Active Life Expectancy Research Articles

Estimating the number and length of episodes in disability using a Markov chain approach

BackgroundMarkov models are a key tool for calculating expected time spent in a state, such as active life expectancy and disabled life expectancy. In reality, individuals often enter and exit states recurrently, but standard analytical approaches are not able to describe this dynamic. We develop an analytical matrix approach to calculating the expected number and length of episodes spent in a state.MethodsThe approach we propose is based on Markov chains with rewards. It allows us to identify the number of entries into a state and to calculate the average length of episodes as total time in a state divided by the number of entries. For sampling variance estimation, we employ the block bootstrap. Two case studies that are based on published literature illustrate how our methods can provide new insights into disability dynamics.ResultsThe first application uses a classic textbook example on prednisone treatment and liver functioning among liver cirrhosis patients. We replicate well-known results of no association between treatment and survival or recovery. Our analysis of the episodes of normal liver functioning delivers the new insight that the treatment reduced the likelihood of relapse and extended episodes of normal liver functioning. The second application assesses frailty and disability among elderly people. We replicate the prior finding that frail individuals have longer life expectancy in disability. As a novel finding, we document that frail individuals experience three times as many episodes of disability that were on average twice as long as the episodes of nonfrail individuals.ConclusionsWe provide a simple analytical approach for calculating the number and length of episodes in Markov chain models. The results allow a description of the transition dynamics that goes beyond the results that can be obtained using standard tools for Markov chains. Empirical applications using published data illustrate how the new method is helpful in unraveling the dynamics of the modeled process.

Disability-Free Life Trends at Older Ages: Implications for Longevity Risk Management

Longevity risk, which is typically portrayed as the problem of people outliving their assets, can be viewed as both an aggregate and an individual-level issue. A related issue is that of ‘active life,’ an individual-level phenomenon, or ‘active life expectancy’ (ALE), an aggregate phenomenon. During their lifetimes, members of a covered population may alternate between ‘active’ and ‘disabled’ status; the average amount of time spent in the ‘active’ state is, for the cohort, its ‘active life expectancy.’ ALE does not appear to have consequences for aggregate longevity risk, but it may have major implications at the individual level. A transition from active to disabled status may signal a shorter-than-expected remaining lifetime, with implications for the speed at which one should draw down one’s assets. Moreover, those with severe care needs but lacking access to family-provided care and long-term care insurance may find that they need to draw down their assets in order to achieve eligibility for Medicaid-funded care services. Indeed, Medicaid and family-provided elder care can be viewed as a particular form of ‘public-private partnership’ for sharing the risks of late-life care needs.

Falling behind the Rest? China and the Gender Gap Index

China’s rank falling in the Global Gender Gap Index of the World Economic Forum has aroused the domestic scholar’s controversy. Based on the data provided by the Global Gender Gap Report, this article will describe the gender inequality in China by comparing its overall index scores and scores in the fields of economic participation and opportunity, education attainment, health and survival, and political empowerment with other countries, and then examining the reasons for China’s falling in rank through the score changes of sub-dimensions and indicators. Analysis of the data suggests that China has not kept up with the rate of improvement in the overall index, and in the four fields, compared to the original 112 countries, the upper-middle income countries, and the Asian and Pacific countries. Over the 13 years covered by the report, China’s score experienced a rapid improvement from 2006 to 2009 and a decline after 2013. China’s high sex ratio at birth, further expansion of gender inequality in active life expectancy, and an enlarged gender gap in secondary education caused China’s lagging overall score and ranking. In addition, the inclusion of measures such as secondary education enrollment, political empowerment, and other indicators also led to the backward ranking of China to some extent.

