Active Life Expectancy Research Articles

Women's reproductive risk score and healthy lifestyle modification in cardiovascular disease: Findings from the UK Biobank

Background and aimsReproductive risk factors are associated with increased risk of cardiovascular disease (CVD) in women. However, the combined effects of the composite reproductive risk factors on CVD are unknown. This study was performed to construct a reproductive risk score (RRS) to measure reproductive status, examine the association between RRS and CVD, and explore the modification effect of healthy lifestyle on the association in women in the UK Biobank cohort. MethodsThe RRS was constructed in 74,141 female participants with data about the items derived for the RRS in the UK Biobank. The RRS was derived from 17 baseline variables, all of which indicated women's reproductive health status. We defined four categories of RRS status: low-risk group (score 0–1); low-intermediate group (score 2–3); high-intermediate group (score 4–5); and high-risk group (score 6–13). We also constructed a healthy lifestyle score (HLS) with five related factors, and categorized into unhealthy lifestyle group (score: 0–1), intermediate lifestyle group (score: 2–3) and healthy lifestyle group (score: 4–5). ResultsEach point increase in the RRS was associated with a 22 % higher risk of CVD (adjusted hazard ratio (aHR): 1.22; 95 % confidence interval (CI): 1.16 to 1.28), 23 % higher risk of IHD (1.23; 1.17 to 1.31) and 19 % higher risk of stroke (1.19; 1.07 to 1.32). The percentage population-attribution risks (PAR%) were 16 % (95 % CI: 8 to 24) for CVD, 15 % (95 % CI: 6 to 24) for IHD and 18 % (95 % CI: 1 to 33) for stroke. A healthy lifestyle significantly attenuated RRS associations with the incidence of CVD and IHD. The attributable proportions due to additive interaction (p < 0.001) between RRS and HLS were 0.14 (95 % CI: 0.07 to 0.22) for CVD and 0.15 (95 % CI: 0.09 to 0.23) for IHD, respectively. ConclusionsHigh RRS was associated with increased risks of CVD, IHD and stroke in female participants in the UK Biobank. The early-stage identification of women with reproductive risk using synthesised indicators and appropriate healthy lifestyle interventions could be useful for the prevention of early CVD and the extension of healthy active life expectancy.

Mathematical Modeling Of The Active Life Expectancy Among The Famous Soviet Mathematicians

The author carried out the mathematical modeling of the longevity index among the famous mathematicians who had most of active life years during the existence of the Soviet Union. Based on a sample of statistical data, the probability distribution and density functions for the longevity of mathematicians who were born or worked in the Soviet Union were created. Modeling was done using polynomial functions through the Excel regression analysis tool. A comparative analysis of the probability distribution functions for the longevity of famous Soviet mathematicians and mathematicians who lived in different countries in the 20th century was performed.

Dual Functionality in Later Life.

Gerontologists have long shown interest in both longevity and quality of life during later life, but considerable debate has ensued as scholars sought to integrate the two. Drawing from research on the topics of exceptional longevity, successful aging, and active life expectancy, we propose the concept of dual functionality to examine how humans reach advanced ages while maintaining physical and cognitive function. Dual functionality refers to being free of both physical and cognitive impairment. The loss of dual functionality challenges social networks to respond to the functional loss and is a harbinger of additional losses. Evidence of change in the percent of the older population maintaining dual functionality would be helpful for evaluating public health policies to aid quality of life during later life. This article is based on the first author's Robert W. Kleemeier Award Lecture at The Gerontological Society of America 2022 Annual Scientific Meeting.

