Years In Poor Health Research Articles

Environmental violence and enterprise: The outsized role of business for environmental peacebuilding

Environmental violence (EV) is the complex of direct and indirect impacts of human-produced pollution on human health and wellbeing. Today, EV is the single largest cause of human mortality and morbidity, resulting in around 8 to 9 million deaths annually and about 275 million years of poor health every year. By comparison, about 89,000 people die from warfare and terrorism each year combined—more than 100 times fewer. EV also drives mass human migration, which displaces about 24 million people annually and is cited as a growing contributory—or even causal—factor for violent conflict. To realize the promise of business for peace, the implications of EV and the systemic suffering it produces must be addressed. This article examines the role of business in producing and mitigating EV and the possibility of reversing it via regenerative practices. It then maps and measures the primary links between business and EV and outlines paths to environmental peacebuilding. Although business is shown to be a chief contributor to EV, this article ultimately argues that it is also one of the most potent tools for countering it and equitably restoring affected communities and ecosystems.

Divergences and gaps in life expectancy and health-adjusted life expectancy in Mexico: Contribution analysis of the Global Burden of Disease Study 2019

Introduction Life expectancy (LE) and Health-adjusted life expectancy (HALE) are summary indicators that reflect a population’s general life conditions and measure inequities in health outcomes. The objective of this study was to identify the differences in LE and HALE by sex, age group, and state in Mexico from 1990 to 2019. Also, to evaluate whether the changes in HALE are related to sociodemographic indicators and indicators of access to and quality of health services. Methods A secondary analysis was performed based on the Global Burden of Disease, Injuries, and Risk Factors Study (GBD). Data were obtained for LE (by sex and state) and HALE (by sex, age group, and state) for the years 1990, 2010, and 2019. The correlations between HALE with the Socio-Demographic Index (SDI) and with the Healthcare Access and Quality (HAQ) Index were estimated for 1990 and 2019 (by total population and sex). Results LE and HALE had an absolute increase of 6.7% and 6.4% from 1990 to 2019, mainly among women, although they spent more years in poor health (11.8 years) than men. The patterns of LE and HALE were heterogeneous and divergent by state. In 2019, the difference in HALE (for both sex) between the states with the highest (Hidalgo) and the lowest (Chiapas) value was 4.6 years. Conclusions Progress in LE and HALE has slowed in recent years; HALE has even had setbacks in some states. Gaps between men and women, as well as between states, are persistent. Public and population policymaking should seek to lengthen LE and focus on ensuring that such years are spent in good health and with good quality of life.

Funding Life-Extension Research.

While the worldwide trend in life expectancy continues to increase slightly overall, the trend for the last few decades in developed countries is that more people are spending more years in poor health with multiple chronic comorbidities. These chronic conditions in aging populations consume high proportions of national healthcare budgets. The relatively young field of longevity research, after accumulating insights into the mechanisms of aging and producing dramatic laboratory demonstrations of life extension in some organisms, is entering the translational phase. This phase, through clinical trials, will confirm or refute the "geroscience hypothesis" that drugs can change the trajectory of the processes of aging within cells, and ultimately in living humans. At the same time, traditional funding patterns do not favor such visionary "moonshot" research, which, despite the potential for ultimately providing benefits for everyone, offers little prospect for rapid return on investment and high probabilities for early phase failure. New radical funding strategies incentivizing innovation will have to be called into play.

Care homes as hospices for the prevalent form of dying: An analysis of long-term care provision towards the end of life in England.

In the UK and the Westernised countries, most people die aged 80+ from disabling, chronic and degenerative diseases, having spent several years in poor health. There is thus continuity between long-term care (LTC) and end of life care (EOLC) in old age, but this continuity is poorly understood within policy and almost nothing is known about what determines the modality and intensity of LTC provision in old age towards the end of life. Drawing on multinomial logistic regression analysis of the English Longitudinal Study of Ageing (ELSA), this paper evaluates how health and socio-demographic factors affect the relative probability of receiving care through one of five long-term care arrangements (LTCAs) from the time of need at age ≥50 to death; and assesses the consequences this has for the English LTC and EOLC policy and planning. The study reveals that hospices provide end-of-life LTC for cancer diagnoses and adults aged 50-64, while care homes provide open-ended and end-of-life LTC for non-cancer diagnoses, dementia, severe disability, and adults aged 80+. Further, the informal, formal, mixed and care home LTCAs reflect increasing levels of disability and ill-health, and decreasing levels of family support, with differences concerning education and gender. Finally, dementia and Parkinson's disease are the single strongest determinants of high formal LTC provision, and overall high care needs determine high formal LTC provision. Within the English context, the consequences of this are that: 1) Continued reliance on informal family care is not sustainable; 2) To provide free formal LTC to old adults with high care needs is appropriate; and 3) Hospices do not cater for the prevalent form of dying in old age while care homes do, being the de facto hospices for severely disabled, very old (80+) adults with dementia. Yet this is not represented in English EOLC policy and research.