要介護データを用いた二次医療圏レベルの健康寿命（平均自立期間）の算出および関連要因の探索

要介護データを用いた二次医療圏レベルの健康寿命（平均自立期間）の算出および関連要因の探索

Salud, sexo y comportamiento sexual: la esperanza de vida sexual activa

ObjectiveTo measure sexually active life expectancy (SALE) estimating the average age at which sexually active life finishes, paying special attention to the older population. Variations in SALE according to self-rated health are examined. MethodDescriptive analysis with cross-sectional data. SALE was calculated for the population by age group (30 to 80 years old) and sex using the Sullivan Method, with data from the Human Mortality Database and the National Survey of Sexual Health (Spain). The analysis distinguishes between individuals that have had coital sex in the last year and those who have not. ResultsCoital activity continues in those aged from 55-59 years old, the SALE is 13.3 years in males and 8 in females. Coital activity is related to health and sexual health, diverging depending on sex and age group. The males showed a more extended sexually active trajectory than the females, but were also more influenced by good general health (adding 2.6 and 1 years respectively) and good sexual health (5.2 and 4.3 years). SALE also varies when poor health (subtracting 2.7 years and adding 2 years) and poor sexual health (subtracting 2.9 and 1.3 years) are considered. Conclusionsthe results reveal that sexual health programmes must be extended to the older ages, given that it is confirmed that sexual activity continues in old age.

The Role of Underweight in Active Life Expectancy Among Older Adults in Japan.

It is underweight, rather than overweight or obesity, that has been a pressing public health concern in Japan. This study examines the impact of being underweight on the health of older Japanese men and women, measured by active life expectancy at age 65. Following the Japanese government's guideline, underweight in this study is defined using the body mass index (BMI) value of 20. Data came from five waves (1999-2009) of the Nihon University Japanese Longitudinal Study of Aging (NUJLSOA). We used the Interpolation of Markov Chain approach to estimate the number of years underweight (BMI < 20), normal weight (20 < BMI < 25), and overweight (25 < BMI) individuals were expected to live without difficulty in activities of daily living (ADLs) or instrumental ADLs. We found differences in life and health expectancies across the three weight categories. Underweight people were expected to live the shortest lives and spend the fewest years in an active state compared with normal and overweight individuals. Results remained unchanged even when accounting for educational attainment, smoking history, and a count of existing chronic conditions. Being underweight is associated with poor quality of life lived among Japanese older adults. This finding suggests the importance of maintaining proper weight and avoids nutritional risks at advanced ages.

Age and cohort trajectories of gender inequality in health among elderly people in China

ABSTRACT Using a multistate model, this article examines gender gap and its trend in health transition, life expectancy (LE), and active life expectancy (ALE) in different age groups and birth cohorts. The transition rate from life independence/disability to death for elderly women is lower than for elderly men. However, their disability rate is higher. The gender gap in LE, ALE, and DLE (disabled life expectancy) declines as age increases. In successive birth cohorts, men’s LE increases more, and gender gaps in LE and ALE decrease over time. In the future, gender issues should be considered for health-care policy to provide nursing care for elderly women in China.

Educational differences of healthy life expectancy among the older adults in China: A multidimensional examination using the multistate life table method

ABSTRACTHealthy life expectancy (HLE) is an emerging field in aging studies. Nevertheless, understanding of HLE from the perspective of socioeconomic status (SES) is inadequate. To fill this gap, the present study explores differences in HLE by SES based on two nationally representative longitudinal databases in China. The study adopts education as a proxy of SES and employs the multistate life table method to compute HLE. Health is measured by the following four indicators: physical function, cognitive function, depression, and self-rated health. The results show that educational differences are associated with significantly different results in these four health indicators. Active life expectancy, cognitive-impairment-free life expectancy, and self-rated healthy life expectancy differ by existence of educational attainment among the old adults, with the nonilliterate group enjoying both longer cognitive-impairment-free life expectancy and self-rated healthy life expectancy, while unexpectedly, the illiterate group has a higher active life expectancy at most ages. In contrast, depression-free life expectancy is similar between the two educational categories. The positive association between educational attainment and cognitive-impairment-free life expectancy and self-rated healthy life expectancy might be explained by the beneficial effect of education in improving and maintaining cognitive ability and SES, while the negative association between educational attainment and active life expectancy might be interpreted by the higher rate of mortality and the absence of social-security support among less educated Chinese senior citizens. The lack of difference by educational attainment in depression-free life expectancy requires further investigation.

Management of The Elderly Cancer Patients Complexity: The Radiation Oncology Potential.