CHRONIC DISEASE AND LIFE EXPECTANCY DISPARITIES OF OLDER ADULTS IN SINGAPORE

Abstract Singapore is one of the countries with longest life expectancy, also one of the most rapidly ageing societies in the world. This study investigates the future demographic transitions in Singapore, focusing on the life expectancy disparities of the older adults. We developed a dynamic Markov microsimulation model based on the Singapore Multi-Ethnic Cohort study. The model was adapted to project future trends of chronic diseases, mental illnesses as well as hospitalisation costs of Singapore older people from 2020 to 2050. The prevalences of diabetes, heart disease, hypertension, stroke, disability, dementia and depression of people aged 51 and above was projected to be increasing. Overall projected life expectancy at age 51 for male is 27.8 years, and for female is 34.5 years. Moreover, for older people with secondary or upper education, the overall projected life expectancy at age 51 is 34.1 years, active life expectancy at age 51 is 28.6 years. For older people with primary or lower education, the overall life expectancy at age 51 is projected to be 27.9 years, and active life expectancy projected to be 23.9 years. Our study has significant social and economic implications for policymakers in the way that it demonstrates disparate trends in aging and costs among different education groups in Singapore.

Subjective Well-Being and Active Life Expectancy in Japan: Evidence From a Longitudinal Study.

Existing research has suggested that older adults in Japan enjoy phenomenal physical health status, but they have poor subjective well-being (SWB). Limited empirical evidence exists, however, on how physical health and SWB intersect and are linked to the lives of older men and women in Japan. Using the concept of health expectancy, this study examines the role of SWB, as measured by life satisfaction, in the mortality and morbidity experiences of Japanese adults aged 65 years and older. We used the nationally representative Nihon University Japanese Longitudinal Study of Aging, 1999-2009. Our measurement of morbidity is disability, based on difficulty in activities in daily living (ADLs) and instrumental ADLs. We use the Interpolation of Markov Chains approach to compute life expectancy (LE), LE without disability (active LE), and LE with differing severity of disability for those who are satisfied with life and for those who are not. We documented significant differences in LE and active LE by the state of life satisfaction among older adults in Japan. Men and women who are satisfied with life are expected to live longer and spend more years without having disability compared to those who are not satisfied. We found no differences in the length of life with disability of differing severity by the state of life satisfaction. Our results highlight the important role of SWB at older ages in Japan, because it is directly related to the physical health of its aging population. Fully understanding the health of the older population requires research that focuses on both objective and subjective dimensions of well-being.

New Advances in Supportive Care: Chemoprotective Agents as Novel Opportunities in Geriatric Oncology.

