Longevity Expectations Research Articles

How Do Subjective Longevity Expectations Influence Retirement Plans?

Increasing life expectancy has made working longer both more necessary and more possible, but the relationship between an individual’s survival expectations and his planned retirement age is unclear in the existing literature. This study uses the Health and Retirement Study and an instrumental variables (IV) approach to examine how subjective life expectancy influences planned retirement ages and expectations of working at older ages, and how individuals update those expectations when they receive new information. The estimates in this paper suggest a large and statistically significant relationship between subjective life expectancy and retirement expectations: a one-standard-deviation increase in optimism about living to ages 75 or 85 is associated with an 8-percent to 24-percent increase over the mean probability of working at these ages. Actual retirement behavior also increases with subjective life expectancy, but the relationship is somewhat weaker. Our IV estimates using parents’ longevity as instruments are largely consistent with our reduced form estimates, strengthening the conclusion that subjective life expectancy impacts both retirement planning and actual retirement behaviors. Finally, we find that increases over time in subjective life expectancy are associated with increases in the probability of planning to work at ages 62 and 65. The results further our understanding of how survival and retirement expectations are “anchored” to the previous generation’s experience and suggest how targeted efforts at increasing knowledge about rising life expectancy may increase the proportion of younger cohorts who decide to work longer.

How Do Subjective Longevity Expectations Influence Retirement Plans?

Increasing life expectancy has made working longer both more necessary and more possible, but the relationship between an individual’s survival expectations and his planned retirement age is unclear in the existing literature. This study uses the Health and Retirement Study and an instrumental variables (IV) approach to examine how subjective life expectancy influences planned retirement ages and expectations of working at older ages, and how individuals update those expectations when they receive new information. The estimates in this paper suggest a large and statistically significant relationship between subjective life expectancy and retirement expectations: a one-standard-deviation increase in optimism about living to ages 75 or 85 is associated with an 8-percent to 24-percent increase over the mean probability of working at these ages. Actual retirement behavior also increases with subjective life expectancy, but the relationship is somewhat weaker. Our IV estimates using parents’ longevity as instruments are largely consistent with our reduced form estimates, strengthening the conclusion that subjective life expectancy impacts both retirement planning and actual retirement behaviors. Finally, we find that increases over time in subjective life expectancy are associated with increases in the probability of planning to work at ages 62 and 65. The results further our understanding of how survival and retirement expectations are “anchored” to the previous generation’s experience and suggest how targeted efforts at increasing knowledge about rising life expectancy may increase the proportion of younger cohorts who decide to work longer.

Subjective mortality hazard shocks and the adjustment of consumption expenditures

I estimate the effect of shocks to subjective mortality hazards on consumption expenditures of retired individuals using the Survey of Health, Ageing and Retirement in Europe. I measure mortality expectations with survey responses on survival probabilities. To create plausibly exogenous variation in mortality hazard, I use the death of a sibling as an instrument. My results show that survey responses contain economically relevant information about longevity expectations and confirm the predictions of life-cycle theories about the effect of these expectations on intertemporal choice.

Explaining Optimistic Old Age Disability and Longevity Expectations

Biased health care decision making has been regarded as responsible for inefficient behaviours (for example, the limited insurance purchase). This paper empirically examines two sets of biases in the perception of old age disability and longevity. Particularly, we test for the existence of a so called cumulative bias and, secondly’ a so called optimism’ bias. Findings are suggestive of a significant overestimation of disability risks but no overestimation of longevity expectations is found. Both disability and longevity perceptions appear to exhibit a ‘cumulative’ pattern when mapped over time. Healthier individuals are less likely to perceive high disability and longevity risks whilst female and younger respondents perceive a higher risk of disability in old age at a population level but not at an individual level.

