Cohort differences in disease and disability in the young-old: findings from the MRC Cognitive Function and Ageing Study (MRC-CFAS)

Carol Jagger,Fiona E Matthews,Eugene S Paykel,Felicia A Huppert,Nicola A Spiers,Judith Nickson,Carol Brayne,Ruth J Matthews

doi:10.1186/1471-2458-7-156

Abstract

BackgroundProjections of health and social care need are highly sensitive to assumptions about cohort trends in health and disability. We use a repeated population-based cross-sectional study from the Cambridgeshire centre of the UK Medical Research Council Cognitive Function and Ageing Study to investigate trends in the health of the young-old UK populationMethodsNon-overlapping cohorts of men and women aged 65–69 years in 1991/2 (n = 689) and 1996/7 (n = 687) were compared on: self-reported diseases and conditions; self-rated health; mobility limitation; disability by logistic regression and four-year survival by Cox Proportional Hazards Regression models, with adjustments for differences in socio-economic and lifestyle factors.ResultsSurvival was similar between cohorts (HR: 0.91, 95% CI: 0.62 to 1.32). There was a significant increase in the number of conditions reported between cohorts, with more participants reporting 3 or more conditions in the new cohort (14.2% vs. 10.1%). When individual conditions were considered, there was a 10% increase in the reporting of arthritis and a significant increase in the reporting of chronic airways obstruction (OR: 1.36, 95% CI: 1.04 to 1.78).ConclusionThis study provides evidence of rising levels of ill-health, as measured by the prevalence of self-reported chronic conditions, in the newer cohorts of the young-old. Though changes in diagnosis or reporting of disease cannot, as yet, be excluded, to better understand whether our findings reflect real increases in ill-health, investment should be made into improved population-based databases, linking self-report and objective measures of health and function, and including those in long-term care.

Highlights

Projections of health and social care need are highly sensitive to assumptions about cohort trends in health and disability
Projections of health and social care need are highly sensitive to assumptions about trends in health and disability, whether life expectancy is increasing slower than healthy life expectancy [1]
The improvement is due to a reduction in refusals, from 175 (20%) in the base cohort to 138(16%) in the new cohort

Summary

Introduction

Projections of health and social care need are highly sensitive to assumptions about cohort trends in health and disability. Despite improved levels of functioning in the US, recent cohorts have higher levels of self-reported health problems and diseases [12,13] and more objectively measured markers of disease [14] These mixed trends have been reported in the UK by analyses of the General Household Survey for 1977–1994, which reports increased prevalence of chronic illness, but similar levels of self-rated health and ADL disability across cohorts in early old age in England and Wales [15], and by analyses of those aged 75 years and over in the Melton Mowbray Ageing Project where decreases in ADL disability were accompanied by increases in less than good self-rated health [16]. The latter predicts that reductions in mortality may well be accompanied by increases in chronic disease but that the resulting disability may be less severe, as observed by a number of studies [13]

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Discussion

Conclusion