To explore the effectiveness of trilaciclib and ALRN-6924 in the prevention of cancer chemotherapy-induced toxicity in older patients. New chemoprotective agents are necessary because age is the main risk factor for chemotherapy complications that account largely for the poorer outcome of cancer in the elderly. Trilaciclib and ALRN-6924 cause a reversible block of the proliferation of normal cells through cell cycle arrest (CCA). With this mechanism, they may prevent the toxicity of cycle-active cancer treatment including neutropenia, anemia, thrombocytopenia, lymphopenia, mucositis, and alopecia. Myelopoietic growth factors may prevent neutropenia in the aged, but they may cause severe bone pain, may aggravate thrombocytopenia and anemia, and may cause myelodysplasia and acute leukemia as a late complication. The prevention of thrombocytopenia, anemia, mucositis, and alopecia is unsatisfactory at present. These complications may jeopardize the treatment outcome as they require a reduction of treatment dose/intensity and because many patients find the resulting symptoms intolerable. In three studies of patients with extensive disease small cell lung cancer (ES-SCLC), trilaciclib reduced the severity and duration of neutropenia and thrombocytopenia as well as the need for blood transfusions. In addition, it produced a significant expansion of T-cell clones. Trilaciclib received FDA approval for the prevention of chemotherapy-induced myelosuppression in patients with ES-SCLC. ALRN-6924 is currently studied in phase II study of ES-SCLC. In a phase IB of 38 patients, ALRN-6924 prevented myelosuppression to an extent comparable with trilaciclib. Both drugs proved as effective in patients 65 and older as they were in the younger ones. In an "ex vivo" study, ALRN-6924 protected the epithelial stem cells of hair follicles from taxanes and promised to prevent alopecia. The possibility that CCA of tumor cells may reduce the effectiveness of cycle-active chemotherapy is a major concern. For this reason, the use of trilaciclib, an inhibitor of CDK 4/6, should be limited to tumors with inactivated RB1, and the use of ALRN-6924, an inhibitor of P53, should be limited to tumors with inactivated P53. Chemotherapy-related toxicities limit dose intensity and contribute to significant morbidity and mortality in elderly cancer patients. Trilaciclib and ALRN-6924 are of particular interest to geriatric oncologists because of their novel mechanism of action. Ameliorating chemotherapy-induced toxicities holds the promise of transforming the practice of geriatric oncology by enabling chemotherapeutic regimens that are currently not feasible for this patient population. Specifically, these agents may prevent chemotherapy-induced neutropenia and thrombocytopenia, perhaps the most life-threatening complications of cytotoxic chemotherapy, thereby obviating the need for the use of rescue strategies such as hematopoietic growth factors. In addition, these agents offer the potential for broad tissue protection from other chemotherapy-related toxicities, including mucositis, diarrhea, and alopecia, which historically have been poorly managed. Importantly, by preventing a spectrum of chemotherapy-related toxicities, these agents may permit the administration of chemotherapy at full-dose intensity, prevent functional decline, and grant maintenance of resilience to older cancer patients. As a result, the successful prevention of chemotherapy-induced side effects may not only mitigate the costs of care but also improve patient outcomes and quality of life. Finally, chemoprotective strategies offer the opportunity to apply geriatric principles to clinical trials of cancer treatment. In particular, they may allow the testing of prolongation of "active life expectancy" as a major goal of clinical trials in elderly patients. They may also enable novel and more practical forms of clinical trials. By assessing the risk of chemotherapy-related toxicity with the Chemotherapy Risk Assessment Scale for High Age Patients (CRASH) or the Cancer and Aging Research Group (CARG) instruments, these agents may permit researchers to utilize patients as their own controls and endorse the approval of supportive care drugs based upon the risk profile of individual patients.

The impact of long-term conditions on disability-free life expectancy: A systematic review.

Although leading causes of death are regularly reported, there is disagreement on which long-term conditions (LTCs) reduce disability-free life expectancy (DFLE) the most. We aimed to estimate increases in DFLE associated with elimination of a range of LTCs. This is a comprehensive systematic review and meta-analysis of studies assessing the effects of LTCs on health expectancy (HE). MEDLINE, Embase, HMIC, Science Citation Index, and Social Science Citation Index were systematically searched for studies published in English from July 2007 to July 2020 with updated searches from inception to April 8, 2021. LTCs considered included: arthritis, diabetes, cardiovascular disease including stroke and peripheral vascular disease, respiratory disease, visual and hearing impairment, dementia, cognitive impairment, depression, cancer, and comorbidity. Studies were included if they estimated HE outcomes (disability-free, active or healthy life expectancy) at age 50 or older for individuals with and without the LTC. Study selection and quality assessment were undertaken by teams of independent reviewers. Meta-analysis was feasible if three or more studies assessed the impact of the same LTC on the same HE at the same age using comparable methods, with narrative syntheses for the remaining studies. Studies reporting Years of Life Lost (YLL), Years of Life with Disability (YLD) and Disability Adjusted Life Years (DALYs = YLL+YLD) were included but reported separately as incomparable with other HE outcomes (PROSPERO registration: CRD42020196049). Searches returned 6072 unique records, yielding 404 eligible for full text retrieval from which 30 DFLE-related and 7 DALY-related were eligible for inclusion. Thirteen studies reported a single condition, and 17 studies reported on more than one condition (two to nine LTCs). Only seven studies examined the impact of comorbidities. Random effects meta-analyses were feasible for a subgroup of studies examining diabetes (four studies) or respiratory diseases (three studies) on DFLE. From pooled results, individuals at age 65 without diabetes gain on average 2.28 years disability-free compared to those with diabetes (95% CI: 0.57-3.99, p<0.01, I2 = 96.7%), whilst individuals without respiratory diseases gain on average 1.47 years compared to those with respiratory diseases (95% CI: 0.77-2.17, p<0.01, I2 = 79.8%). Eliminating diabetes, stroke, hypertension or arthritis would result in compression of disability. Of the seven longitudinal studies assessing the impact of multiple LTCs, three found that stroke had the greatest effect on DFLE for both genders. This study is the first to systematically quantify the impact of LTCs on both HE and LE at a global level, to assess potential compression of disability. Diabetes, stroke, hypertension and arthritis had a greater effect on DFLE than LE and so elimination would result in compression of disability. Guidelines for reporting HE outcomes would assist data synthesis in the future, which would in turn aid public health policy.

