopus 1966-22 September 2019, Health Management Information Consortium, 1979-September 2019), and the UK Office for National Statistics website (November 2019).

ELIGIBILITY CRITERIA

English language studies published from 2016 that reported trends in healthy, active and/or disability-free life expectancy in an OECD high-income country.

DATA EXTRACTION AND SYNTHESIS

Records were screened independently by two researchers. Study quality was assessed using published criteria designed to identify sources of bias in studies reporting trends, and evidence summarised by narrative synthesis.

FINDINGS

Twenty-eight publications from 11 countries were included, covering periods from 6 to 40 years, between 1970 and 2017. In most countries, gains in healthy and disability-free life expectancy do not match the growth in total life expectancy. Exceptions were demonstrated for women in Sweden, where there were greater gains in disability-free years than life expectancy. Gains in healthy and disability-free life expectancy were greater for men than women in most countries except the USA (age 85), Japan (birth), Korea (age 65) and Sweden (age 77).

CONCLUSION

An expansion of disability in later life is evident in a number of high-income countries, with implications for the sustainability of health and care systems. The recent COVID-19 pandemic may also impact health expectancies in the longer term.

How Fast Is Europe Getting Old? Analysis of Dynamics Applying the Spatial Shift–Share Approach

In this article, we analyzed the dynamics of the population aging process in Europe. The study was conducted on the basis of statistical data on the number of people aged 65 and above per 1000 of the population in 32 European countries in the years 1991–2018. The analyses also took into account the structure of the population by gender in five age groups: 65–69, 70–74, 75–79, 80–84, and 85 and above. An extensive analysis of the rate of changes in the magnitude of the phenomenon was carried out, which gave an answer to the question about how quickly Europe is aging. We applied the spatial dynamic shift–share method. The spatial variant of the method allowed, among others, indicating countries where the pace of population aging in a specific age group was faster/slower than in locations neighboring the examined country. Specific regions characterized by the fastest population aging were also indicated, and shares of structural and sectoral factors of the changes were estimated. Furthermore, based on the values of local competitiveness indicators, regions were identified where the aging of the population decelerated or accelerated the phenomenon in neighboring countries in the study period.

Actitudes de estudiantes españoles de terapia ocupacional hacia las personas mayores

Introducción. La población mundial está creciendo y envejeciendo. Debido al cambio demográfico en la población, gran parte de los profesionales de ciencias de la salud trabajarán con personas mayores, aunque la mayoría de los estudiantes de estas áreas tienen poco conocimiento e interés para ocuparse de esta población.Objetivo. Analizar las actitudes hacia las personas mayores en los estudiantes del programa de Terapia Ocupacional de la Universidad de Granada en España.Materiales y métodos. Estudio descriptivo. Se utilizó la escala de actitudes hacia el adulto mayor de Kogan (KAOP), validada al español, en 109 estudiantes de Terapia Ocupacional de la Universidad de Granada.Resultados. Los estudiantes participantes manifestaron tener, de media, una actitud neutral hacia el adulto mayor (valor KAOP 143.60±11.70). No se encontraron diferencias estadísticamente significativas por género ni por año académico (p=0.804) en los datos observados.Conclusiones. La actitud observada hacia el adulto mayor entre los estudiantes de Terapia Ocupacional de la Universidad de Granada es neutral, sin diferencias por género ni por año académico. Son necesarios estudios futuros sobre la temática para esclarecer las posibles causas de esta actitud.