Age‐related changes in semen quality characteristics and expectations of reproductive longevity in Duroc boars

Quadratic fitting was used to regress semen characteristics of 1441 samples consisting of 12-month collection from 58 Duroc boars against animal age varied from 10 to 80 months. Data was divided into two groups of cool (14.0-22.7 degrees C, RH 81.5%) and hot season (22.9-29.9 degrees C, RH 86.6%), to test effects of age, season and their interactions. Results revealed that young boars of around 1 year old could endure the hot season. The endurance gradually diminished as animals grew. In the hot season animals exhibited peak performance at age around 33 month and it remained for 1 month, while cool-season kept boars could last for 48 months from 16 months old onward. The reproductive longevity should be 51 month in a subtropical environment and it may extend to 70 month if heat stress can be avoided. The estimated total sperm contribution of a Duroc boar would be 1.8 times more when kept below 22 degrees C than in a natural subtropical environment. It is concluded that to maintain Duroc boars as semen donor to at least 4 years of age is feasible in a subtropical environment and boar longevity could reach 6 years old if well kept in a temperate region.

Subjective mortality expectations and consumption and saving behaviours among the elderly

Abstract Life expectancy is an important factor that individuals have to take into account for saving and consumption choices. The life‐cycle model of consumption and saving behaviour predicts that consumption growth should decrease with higher mortality rates. The aim of this study is to test this hypothesis based on data about subjective longevity expectations from the Health and Retirement Study merged with detailed consumption data from two waves of the Consumption and Activities Mail Survey. This study finds that an increase in subjective mortality by 1% corresponds to an annual decrease in consumption of non‐durable goods of around 1.8%.

Permanent Atrial Pacing Lead Implant Route after Fontan Operation

Atrial pacing is indicated for sinus node dysfunction (SND) after Fontan surgery; preferred lead implantation technique is debated. We compare outcomes of transvenous (TV) and epicardial (Epi) atrial lead implants in this population. Retrospective review of Fontan patients undergoing atrial lead implant between 1992 and 2007. Demographics, lead performance data, and outcomes were analyzed. 78 patients had 90 leads implanted: 25 via TV route and 65 via Epi route. Median follow-up was 1.6 years (TV) and 3.6 years (Epi). TV leads were implanted in older patients (23.1 vs 9.3 years, P < 0.001) and at longer intervals after Fontan (15.2 vs 4.9 years, P < 0.001). Pacing indication for most TV leads was SND, while Epi leads were also indicated for atrioventricular block. Acute complication rates were similar (8% TV vs 19% Epi, P = 0.23), but median hospital stay was shorter for TV (2 vs 5 days, P = 0.03). Thrombus was observed in five patients (two in TV; three in Epi), but no thromboembolic events were observed. Mean lead survival was similar (TV 9.9 vs Epi 7.8 years, P = NS). Energy threshold was lower at implant for TV leads (0.9 vs 2.2 microJ, P = 0.049), but similar at follow-up (1.2 vs 2.6 microJ, P = 0.35). Atrial sensing was unchanged over time for TV (2.2 to 2.1 mV, P = NS), but decreased for Epi (3.3 to 2.5 mV, P = 0.02). Compared to epicardial leads, transvenous atrial pacing leads may be placed in Fontan patients with lower procedural morbidity and equivalent expectation of lead performance and longevity.

Selective site pacing in paediatric patients--technology or function?

This editorial refers to 'Selective-site pacing in paediatric patients: a new application of the Select Secure system' by F. Cantuet al., on page 601 While the debate about the role of selective site pacing in adults with structurally normal hearts continues, many in the paediatric pacing fraternity have adopted the new technologies available with open arms as a means to address some of the long-standing difficulties associated with pacing infants, children, and young adults. The chal- lenges for endocardial pacing in the paediatric population are many, but include unusual anatomy, smaller access vessels, need for active fixation, need for good manoeuvrability of the lead/delivery system, ability to deal with growth and leads with very high expectations of longevity and reliability. In many ways, a new catheter-delivered

Risk Perceptions, Optimism, and Natural Hazards

This article uses the panel survey developed for the Health and Retirement Study to evaluate whether Hurricane Andrew in 1992 altered longevity expectations of respondents who lived in Dade County, Florida, the location experiencing the majority of about 20 billion dollars of damage. Longevity expectations have been used as a proxy measure for both individual subjective risk assessments and dispositional optimism. The panel structure allows comparison of those respondents' longevity assessments when the timing of their survey responses bracket Andrew with those of individuals where it does not. After controlling for health effects, the results indicate a significant reduction in longevity expectations due to the information respondents appear to have associated with the storm.