Is there compression or expansion of morbidity in the Philippines?

This study contributes to previous initiatives examining healthy and active aging in the Philippines. We employed the Sullivan method to calculate healthy life expectancy (HLE) and active life expectancy (ALE) using the 2007 Philippine Survey on Aging and the 2018 Longitudinal Study of Ageing and Health. We compared the estimates at two time points, providing evidence of change over time. There was no statistically significant change in the relative proportion of HLE over time for both sexes, suggesting dynamic equilibrium. For men, the increase in life expectancy was mainly an increase in unhealthy state (UHLE). The slight increases in HLE for all ages were not statistically significant. The differences in relative increase in HLE were not statistically significant. HLE for women increased over time, with statistically significant increases at ages 60 and 70 years. ALE declined in all age groups for both sexes, but the decline was statistically significant only among women in their 60s and 70s. There was also a statistically significant decline in the proportion of remaining life in an active state for all ages among both men and women, suggesting an expansion of morbidity. Findings suggest no evidence of compression of morbidity in the Philippines from 2007 to 2018. The HLE results suggest a dynamic equilibrium, while ALE results indicate an expansion of morbidity. The findings emphasize the need for the government to promote life course interventions that foster healthy choices and conduct further research to understand the factors influencing longevity and active aging in the Philippines. Geriatr Gerontol Int 2022; 22: 511-515.

Association between self-reported body mass index and active life expectancy in a large community-dwelling sample of older U.S. adults

BackgroundObesity may have a protective effect (greater survival) in older adults, a finding known as the “obesity paradox.” This study examined the association between self-reported body mass index (BMI) and active life expectancy (ALE) among older U.S. adults.MethodsUsing the Medicare Health Outcomes Survey Cohort 15 (2012 baseline, 2014 follow-up), we estimated life expectancy and ALE by participants’ baseline BMI and age using multi-state models. A participant was classified as in an active state if this person reported having no difficulty for any of these six activities of daily living (ADLs).ResultsSmall differences in life expectancy were noted among persons in normal weight (BMI 18.5–24.9 kg/m2), overweight (BMI 25–29.9 kg/m2), and obesity ranges (BMI 30 kg/m2 and higher). However, persons with obesity had a significantly lower ALE. ALE at age 65 was 11.1 (11.0–11.2) years for persons with obesity, 1.2 (1.1–1.3) years less than that for the normal weight and overweight persons (12.3 years for both, 12.2–12.4). Persons with class III obesity had a significantly lower life expectancy and ALE than normal weight persons. Although persons with class I or II obesity had a similar life expectancy as normal weight persons, they have a shorter ALE.ConclusionsAlthough older adults with obesity have a similar life expectancy as normal weight persons, they have a significantly shorter ALE. Given the complex relationship of BMI and ALE, a “one size fits all” approach to weight management is not advisable.