Radiation oncology has the potential to be an excellent option for the frail elderly cancer patients because of its limited systemic toxicities. It can be effective for curative, prophylactic, disease control or palliative purposes. Currently about 60% of all cancer patients undergoing active treatment at some point receive radiation treatment. However, though widely used, there are limited clinical trials strictly designed for the elderly. This paper will review the key points in the assessment and treatment of elderly cancer patient including quality of life, active life expectancy, cognitive performance, frailty, sarcopenia and how the new technologies can help to reach the key goal of maintaining autonomy and independence for the elderly cancer patient.

Changing Impact of Obesity on Active Life Expectancy of Older Americans.

The rise in the number and earlier age of onset of obese persons has raised critical concerns about consequences of obesity; however, recent evidence suggests that the impact of obesity on health outcomes may have changed. This study aims to assess the change of the impact of obesity on active life expectancy among Americans aged 70 years and older over almost two decades, 1993-1998 to 2010-2014. For each period, we use three waves of data from the Health and Retirement Study to estimate age-specific transition probabilities between health states. The average number of years active and disabled is calculated with Interpolated Markov Chain software based on estimated transition probabilities. Overall obesity and severe obesity increased markedly over time yet active life expectancy expanded for all individuals and the increases are greater among the obese and women. Increases in total and active life expectancy occurred because of the changing association of obesity with disability and mortality. Individuals at age 70 years in the later period in each weight group could expect to live a smaller proportion of remaining life with activities of daily living disability than those in the earlier period. High levels of obesity continue to have significant adverse effects on the quality of life. The increasing prevalence of severe obesity and the growing number of older persons may result in substantial additional health care needs and costs. Continued effort to improve cardiovascular health is required to control the burden of obesity in later life in an era of rising obesity.

Long-term effect of community-based continence promotion on urinary symptoms, falls and healthy active life expectancy among older women: cluster randomised trial.

BackgroundThe long-term effectiveness of group continence promotion delivered via community organisations on female urinary incontinence, falls and healthy life expectancy remains unknown.MethodsA pragmatic cluster randomised trial was conducted among 909 women aged 65–98 years with urinary incontinence, recruited from 377 community organisations in the UK, Canada and France. A total of 184 organisations were randomised to an in-person 60-min incontinence self-management workshop (461 participants), and 193 to a control healthy ageing workshop (448 participants). The primary outcome was self-reported incontinence improvement at 1-year. Falls and gains in health utility were secondary outcomes.ResultsA total 751 women, mean age 78.0, age range 65–98 completed the trial (83%). At 1-year, 15% of the intervention group versus 6.9% of controls reported significant improvements in urinary symptoms, (difference 8.1%, 95% confidence intervals (CI) 4.0–12.1%, intracluster correlation 0.04, number-needed-to-treat 13) and 35% versus 19% reported any improvement (risk difference 16.0%, 95% CI 10.4–21.5, number-needed-to-treat 6). The proportion of fallers decreased from 42% to 36% in the intervention group (−8.0%, 95% CI −14.8 – −1.0) and from 44% to 34% in the control group (−10.3%, 95% CI −17.4 – −3.6), no difference between groups. Both intervention and control groups experienced a gain in health utility (0.022 points (95% CI 0.005–0.04) versus 0.035 (95% CI 0.017–0.052), respectively), with no significant difference between groups.ConclusionCommunity-based group continence promotion achieves long-term benefits on older women’s urinary symptoms, without improvement in falls or healthy life expectancy compared with participation in a healthy ageing workshop.

Biological, Psychological, and Social Predictors of Longevity Among Utah Centenarians.

Studies of longevity among centenarians examine biological, psychological, and social factors, yet few consider these components concurrently. This study explores such factors individually and collectively, as they are related to days lived past the age of 100 years. Data from 268 family members of centenarians identified in the State of Utah between 2008 and 2015 were used in negative binomial models predicting number of days lived among the centenarians. Findings suggested that sleep latency (biological), life satisfaction (psychological), and attachment closeness (social) were predictive factors of more days lived within individual models. When considered together, sleep latency and life satisfaction remained significant predictors of days lived. Although biological factors are commonly considered in relation to longevity, this study further indicates that psychological and social factors may play important roles in life expectancy. Further examination is needed to explore how these factors link additionally to active life expectancy.