How Does Self-Rated Health Differ among Older Vietnamese Men and Women?

Due to gender differences in life expectancy, women outlive their male counterparts but experience more years of poor health. Whereas the correlates of gender differences in later life health have been examined in Western countries there is a limited but growing body of research among older adults in developing countries. Utilizing data from the 2011 Vietnam National Aging Study, this study examines gender differentials in self-rated health among Vietnamese aged 60 years and over (N = 2467) within the differential exposure and differential vulnerability frameworks. Logistic regression analyses show women had higher odds of reporting poor health but this differential was significantly reduced after adjusting for socio-demographic factors. Differential exposure to socio-economic resources did not explain the gender gap in perceived health status. After controlling for health behaviors, physical and mental health conditions, the gender differential was reversed with women showing lower odds of reporting poor health than similar men. Gender specific associations were evidenced by social participation, educational attainment, and employment status, which were protective for women’s health but unrelated to men’s. Older Vietnamese men and women show many similarities in the correlates of self-rated health. Comorbidity of chronic conditions, functional limitations, symptoms of psychological distress, and living in the Central region of Viet Nam were positively associated with poor self-rated health for men and women. The findings provide insight for gender sensitive social policies and investments in health systems to address the changing health profile of the Vietnamese population.

The Role of Saikosaponins in Therapeutic Strategies for Age-Related Diseases.

As life expectancy increases, elderly populations tend to spend an increasing number of years in poor health, with chronic age-related diseases and disability. Therefore, the development of therapeutic strategies to treat or prevent multiple pathophysiological conditions in the elderly may improve health-adjusted life expectancy and alleviate the potential economic and social burdens arising from age-related diseases. Bioactive natural products might represent promising new drug candidates for the treatment of many chronic age-related diseases, including cancer, Alzheimer's disease, cardiovascular disease, obesity, and liver disease. Here, we discuss a therapeutic option using saikosaponins, which are triterpene saponins isolated from Bupleurum, against a variety of age-related diseases. Understanding the underlying mechanisms of natural products like saikosaponins in the treatment of age-related diseases may help in the development of diverse natural product-derived compounds that may be effective against a number of chronic health problems.

Desigualdades sociales en salud en población mayor: una aportación desde la salud pública al debate sobre el retraso de la edad de jubilación en España

ObjectiveTo analyse the inequalities in life expectancy in the Spanish population over the age of 65 according to educational level. MethodCross sectional study on the Spanish population aged 65 years and over. Life expectancy and healthy life expectancy were calculated combining mortality, health and population data. ResultsPeople aged 65 and over with a lower educational level had shorter lives, with fewer years of good health and more years of poor health. Women lived longer, but with proportionally more years of poor health. DiscussionSocial inequalities in health must be considered in the current debate on delaying the age of retirement.

Calorie Restriction and Dietary Restriction Mimetics: A Strategy for Improving Healthy Aging and Longevity