Changes in Health Expectancy for Older Adults in Japan: Results from Two Longitudinal Surveys

Background: Although there is evidence of improvements in health expectancy among the Japanese population, existing estimates are based on the prevalence of morbidity taken from cross-sectional survey data. Objectives: This study employed a multistate life table approach to compute incidence-based health expectancy measures, namely active and inactive life expectancy (LE), for two longitudinal survey cohorts from 1990 to 2009. Methods: This study used data from two longitudinal surveys of older adults in Japan: the National Survey of the Japanese Elderly (1990–1999) and the Nihon University Japanese Longitudinal Study of Aging (1999–2009). We employed the Interpolation of Markov Chains technique to compute the number of years at age 65 years to be spent with and without difficulty in performing activities of daily living (ADLs) or instrumental ADLs. Results: We documented significant increases in active LE for men and women at age 65 years over the 10-year study period. There were significant changes in total LE for men and in the percentage of active life for women. Inactive LE did not significantly change across the two survey cohorts during the study period. Conclusions: Our results show that the health status of older adults in Japan has largely improved over the 10-year study period, with increases in both the duration of life and time spent in an active state. This finding offers evidence of compression of morbidity among older men and women in Japan.

Demographic Profile of the Population Residing in the Metals and Mining Areas in the European Part of the Arctic Zone of the Russian Federation

Introduction: The relevance of the study is determined by the national goals of strategic development providing for sustainable population growth and an increase in active life expectancy, primarily in demographically disadvantaged areas to which most of the regions of the Russian Arctic Zone belong. Objective: To assess changes in the demographic structure of the Murmansk Region, one of the most industrially developed regions of the Russian Arctic, and the loss of its labor potential in 1989–2019 in order to substantiate the necessity to consider these changes for better planning of health care and adjusting the resource provision of the regional health care system. Materials and methods: We studied demographic characteristics of the population residing in administrative areas of the Murmansk Region with the main town-forming metals and mining enterprises by comparing data for 1989 with those for the years 1999, 2009, and 2015–2019 to establish trends in medical demography situation. The average age of the population was estimated as the arithmetic mean based on distribution of the population by age groups. Results: We established a significant decrease in the size of population of the Murmansk Region in 1989–2019 (by 34.8 %) accompanied by changes in the demographic profile. The increase in the average age of the population was attributed to the sharp decline in the child population, a decrease in the number of people of working age (16–59 years), and a significant increase in the population of older age groups. Changes in the age structure of the population had a significant effect on the old age dependency ratio, which demonstrated a 2.7 and 3.2-fold increase over the three 1989-to-2019 decades in the region and its industrial monotowns, respectively. Conclusion: The negative structural demographic trend resulted in a pronounced regressive regional age and sex pyramid, which by 2019 had a characteristic unstable shape with a relatively narrow base and a slope of its top to the left due to the significant predominance of the female population in the older age group. The observed changes in the demographic profile of the population suggest the need to consider this trend when planning local social policy including the volume and resource provision of health care services.

Association Between Neighborhood Disadvantage and Functional Well-being in Community-Living Older Persons

Neighborhood disadvantage is a novel social determinant of health that could adversely affect the functional well-being of older persons. Deficiencies in resource-poor environments can potentially be addressed through social and public health interventions. To evaluate whether estimates of active and disabled life expectancy differ on the basis of neighborhood disadvantage after accounting for individual-level socioeconomic characteristics and other prognostic factors. This prospective longitudinal cohort study included 754 nondisabled community-living persons, aged 70 years or older, who were members of the Precipitating Events Project in south central Connecticut from March 1998 to June 2020. Disability in 4 essential activities of daily living (bathing, dressing, walking, and transferring) was assessed each month. Scores on the Area Deprivation Index, a census-based socioeconomic measure with 17 education, employment, housing quality, and poverty indicators, were obtained through linkages with the 2000 Neighborhood Atlas. Area Deprivation Index scores were dichotomized at the 80th state percentile to distinguish neighborhoods that were disadvantaged (81-100) from those that were not (1-80). Among the 754 participants, the mean (SD) age was 78.4 (5.3) years, and 487 (64.6%) were female. Within 5-year age increments from 70 to 90, active life expectancy was consistently lower in participants from neighborhoods that were disadvantaged vs not disadvantaged, and these differences persisted and remained statistically significant after adjustment for individual-level race and ethnicity, education, income, and other prognostic factors. At age 70 years, adjusted estimates (95% CI) for active life expectancy (in years) were 12.3 (11.5-13.1) in the disadvantaged group and 14.2 (13.5-14.7) in the nondisadvantaged group. At each age, participants from disadvantaged neighborhoods spent a greater percentage of their projected remaining life disabled, relative to those from nondisadvantaged neighborhoods, with adjusted values (SE) ranging from 17.7 (0.8) vs 15.3 (0.5) at age 70 years to 55.0 (1.7) vs 48.1 (1.3) at age 90 years. In this prospective longitudinal cohort study, living in a disadvantaged neighborhood was associated with lower active life expectancy and a greater percentage of projected remaining life with disability. By addressing deficiencies in resource-poor environments, new or expanded social and public health initiatives have the potential to improve the functional well-being of community-living older persons and, in turn, reduce health disparities in the US.