BENEFITS OF AEROBIC EXERCISE TRAINING WITH RECOMMENDATIONS FOR HEALTHY AGING

The purpose of this article is to provide an overview on the importance of aerobic exercise and its characteristics for healthy aging. The first section briefly reviews the effects of aging on maximal aerobic power; Section 2 considers the effects of aerobic exercise training, and Section 3 summarizes the recommendations and some limitations of the current guidelines for aerobic exercise training. Physical activity cannot stop the biological aging processes; however, there is evidence that regular aerobic exercise can minimize the physiological effects of an otherwise sedentary lifestyle and increase active life expectancy by limiting the development and progression of chronic disease and disability conditions. The use of moderately standardized guidelines for exercise prescription resulted in safe and effective impact on health-related outcomes.

EFFECT OF OBESITY ON ACTIVE LIFE EXPECTANCY IN THE UNITED STATES: CHANGES OVER TIME

In recent decades, life expectancy increase has slowed in the United States. Also, there have been striking increases in the prevalence of obesity, decreases in the age of obesity onset, and increases in the length of time people are living with obesity. In addition, the link between obesity and mortality appears to have weakened in more recent years. These trends indicate value in revisiting the links between obesity and active life expectancy. Building on earlier work using HRS data from 1993 to 1998 for the 70 plus population in the United States, we use HRS data from 2004 through 2008 to examine how the links between obesity, mortality, disability and subsequent active life expectancy have changed. We find that in the later cohort obesity is less related to mortality, more to disability, and remains a strong determinant of active life.

Dietary Supplements as Surrogate of Mediterranean Diet in Healthy Smoking Subjects.

The interventions to slow aging, favoring active life expectancy, represent the new perspectives in ageing investigation. Some mechanisms that delay or prevent the onset of aging pathologies have been identified. Between them, a healthy lifestyle seems to reduce many risk factors. In particular, eating habits represent the most concrete, low-cost way to act on aging process. Mediterranean diet has received much attention since its antioxidant and anti-inflammatory effects have been consistently demonstrated. Unfortunately, many people follow a Western diet, poor in phytochemicals that represent the main source of beneficial effects of this dietary pattern. So, supplements administration should be considered, especially in subjects exposed to high level of oxidative stress and inflammation. So, we tested the properties of a commercial food supplement containing a series of plant polyphenols in combination with caffeine, bioperine (black pepper extract), and selenium in smoking healthy volunteers. Fifty participants have been recruited and hematochemical analyses and biochemistry tests have been performed, before and after 60 days of supplement intake. Thirteen subjects dropped out of the study. At the end of the intervention, the variation of inflammatory and oxidant markers has been evaluated, measuring urinary isoprostanes, serum advanced glycation end products, and oxidized low-density lipoproteins. The results showed that this supplement exhibits promising antioxidant and anti-inflammatory responses, especially in women, highlighting the role of supplementation in certain groups of subjects, for the control of oxidative stress as well as inflammatory status. So, its intake should be useful in delaying the onset of age-related diseases.

Healthy ageing – happy ageing: Health Promotion for Older People in Italy

Health Promotion for Older People (HP4OP) is a relevant issue in Italy, one of the countries where people live the longest. Strategies, programmes and projects are set and planned at the national level, mainly by the Ministry of Health within the National Health Service, but strong competencies, funds and resources derive also from the Government, the Ministry of Labour and Social Policies and the Ministry of Internal Affairs. Moreover, European funds contribute to programmes and projects in this field. After strategic implementation at the regional level, programmes and projects are carried out at the local level under the National Health Service, mainly by the Local Health Authorities in conjunction with municipalities and other relevant stakeholders such as NGOs, the voluntary sector, families and educational and religious entities, etc. Even though Italy has been engaged in HP4OP to improve active life expectancy since 1992, a lack of planning and resources for HP4OP, policy diversification at the regional level and a prevailing interest in care-assistance rather than health promotion and prevention have prevented consistent implementation of HP4OP throughout the country.