Sources of Advantageous Selection: Evidence from the Medigap Insurance Market

We provide evidence of advantageous selection in the Medigap insurance market and analyze its sources. Conditional on controls for Medigap prices, those with Medigap spend, on average, $4,000 less on medical care than those without. But if we condition on health, those with Medigap spend $2,000 more. The sources of this advantageous selection include income, education, longevity expectations, and financial planning horizons, as well as cognitive ability. Conditional on all these factors, those with higher expected medical expenditures are more likely to purchase Medigap. Risk preferences do not appear as a source of advantageous selection; cognitive ability is particularly important.

Time Preference and its Relationship With Age, Health, and Longevity Expectations

Although theories in both evolutionary biology and economics predict that an individual's health should be associated with the individual's time preference, no prior study has been done to empirically support or refute such predictions. By collecting detailed measures of health, time preference, and expected longevity on a sample of individuals in townships around Durban, South Africa, this study breaks new ground by being the first to analyze in detail the relationship between time preference and health, in an area of the world with high mortality and morbidity. Interestingly, we find that both physical health and expectations of longevity have a U-shaped relationship with the person's subjective discount rate. This suggests that those in very poor health have high discount rates, but those in very good health also have high discount rates. Similarly those with longevity expectations on the extremes have high discount rates. The research question addressed by this pilot project is policy relevant, as the study tries to determine the importance of health in economic development, not from the commonly asserted productivity-gain argument, but from a much broader investment-for-the-future argument.

Abstract 2972: Permanent Atrial Pacing Lead Implantation Route After Fontan Operation

Background: Atrial pacing is commonly used for sinus node dysfunction (SND) after Fontan surgery. The preferred route of lead implant has been debated. We compare procedural and clinical outcomes of transvenous (TV) and epicardial (Epi) atrial lead implants in this population. Methods: All Fontan patients having an atrial lead implant without other associated surgery between 1992 and 2007 were studied. Demographics, pacing lead performance data and procedural outcome were retrospectively analyzed. Results: 78 patients (22 TV and 56 Epi) had 90 leads implanted (25 TV/ 65 Epi). Mean follow-up was 3.3±4.1 yrs (TV) and 4.4±3.6 yrs (Epi). TV leads were implanted in older patients (mean age: 23.9 vs. 13.8 yrs, p&lt;0.001), at longer interval after Fontan surgery (mean: 15.1 vs. 5.7 yrs, p&lt;0.001). Indication for TV was more likely to be SND, while Epi pacing was indicated for AV block. Pacing modes were exclusively AAI/AAI-T in TV and mostly DDD in Epi leads. Acute complication occurred in 2/25 (8%) of TV (pneumothorax n=1, skin erosion n=1) and 12/65 (19%, p=0.23) of Epi implants (effusions n=5, heart failure n=1, retained foreign body n=1, pneumothorax n=1, hematoma n=1, disconnection n=1, sepsis n=1, blood loss n=1). Median hospital stay was shorter in TV (2.0 vs 4.5 days, p=0.03). All TV patients and 43 Epi (77%) were anticoagulated. At follow-up, pocket infection occurred in one Epi patient. No clinical thromboembolic event was observed in either group. 3 TV leads failed in 2 patients (9%), while 12 Epi leads failed in 10 patients (18%); however, mean duration of freedom from lead failure was not significantly different (TV 9.9 vs. Epi 8.0 yrs, P=ns). The mean energy threshold was lower at implant for TV leads (0.9 vs 2.2 μJ, P=0.049), but similar for both leads on follow-up (1.2 vs 2.6 μJ, P=0.35). Atrial sensing was unchanged over time for TV (2.2 to 2.0 mV, P=ns), but significantly decreased in Epi (3.4 to 2.4 mV, p=0.006). Conclusions: Transvenous atrial pacing leads may be placed in Fontan patients with lower procedural morbidity than epicardial leads, and equivalent expectation of lead performance and longevity. Although the thromboembolic event rate appears low in anticoagulated patients with both lead types, the present study design cannot fully address this important issue.