Functional outcomes of arthroscopic transosseous rotator cuff repair using a 2-mm tape suture in a 137-patient cohort.

BackgroundAlthough being the historical gold standard for rotator cuff repair, open transosseous (TO) repair was largely replaced by anchor-based methods with the advent of arthroscopic surgery owing to their comparative ease of use. However, suture anchors are at risk of dislodgement, especially among older patients, who have more osteopenic bone or those presenting large tears. Considering the ever-increasing active life expectancy and associated increased quality of life expectations by older generations, the need to offer safe and efficient surgical treatments to these patients imposes itself. Arthroscopic TO repairs would combine the best of both worlds and be well adapted to these populations. The primary objective of this study was to evaluate the functional outcome and complication rate of the TO arthroscopic repair technique when using a 2-mm braided suture tape. The secondary objective of this study was to assess functional outcome of TO repair in older patients and patients with >3-cm tears.MethodsOne hundred thirty-seven consecutive patients with full-thickness rotator cuff tear who underwent arthroscopic TO (anchorless) rotator cuff repair between January 2011 and December 2013 were reviewed. The surgery was performed by a single surgeon with a reusable curved suture passer and 2-mm braided tape suture. Follow-up was 3 to 5 years (mean = 50 months). All patients underwent preoperative and postoperative functional assessments (American Shoulder and Elbow Surgeons and Quick Dash) and were questioned with their overall satisfaction.ResultsThirty-eight (28%) of the 137 patients were 65 years and older, and 62 (45%) had a large or massive tear. One patient (0.7%) had early retear at the suture-tendon interface after trauma 3 weeks postoperatively. The average Quick Dash score improved by 55.6 points and the average American Shoulder and Elbow Surgeons score improved by 69.7 points 3.5 and 6.3 times their minimal clinically important differences, respectively. There was no significant difference in final functional outcomes between patients 65 years and older and younger patients or between patients with large and massive (>3 cm) and smaller tears (≤3 cm). Mean operative time was 68 min ± 16.ConclusionsArthroscopic TO repair using a 2-mm tape material has achieved significant mid-term functional improvement, with results statistically unaffected by larger tear size (>3 cm) or older age (≥65 years).

Loneliness and health expectancy among older adults: A longitudinal population-based study.