Health status and years of sexually active life among older men and women in South Africa

Little is known about sexual activity in old age, particularly in Africa. The objective of this paper is to estimate years of sexually active life for older men and women, and examine the association between sexual activity and self-rated health status. Data were extracted from two large cross sectional HIV household surveys conducted in 2005 and 2012 in South Africa. The Sullivan method was used to estimate sexually active life expectancy, whilst logistic regression was used to assess associations with sexual activity. Sexually active life expectancy was higher among men across all the age groups in both surveys. At age 50, the sexually active life expectancy for men was double that for women – 2005 (12.6 vs. 5.9 years), 2012 (12.7 vs. 7.2 years). Self-rated health was significantly associated with sexual activity in men (adjusted Odds Ratio (aOR) 1.56; 95% CI 1.11-2.19; p<0.001). Among older women, moderate exercise was associated with being sexual active, while HIV infection was significantly associated with reduced sexual activity. The presence of chronic conditions was also significantly associated with reduced sexual activity among men. The results confirm that older adults are sexually active, and that factors associated with sexual activity are different for men and women. HIV among women and chronic conditions among men are areas of intervention to improve sexual activity in older people.

Moxie matters: associations of future orientation with active life expectancy

ABSTRACTObjective: Being oriented toward the future has been associated with better future health. We studied associations of future orientation with life expectancy and the percentage of life with disability.Method: We used the Panel Study of Income Dynamics (n = 5249). Participants’ average age in 1968 was 33.0. Six questions repeatedly measured future orientation, 1968–1976. Seven waves (1999–2011, 33,331 person-years) measured disability in activities of daily living for the same individuals, whose average age in 1999 was 64.0. We estimated monthly probabilities of disability and death with multinomial logistic Markov models adjusted for age, sex, race/ethnicity, childhood health, and education. Using the probabilities, we created large populations with microsimulation, measuring disability in each month for each individual, age 55 through death.Results: Life expectancy from age 55 for white men with high future orientation was age 77.6 (95% confidence interval 75.5–79.0), 6.9% (4.9–7.2) of those years with disability; results with low future orientation were 73.6 (72.2–75.4) and 9.6% (7.7–10.7). Comparable results for African American men were 74.8 (72.9–75.3), 8.1 (5.6–9.3), 71.0 (69.6–72.8), and 11.3 (9.1–11.7). For women, there were no significant differences associated with levels of future orientation for life expectancy. For white women with high future orientation 9.1% of remaining life from age 55 was disabled (6.3–9.9), compared to 12.4% (10.2–13.2) with low future orientation. Disability results for African American women were similar but statistically significant only at age 80 and over.Conclusion: High future orientation during early to middle adult ages may be associated with better health in older age.

Disability-Free Life Expectancy Over 30 Years: A Growing Female Disadvantage in the US Population

To examine changes in active life expectancy in the United States over 30 years for older men and women (aged ≥ 65 years). We used the 1982 and 2004 National Long Term Care Survey and the 2011 National Health and Aging Trends Study to estimate age-specific mortality and disability rates, the overall chances of survival and of surviving without disability, and years of active life for men and women. For older men, longevity has increased, disability has been postponed to older ages, disability prevalence has fallen, and the percentage of remaining life spent active has increased. However, for older women, small longevity increases have been accompanied by even smaller postponements in disability, a reversal of a downward trend in moderate disability, and stagnation of active life as a percentage of life expectancy. As a consequence, older women no longer live more active years than men, despite their longer lives. Neither a compression nor expansion of late-life disability is inevitable. Public health measures directed at older women to postpone disability may be needed to offset impending long-term care pressures related to population aging.

New Characteristics of Active Life Expectancy of the Elderly in China

Life expectancy of the elderly is a significant problem in China, and it changes not only the health care, but also the pension. This study used tracking data from the Chinese Urban and Rural Elderly Population Survey to calculate the age-specific Active Life Expectancy (ALE) of the Chinese elderly population aged 60 years and over. For analysis, this population was divided into different sub-populations according to gender, census register and region. The main conclusions of our study are as follows: 1) The quality of life for elderly males may be greater than that for elderly females; 2) There were significant differences in Active Life Expectancy (ALE) and Inactive Life Expectancy (ILE) between urban and rural elderly; 3) The differences in ALE between the eastern, central and western regions of China were not significant; and 4) The increased remaining life expectancy of the elderly was mainly attributed to the extended ALE in the lower age group and the expanded ILE in the higher age group. This study expands the knowledge of Chinese elderly’s life expectancy in different health status.