Active Life Expectancy Research Articles

Cohort Changes in Active Life Expectancy in the U.S. Elderly Population: Experience From the 1982-2004 National Long-Term Care Survey

To understand declines in chronic disability prevalence in the U.S. elderly population, we examined cohort changes in active life expectancy, a health measure relating population disability and longevity dynamics. We computed active life expectancy and life expectancy using the six National Long-Term Care Surveys done from 1982 to 2004 and linked to continuous-time Medicare service data for the same time period by using a stochastic process model based on disability scores calculated using grade of membership analyses. We simultaneously estimated continuous-time disability dynamic and mortality functions to calculate life tables for specific disability states and for temporally changing mixtures of disability states. Disability dynamics, measured as changes in grade of membership scores, showed significant variation across two birth cohorts followed for 24 years. Disability dynamics and disability-specific hazard functions were significantly improved in the younger cohort (persons aged 65-74 in 1982). Our results, supporting the hypothesis of morbidity compression, indicate that younger cohorts of elderly persons are living longer in better health. The methods describe individual disability transitions and mortality and other factors associated with disability changes, making it possible to better evaluate interventions to promote future declines in disability.

Mentoring Junior Faculty in Geriatric Oncology: Report From the Cancer and Aging Research Group

Mentoring Junior Faculty in Geriatric Oncology: Report From the Cancer and Aging Research Group

Active Life Expectancy of Filipino Older People

Active Life Expectancy of Filipino Older People

The Impact of Depressive Symptoms and Chronic Diseases on Active Life Expectancy in Older Americans

The authors prospectively examined whether depressive symptoms (DS) in older adults negatively affected active live expectancy (ALE), or remaining years free of disability, and mortality, independently and in the presence of chronic diseases, and after stratification by gender. Prospective cohort study, first three waves (1993-1998) of the Asset and Health Dynamics Among the Oldest Old. University of Michigan; analysis: University of South Florida. Nationally representative sample of community-dwelling adults age 70 and older (N = 7,381). DS (Center for Epidemiological Studies Depression, 8-item version), self-reported cancer, diabetes, heart disease, or stroke, difficulty with activities of daily living, death, and estimates of total, active, and disabled life expectancy. DS reduced ALE by 6.5 years for young-old men (age 70), 3.2 years for old-old men (age 85), 4.2 years for young-old women, and 2.2 years for old-old women, and these effects remained significant at all ages and across gender even after controlling for chronic disease, the one exception being DS and cancer in old-old women. DS also reduced total life expectancy significantly, although controlling for some chronic diseases (particularly cancer and stroke) eliminated the effect of DS across age and gender groups. Depressive symptoms represent a serious and distinct threat to independent functioning in older adults. Whether experienced alone, or in combination with chronic diseases, depressive symptoms shorten ALE substantially. Timely diagnosis and treatment of depressive symptoms in older adults may delay the onset of disability and improve the quality of life.

Active Life Expectancy and Functional Health Transition among Filipino Older People

The study provides a baseline information on the functional health transition patterns of older people and computes for the Active Life Expectancy (ALE) using a multistate life table method. Findings on ALE demonstrate that females and urban residents live longer and have a greater proportion of their remaining life in active state compared to their counterparts. Health transition analysis indicates a significant proportion experiencing recovery. Age, sex, place of residence and health status/behavior indicators (self-assessed health, drinking and exercise) display a significant influence on future health and mortality trajectories although surprisingly, education did not show any significant effect.

Weight, mortality, years of healthy life, and active life expectancy in older adults.

To determine whether weight categories predict subsequent mortality and morbidity in older adults. Multistate life tables, using data from the Cardiovascular Health Study, a longitudinal population-based cohort of older adults. Data were provided by community-dwelling seniors in four U.S. counties: Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Allegheny County, Pennsylvania. Five thousand eight hundred eighty-eight adults aged 65 and older at baseline. The age- and sex-specific probabilities of transition from one health state to another and from one weight category to another were estimated. From these probabilities, future life expectancy, years of healthy life, active life expectancy, and the number of years spent in each weight and health category after age 65 were estimated. Women who are healthy and of normal weight at age 65 have a life expectancy of 22.1 years. Of that, they spend, on average, 9.6 years as overweight or obese and 5.3 years in fair or poor health. For both men and women, being underweight at age 65 was associated with worse outcomes than being normal weight, whereas being overweight or obese was rarely associated with worse outcomes than being normal weight and was sometimes associated with significantly better outcomes. Similar to middle-aged populations, older adults are likely to be or to become overweight or obese, but higher weight is not associated with worse health in this age group. Thus, the number of older adults at a "healthy" weight may be much higher than currently believed.