The population health impact of loneliness remains unknown. We quantified the impact of loneliness on total life expectancy (TLE) and health expectancy (the duration of remaining life lived in different health states) among older adults, aged ≥60 years. Multistate life table analysis of a nationally representative longitudinal survey. Singapore. Survey participants (n=3449) interviewed in 2009, 2011-12, and 2015. Health states were defined using self-rated health (SRH) status and activity of daily living (ADL)/instrumental ADL (IADL) status. Participants with somewhat or very unhealthy SRH were considered as unhealthy. Those reporting health-related difficulty with any ADL/IADL were considered to have limitation in ADLs/IADLs. TLE and health expectancy (healthy and unhealthy life expectancy (HLE and UHLE) in the context of SRH, and active and inactive life expectancy (ALE and IALE) in the context of ADLs/IADLs) were estimated using the multistate life table method with a microsimulation approach, considering loneliness as time varying. At age 60, 70, and 80, those sometimes lonely or mostly lonely generally had shorter TLE, HLE and ALE, similar UHLE and IALE, and a higher proportion of remaining life with unhealthy SRH or with ADL/IADL limitations versus those never lonely. For example, at the age of 60, those sometimes lonely versus never lonely had shorter TLE (by 5.4 [95% Confidence Interval: 3.4-7.9] years), shorter HLE (by 5.9 [4.1-8.6] years), similar UHLE (difference: 0.6 [-0.7-1.7] years), and higher proportion of remaining life with unhealthy SRH (by 6.2 [1.2-10.8] percentage points). For those mostly lonely versus never lonely, TLE was shorter by 3.6 (0.7-6.6) years, HLE was shorter by 4.8 (2.3-8.2) years, UHLE was similar (difference: 1.2 [-0.1-4.0] years), and proportion of remaining life with unhealthy SRH was higher by 7.2 (2.1-18.1) percentage points. Identification and management of loneliness may increase years of life with healthy SRH and without limitation in ADLs/IADLs among older adults.

Trends in health expectancies: a systematic review of international evidence

ObjectivesA clear understanding of whether increases in longevity are spent in good health is necessary to support ageing, health and care-related policy.DesignWe conducted a systematic review to update and summarise...

Multidimensional healthy life expectancy of the older population in China

Research on healthy life expectancy (HLE) that considers cognitive impairment has been inadequate, particularly in the context of less developed countries. Using data from the China Health and Retirement Longitudinal Study, our study fills this research gap by computing active life expectancy (ALE), cognitive-impairment-free life expectancy (CIFLE), and active and cognitive-impairment-free life expectancy (ACIFLE) for China’s older population, using multistate life tables. Results show that at age 60, the three life expectancies were 19.4 years (ALE), 9.5 years (CIFLE), and 8.8 years (ACIFLE) during the period 2011–13. HLE exhibits significant differentials by sex, urban/rural residence, educational level, marital status, and health status at age 60. Among China’s older people, males and those living in urban areas experience higher CIFLE, and those who live with a spouse, are more educated, and are healthy at age 60 expect more years in good health according to all three HLE measures. Supplementary material for this article is available at: https://doi.org/10.1080/00324728.2021.1914854

Cumulative Effects of Physical Activity, Dietary Variety, and Social Participation on Active Life Expectancy

Regular physical activity, dietary variety, and active social participation are modifiable and influential factors of adverse health outcomes. However, the cumulative effects of these behaviors are unknown. We examined these cumulative associations with active life loss in older adults. We analyzed 3-year longitudinal data from 7246 initially non-disabled residents aged 65-84 years from 18 districts of Ota City, Tokyo. Sufficiency of moderate- to vigorous-intensity physical activity (MVPA) of ≥150 minutes/week, dietary variety score (DVS) of ≥3, and social participation of ≥1 time/month were assessed using self-administered questionnaires. We operationally defined active life loss for individuals as being newly certified for long-term care insurance or death without prior certification. Multilevel survival analyses were applied to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). During an average follow-up of 2.9 years, the cumulative incidence of active life loss was 11.3% (817 individuals: 650 new certifications and 167 deaths without prior certification). Multivariate-adjusted HRs (95% CIs) for active life loss were 0.73 (0.58-0.92) in only MVPA of ≥150 minutes/week, 0.88 (0.67-1.15) in only DVS of ≥3, 0.75 (0.51-1.09) in only social participation of ≥1 time/month, 0.56 (0.45-0.70) in the group satisfying any two, and 0.52 (0.40-0.67) in the group satisfying all three behaviors, compared with a reference group that did not satisfy any of the behaviors. Sensitivity analysis that excluded active life losses during the first year showed similar results. The combination of regular physical activity, dietary variety, and social participation further enhances the effects on active life expectancy than individual practices.