Equipment and methods for testing friction couples

Because the outcome of articular implants is directly affected, wear performance of friction couples is one of the most investigated areas of medical devices development. Raw material structures, surface treatments, manufactured surface qualities, and component designs all have potential effects of the overall capability of a particular prosthesis to sustain demanding function and increasing expectations for longevity. This article reviews the various equipments which are used to characterize the friction behaviour of wear couples and joint prosthesis.

Health Information and Subjective Survival Probability: Evidence from Taiwan

The effect of new health information on individuals' expectations about their longevity is examined using a Bayesian learning model. Using two‐period panel‐structured survey data from Taiwan, we find that subjective probabilities of living to age 75 and 85 are significantly smaller for respondents with more abnormal medical test outcomes and for those receiving more extensive advice on health behavior from their physicians. The subjective probability of survival declines with health shocks such as developing heart disease. Using pooled cross‐sectional data, we find that males and married persons are more optimistic about their longevity expectations than females and single persons, and that income is strongly correlated with the subjective probability of living to age 75. Consistent with previous studies, the longevity of the same‐sex parent is strongly associated with an individual's own expectation of living to age 75.

Revision Total Hip Arthroplasty

We evaluated a consecutive series of patients followed for at least 1 year after revision total hip arthroplasty. We surveyed 488 patients treated at three referral centers from 1998 to 2002. An experienced medical interviewer contacted patients and rated their degree of satisfaction with the original and revision arthroplasties, the reason of original arthroplasty failure, and their expectations for revision arthroplasty longevity. Surveys were completed on 320 of the 488 patients (66%). A member of the research team reviewed patients' operative reports, clinical records, and radiographs to determine the diagnosis at revision, procedure performed, and the most likely cause of failure. Patient satisfaction with the primary procedure was directly related to the time to revision. Most patients (214 of 320; 67%) expected their revision to last longer than their primary arthroplasty regardless of revision diagnosis or how long the primary procedure lasted before revision. The surgeons' failure assessments agreed with the patients' failure assessments only 36% of the time. Although the majority of patients (262 of 320; 82%) were satisfied with the results of the revision procedure, most did not agree with their surgeon as to why the original arthroplasty failed, and most had unrealistic expectations regarding revision longevity.

Mobile-bearing Total Knee Arthroplasty

Premature polyethylene wear is a major cause of total knee arthroplasty (TKA) failure. It has been attributed to numerous factors including poor surgical technique, reduced polyethylene thickness, poor locking mechanisms of modular fixed bearing tibial components, gamma irradiation sterilization techniques in the presence of oxygen, and low conformity implant designs. The incidence of implantation of TKA into younger patients who have increased activity requirements and longevity expectations is increasing. This requires continued analysis of design features lessening polyethylene wear. The purpose of this manuscript is to review clinical and basic scientific studies of factors influencing polyethylene wear, focusing on the potential benefits of mobile bearing TKA which potentially reduce long-term polyethylene wear by providing increased implant conformity and reduced polyethylene contact stresses. In vivo kinematic studies have shown self-alignment of the polyethylene bearing with the femoral component typically occurs in rotating platform TKA designs which should hypothetically lessen polyethylene surface stresses, minimize stabilizing post impingement, and increase the potential for enhanced polyethylene longevity.