Long and happy living: Trends and patterns of happy life expectancy in the U.S., 1970–2000

This study assesses the trends and differentials in length of quality life in the U.S. population as measured by happy life expectancy in 1970, 1980, 1990, and 2000. The analysis combines age-specific prevalence rates of subjective well-being from a large nationally representative survey and life table estimates of mortality in decennial Census years. Employing the period prevalence-rate life table method—Sullivan method, the analysis finds evidence for improvement in quality of life in the U.S. Happy life expectancy largely increased in both absolute terms (number of years) and relative terms (proportion of life) over time at all adult ages examined. And increases in total life expectancy were mainly contributed by increases in expectancy in happy years rather than unhappy years. Happy life expectancy is longer than active life expectancy. And there has been greater compression of unhappiness than compression of morbidity. There are substantial differentials in happy life expectancy by sex and race because of differential prevalence rates of happiness. Women and whites had longer years of total and happy life expectancies at most ages and dates, while men and blacks had greater proportions of happy life expectancies across the three decades. Although race differentials generally decreased at older ages and with time, relative disadvantages of blacks persisted.

Preventive home visitation programmes for older people: the role of municipality organisation.

The organisational influence on benefits of preventive home visitation programmes for older people has escaped scientific evaluation. This study aims to investigate organisational structures and processes in relation to preventive home visits. As part of a randomised controlled trial investigating whether educational intervention towards municipality health care professionals could enhance active life expectancy, information of municipality leadership, home visit approach, strengths and limitations of communication within the organisation were obtained using individual and focus group interviews. Thirty-four municipalities in four counties participated. Data was systematically condensed using a phenomenological approach upon which general patterns were categorised into a theory-based formal typology of the preventive home visitation management in the municipalities. Three distinct strategies for preventive home visitation programmes were identified. Eighteen municipalities were categorised as "Framework Management", 15 as "Management by Rules" and one as "Project Management". Small municipality size was associated with the "Framework Management" type. "Management by Rules" municipalities had higher population densities and their overall expenses for older people were higher. "Framework Management" municipalities used more resources on preventive home visits, communicated better, experienced less staff changing and had higher social capital than "Management by Rules" municipalities. Municipality structures and management processes of preventive home visitation programmes varied considerably in 34 Danish municipalities, but the majority could be categorised as using either a "Framework Management" or a "Management by Rules" strategy. Each strategy is associated with particular advantages and disadvantages, which may explain differences in the overall benefit of the programme between municipalities.

Was there compression of disability for older Americans from 1992 to 2003?

Medical advances and the growth of the elderly population have focused interest on trends in the health of the elderly. Three theories have been advanced to describe these trends: compression of morbidity, expansion of morbidity, and dynamic equilibrium. We applied multistate life table methods to the Medicare Current Beneficiary Survey to estimate active and disabled life expectancy from 1992 to 2003, defining disability as having difficulty with instrumental activities of daily living or activities of daily living. We found increases in active life expectancy past age 65 and decreases in life expectancy with severe disability. These trends are consistent with elements of both the theory of compression of morbidity and the theory of dynamic equilibrium.