Inequalities in Trends in Healthy and Disability-Free Life Expectancies: A Systematic Review

To update previous reviews, we searched Medline, Embase, Scopus and the Office for National Statistics (ONS) website for studies and reports published after 2016 that describe trends in healthy life expectancy, active life expectancy or disability-free life expectancy (DFLE) in the UK and other OECD high-income countries. We focus here on studies reporting inequalities by socioeconomic position (SEP) in these trends. There was mixed evidence of educational and area-level deprivation inequalities in trends in DFLE, with four studies indicating that educational inequalities were widening in European countries. No studies were identified that examined inequalities in disability-free life expectancy trends in the UK. All studies were based on cross-sectional data from multiple time points or longitudinal panel studies. We discuss the size of inequalities in DFLE between SEP groups and the limitations of previous studies.

Life expectancy and active life expectancy by disability status in older U.S. adults.

The Medicare Health Outcome Survey (HOS) is the largest longitudinal survey of the U.S. community-dwelling elderly population. This study estimated total life expectancy, active life expectancy (ALE), and disability-free life expectancy (DFLE) by disability status among HOS participants. Data were from the Medicare HOS Cohort 15 (baseline 2012, follow-up 2014). We included respondents aged ≥ 65 years (n = 164,597). Participants' disability status was assessed based on the following six activities of daily living (ADL): bathing, dressing, eating, getting in or out of chairs, walking, and using the toilet. The multi-state models were used to estimate life expectancy, ALE, and DFLE by participants' baseline disability status and age. Persons who had higher-level ADL limitations had a shorter life expectancy, ALE, and DFLE. Also persons with disability had greater expected life years with disability than those with no limitations and those with mild limitations. For example, among 65-year old respondents with no limitations, mild limitations, and disability, life expectancy was 19.9, 18.6, and 17.1 years, respectively; ALE was 14.0, 9.5, and 7.2 years, respectively; DFLE was 17.3, 15.2, and 11.4 years, respectively; and expected years with disability was 2.6, 3.4, and 5.7 years, respectively. This study demonstrated that greater levels of disability adversely impact life expectancy, ALE, DFLE, and expected number of years with a disability among U.S. older adults. Understanding levels of disability, and how these may change over time, would enhance health care quality and planning services related to home care and housing in this community-dwelling population.

Life expectancy and active life expectancy by marital status among older U.S. adults: Results from the U.S. Medicare Health Outcome Survey (HOS).

BackgroundPrevious investigations of the relationship between marital status and life expectancy and healthy life expectancy rely on the assumption that participants will remain in a given marital status until death. This study estimated total life expectancy (TLE) and active life expectancy (ALE) for respondents by their baseline marital status using a large longitudinal sample of the U.S. community-dwelling elderly population.MethodsData were from the Medicare Health Outcomes Survey Cohort 15 (2012 baseline, 2014 follow-up). We included respondents aged ≥65 years (n = 164,597). Multi-state models estimated TLE and ALE by marital status to allow participants’ marital status to change during the remaining lifetime.ResultsBetween 65 and 85 years, married men and women had a longer TLE and ALE than unmarried men and women. For example, at 65 years, TLE for married men was 18.6 years, 2.2 years longer than unmarried men, and ALE for married men was 12.3 years, 2.4 years longer than unmarried men. Similarly, at 65 years, TLE for married women was 21.1 years, 1.5 years longer than unmarried women, and ALE for married women was 13.0 years, 2.0 years longer than unmarried women. Such marriage protection effects decreased with age. In subgroups of unmarried persons, never married persons had the shortest TLE and ALE among men, and never married, divorced, and widowed persons had a similar, and shorter, TLE and ALE among women. The difference in TLE between married and unmarried persons was smaller after adjusting for baseline activity limitation status.ConclusionsThis study provides additional evidence for marriage's protective effect, with the magnitude of protection being greater for younger as compared to older persons. Selection bias was a large contributor to longer life expectancy among married persons.