A model with self-fulfilling prophecies of longevity

In a model where longevity increases with average human capital, self-fulfilling prophecies of ageing can occur. If agents expect a low life expectancy they invest less in education, thus generating low human capital and longevity. As a result, policies that affect longevity expectations may be welfare-improving.

Indications and surgical alternatives for palliation of rectal cancer.

The goals of palliation of rectal cancer are relief of disabling symptoms and maximizing quality of life. Surgical intervention is appropriate in specific situations, where the selected procedure is chosen based on likelihood of achieving these goals, balanced against morbidity and recognition of the patient's limited life expectancy. Locally unresectable rectal cancer may be treated by transanal procedures where obstruction is the major feature; techniques used include local resection, self-expanding metal stents, and laser debulking of tumor where the rectal lumen is compromised. As well, colostomy may be used with or without external beam radiation therapy but is preferred when transanal techniques are unsuitable. Resective techniques such as anterior proctosigmoidectomy and anastomosis, Hartmann's resection, or abdominoperineal rectal excision are preferred in fit patients where local clearance is possible and longevity expectations are deemed reasonable--e.g., six months or more. Decisions for performing restorative procedures are based on risk assessment for anastomotic leak and quality of anal function. In rare cases, palliative exenteration is an option, although controversial. Recognition of contraindications to resection will minimize the risk of disabling or lethal complications of these procedures.

From the stress theory of aging to energetic and evolutionary expectations for longevity.

Stress targets energy carriers. Genes for stress resistance are selected that convey high metabolic efficiency enabling adaptation to the energetically restrictive and hence stressful environments of natural populations. Data from experimental organisms and from humans are consistent with a primary role for stress resistance underlying life span, which provides a hitherto neglected procedure for assaying longevity in natural populations. Taking into account the metabolic consequences of stressful environments, the free-radical theory of aging becomes a general stress theory of aging. A recent derivative, the deprivation-syndrome theory of aging, highlights resource and hence energy shortages. Energy balances under the stress theory of aging are primary for an understanding of the evolutionary limits of longevity of organisms in their habitats. In contrast, well-nourished humans of the modern era, and laboratory, domesticated and island populations are exposed to more benign conditions which appear to provide the background for other evolutionary theories of aging, especially the mutation accumulation and antagonistic pleiotropy theories. In modern human populations where selection for stress resistance is relaxed compared with earlier harsher conditions, substantial future evolutionary extensions to maximum life span may be difficult to attain because of the mutation accumulation process. However there is an urgent need for comparative empirical studies of life-history traits including longevity under benign and harsh environments.

Synergising acute care and palliative care to optimise nursing care in end-stage cardiorespiratory disease

Advances in the practice of medicine and nursing science have increased survival for patients with chronic cardiorespiratory disease. Parallel to this positive outcome is a societal expectation of longevity and cure of disease. Chronic disease and the inevitability of death creates a dilemma, more than ever before, for the health care professional, who is committed to the delivery of quality care to patients and their families. The appropriate time for broaching the issue of dying and determining when palliative care is required is problematic. Dilemmas occur with a perceived dissonance between acute and palliative care and difficulties in determining prognosis. Palliative care must be integrated within the health care continuum, rather than being a discrete entity at the end of life, in order to achieve optimal patient outcomes. Anecdotally, acute and critical care nurses experience frustration from the tensions that arise between acute and palliative care philosophies. Many clinicians are concerned that patients are denied a good death and yet the moment when care should be oriented toward palliation rather than aggressive management is usually unclear. Clearly this has implications for the type and quality of care that patients receive. This paper provides a review of the extant literature and identifies issues in the end of life care for patients with chronic cardiorespiratory diseases within acute and critical care environments. Issues for refinement of acute and critical care nursing practice and research priorities are identified to create a synergy between these philosophical perspectives.