Geriatric Oncology: A Field Coming of Age

A saying within oncology is: If you’re not a pediatric oncologist, you’re a geriatric oncologist. Maybe while not literally true, this phrase is recognition that all of the subspecialties of oncology are rapidly becoming a field that will be primarily concerned with the care of older patients. While there is not one precise definition of the age of geriatric patients, it is clear that the aging of our society has necessitated a focus on this segment of the population. It has long been recognized that the most significant risk factor for the development of cancer is increasing age. This, together with epidemiologic shifts, has resulted in a marked increase in the number of older patients with cancer, which will markedly increase the cancer burden to the world. It may also compromise the life expectancy, as well as the active life expectancy, of older individuals. Cancer and cancer treatment may appear as several of the prime causes, not only of mortality, but also of disability, in older individuals. The traditional ways in which cancer is studied—by clinical trials focusing on younger, healthier patients—has left us devoid of useful data with which to treat older patients in an evidenced-based fashion. Not only have these earlier trials failed to establish the relative efficacy of cancer treatment in the elderly, but they also were unable to provide information related to the shortand long-term complications of treatment including decline in function. Among the first to recognize this issue was Dr Rosemary Yancik, who in 1983 organized a symposium sponsored by the National Cancer Institute and the National Institute on Aging, which resulted in a monograph, “Perspectives on Prevention and Treatment of Cancer in the Elderly.” The conference reached a number of conclusions and set a research agenda (Tables 1 and 2). In the 1988 American Society of Clinical Oncology (ASCO) Presidential Address, Dr B.J. Kennedy encouraged the study of aging and cancer. He stated “ . . .our society need not ration how we will treat our disadvantaged members, but should continue to seek those preventive and positive measures that can shorten our later period of morbidity. A very major cancer load will persist well into the 21st century, even if the attempts at prevention are eventually a total success. There is a developing knowledge on aging. Care of the older person needs to be part of medical education and oncology education. Research will help attain a desirable quality of life with aging and a reduced morbidity.” Since that time, studies of older cancer patients have revealed a significant amount of important clinical information. This has included the degree and severity of comorbidity and its effect on treatment, the role of polypharmacy, and the various social and financial problems facing older patients with cancer. The relative and absolute under-representation of older patients in clinical trials has been amply documented. The adverse outcomes of inadequate dosing and supportive care in both curative and palliative treatments have been demonstrated in a number of treatment settings. Even when clinical trials are available, barriers to participation of older patients have been shown to be primarily due to physician reluctance due to fear of toxicity, limited expectation of benefit, or ageism. A number of important strides have been made in the evaluation of older patients through various methodologies of geriatric assessment. The Comprehensive Geriatric Assessment developed by geriatricians is a multidisciplinary evaluation of the older patient encompassing a number of important clinical domains. Researchers in this area have shown that traditional oncology measures of performance are not adequate in older patients and that geriatric specific measures, such as activities of daily living and instrumental activities of daily living, have a much greater predictive value. Table 1. Prospects for Cancer Control in the Elderly

Indonesia’s social capacity for population health: the educational gap in active life expectancy

In this paper, we lay the initial groundwork for anticipating Indonesia’s future burden of disease by developing a demographic model of population health. We develop this model within the analytic framework of a Markov-based multistate life table model to calculate an important indicator of the burden of disease, the expected years of active life of elderly Indonesians. The magnitude of the gap points to the potential consequences of improvements in the nation’s educational level for the future burden of disease. The results show that having some education increases life expectancy but it also expands the expected years with a major functional problem. Overall educational attainment levels, however, are very low, indicating that Indonesia’s elderly are at the leading edge of improvements in the nation’s social capacity for health. The life tables suggest that at the early stages of development, longer life is accompanied by an expansion of morbidity.

Skeletal muscle aging

Average world life expectancy has seen a dramatic rise over the last two centuries although active life expectancy remains relatively unchanged. One reason for this is that aging results in skeletal muscle becoming smaller, weaker and more susceptible to contraction-induced injury. By the age of 70, muscle strength is reduced by around 30–40% and this can have catastrophic effects on quality of life. Despite a vast amount of research into age-related changes in skeletal muscle, the exact mechanisms responsible for this is still unclear and thus treatments to preserve muscle function with aging remain elusive.

Active life expectancy of the elderly population in a city of the Tohoku district in Japan

6) Objective: The purpose of this study was to determine the active life expectancy (ALE) of residents aged 65 and older from a city of Tohoku District in Japan based on changes in their Activities of Daily Living (ADL) over the course of three years, taking into account the ADL functional recovery rate. Methods: According to the method of Andrei Rogers, et aI., the survey was conducted twice using a Questionnaire covering Questions as to ADL independence. The life table was prepared based on the transition probability of ADL by age for the subject populations to determine the average life expectancy and ALE. Results: Among the independent persons surveyed first, the average life expectancy was 18.7 and 23.5 years for 65-year-old males and females, respectively. When the ADL functional recovery rate was taken into account, the ALE stood at 17.2 and 20.7 years for males and females at the age of 65, respectively. Assuming that the difference between the average life expectancy and ALE represents the duration of dependence, it was calculated to be 1.5 and 2.8 years for 65-year­ old males and females, respectively. Conclusion: Comparison of the average life expectancy and ALE with other areas already reported revealed that the inhabitants of the city studied had a long average life expectancy and ALE, and a comparatively short duration of dependence.

Disability and Active Life Expectancy Among Older Cambodians

Older adults in Cambodia are survivors of harsh living conditions, including poverty and periods of extreme violence. Although these experiences may affect health outcomes, little data has existed to monitor Cambodia's older population. The current paper uses data from the 2004 Study of the Elderly in Cambodia (SEC) and focuses on disability status. The data is the first of its kind for Cambodia—a comprehensive survey employing a representative sample of adults 60 and older living across the country. Disability prevalence by age and sex, Active Life Expectancy (ALE) and common correlates of disability, using Activity of Daily Living (ADL) items, are examined. In addition, disability prevalence rates are compared to those for older adults living in other countries in South-east Asia. The results indicate that older Cambodians are more disabled than their counterparts living elsewhere. Possible reasons include long-term influence of social disruption and poverty. Women live longer than men, but spend a greater proportion of their remaining life in states of disability and severe disability. Correlates of disability show that younger age, being male, having higher income satisfaction, being married and living in urban areas associate with lower probabilities of reporting disability. A contribution of the analysis is the examination of a basic measure of health among a population of which little is known.

Trends in active life expectancy in Germany between 1984 and 2003—a cohort analysis with different health indicators

Aim This article examines trends in active life expectancy and their dependency on indicators of health using data from the German Socio-Economic Panel (GSOEP).

Cancer in the Elderly Population: The Protection Racket

For the past century, patients of older age have constituted one of the substantially underserved populations in cancer care, 1 a puzzling dichotomy when one considers that cancer is classically a disease of the older population and that the proportion of these patients in the community is increasing. 2 The reasons for this imbalance are protean— older patients are traditionally conservative, have a somewhat nihilistic view of cancer treatment, and often have fewer resources needed to gain optimal care. The situation has been compounded by the medical protectionism that has been fostered by the government—in the past, studies of the National Cancer Institute (Bethesda, MD) have excluded patients over the age of 65 or 70 years, few provisions have been made for the additional requirements for participation in clinical trials by older patients, and government agencies have interfered with the implementation of studies focused on them by limiting the aggression of proposed treatment protocols in favor of more conservative, gentler regimens. In addition, physicians have been notoriously reluctant to refer older patients for clinical trials, and as a result of governmental disincentives, have avoided designing trials specifically for older patients. It is clear that the use of optimal treatment for curable cancers in elders is ultimately much less morbid than the implementation of attenuated strategies that sacrifice the chance of cure in exchange for reduced acute toxicity. Although this is particularly important in the management of localized disease, our studies from more than 15 years ago showed quite clearly that chemotherapy can be very useful in curing or palliating elderly populations with advanced cancer. 3,4 The choice of treatment must be predicated on consideration of the untreated natural history of the disease, the efficacy and toxicity of the proposed treatment, and the active life expectancy and comorbidities of the patient— essentially a costbenefit analysis. In the setting of advanced disease, the efficacy and toxicity of treatment are influenced by several factors, including age, comorbidity and organ function, other medications, and adherence to medication schedules. Unfortunately, this information is not available for many of the drugs available for cancer treatment in very elderly populations, largely because the acquisition of these data requires time and commitment on the part of investigators and patients. The investigators of Cancer and Leukemia Group B are to be complimented for their creativity in modifying pharmacologic sampling schedules, and thus in completing this important study that shows the variability of pharmacokinetics of paclitaxel in older patients, with the general reduction of clearance of this agent with increasing age. 5 However, there was no attempt at direct comparison

Long-Term Trends in Life Expectancy and Active Life Expectancy in the United States

Changes in life expectancy and in active life expectancy may have effects on the fiscal integrity of both the Social Security and Medicare programs. Analysis of the fiscal stability of these programs shows that the most serious problem may be the growth of Medicare expenditures projected to surpass, in about 2024, Social Security costs. This is aggravated by the associated rapid growth of the Medicaid program. To understand how the growth of Medicare, Medicaid, and Social Security might be correlated we present estimates of changes in life expectancy and active life expectancy from 1935 to 1999 and then project those values to 2080. How the correlation of life expectancy and active life expectancy changes over time, and by age, may provide insights into how increased health care expenditures, if effective in changing health in the elderly, could modify the age structure of the labor force and the availability of human capital.

Does the Hot Spring Contribute to the Active Life Expectancy?

Does the Hot Spring Contribute to the Active Life Expectancy?

Estimates of active life expectancy based on the data of the public nursing-care insurance in Mie prefecture

Estimates of active life expectancy based on the data of the public nursing-care insurance in Mie prefecture

Scientific aspects of ageing: a lordly report

Scientific aspects of ageing: a lordly report