Improvements in health care have increased human life expectancy in recent decades, and the elderly population is thus increasing in most developed countries. Unfortunately this still means increased years of poor health or disability. Since it is not yet possible to modify our genetic background, the best anti-aging strategy is currently to intervene on environmental factors, aiming to reduce the incidence of risk factors of poor health. Calorie restriction (CR) with adequate nutrition is the only non-genetic, and the most consistent non-pharmacological intervention that extends lifespan in model organisms from yeast to mammals, and protects against the deterioration of biological functions, delaying or reducing the risk of many age-related diseases. The biological mechanisms of CR's beneficial effects include modifications in energy metabolism, oxidative stress, insulin sensitivity, inflammation, autophagy, neuroendocrine function and induction of hormesis/xenohormesis response. The molecular signalling pathways mediating the anti-aging effect of CR include sirtuins, peroxisome proliferator activated receptor G coactivator-1α, AMP-activated protein kinase, insulin/insulin growth factor-1, and target of rapamycin, which form a pretty interacting network. However, most people would not comply with such a rigorous dietary program; research is thus increasingly aimed at determining the feasibility and efficacy of natural and/or pharmacological CR mimetic molecules/ treatments without lowering food intake, particularly in mid- to late-life periods. Likely candidates act on the same signalling pathways as CR, and include resveratrol and other polyphenols, rapamycin, 2-deoxy-D-glucose and other glycolytic inhibitors, insulin pathway and AMP-activated protein kinase activators, autophagy stimulators, alpha-lipoic acid, and other antioxidants.

Economics of chronic diseases protocol: cost-effectiveness modelling and the future burden of non-communicable disease in Europe.

BackgroundThe majority of chronic disease is caused by risk factors which are mostly preventable. Effective interventions to reduce these risks are known and proven to be applicable to a variety of settings. Chronic disease is generally developed long before the fatal outcome, meaning that a lot of people spend a number of years in poor health. Effective prevention measures can prolong lives of individuals and significantly improve their quality of life. However, the methods to measure cost-effectiveness are a subject to much debate. The Economics of Chronic Diseases project aims to establish the best possible methods of measuring cost-effectiveness as well as develop micro-simulation models apt at projecting future burden of chronic diseases, their costs and potential savings after implementation of cost-effective interventions.MethodThis research project will involve eight European countries: Bulgaria, Finland, Greece, Lithuania, The Netherlands, Poland, Portugal and the United Kingdom (UK). A literature review will be conducted to identify scientific articles which critically review the methods of cost-effectiveness. Contact will be made health economists to inform and enrich this review. This evidence will be used as a springboard for discussion at a meeting with key European stakeholders and experts with the aim of reaching a consensus on recommendations for cost-effectiveness methodology. Epidemiological data for coronary heart disease, chronic kidney disease, type 2 diabetes and chronic obstructive pulmonary disease will be collected along with data on time trends in three major risk factors related to these diseases, specifically tobacco consumption, blood pressure and body mass index. Economic and epidemiological micro-simulation models will be developed to asses the future distributions of risks, disease outcomes, healthcare costs and the cost-effectiveness of interventions to reduce the burden of chronic diseases in Europe.DiscussionThis work will help to establish the best methods of measuring cost-effectiveness of health interventions as well as test a variety of scenarios to reduce the risk factors associated with selected chronic diseases. The modelling projections could be used to inform decisions and policies that will implement the best course of action to curb the rising incidence of chronic diseases.

Healthy life expectancy in Thailand, 2009

BackgroundIt is essential for policy makers in the context of mortality decline to assess how long people can expect to live in full health. Healthy life expectancy (HALE) extends measures of life expectancy by incorporating levels of health conditions. This study assesses how long Thai people are expected to live in their full health in 2009. MethodsHALE was estimated based on Sullivan's method. Mortality was estimated from national vital registration with incompleteness adjustment as applied in the 2009 national burden of disease study. Perceived functional health was assessed using the European quality of life-5 dimensions (EQ5D) questionnaire applied to the 2009 Health and Welfare Survey, a nationally representative household survey conducted by the National Statistical Office. Health state values were derived by applying the scoring algorithm of the national Thai valuation study conducted for 86 health states. FindingsWhile life expectancy at birth in 2009 was 70·5 years (95% CI 70·48–70·52) for men and 77·3 years (77·28–77·33) for women, HALE was 64·68 years (64·67–64·69) and 68·00 years (67·99–68·01), respectively. Women at birth can expect to live 6·8 years longer than men while spending 3·491 years (3·490–3·492) more than men in less than full health. Expected healthy years lost at age of 60 years were 4·61 years (4·60–4·62) in men and 6·53 years (6·52–6·53) in women. InterpretationThai women are expected to live longer than men but spend more years in poor health. The gap between life expectancy and HALE increases significantly with age. Self-reported health assessment, with the application of EQ5D is useful for HALE estimation and can be integrated into a regular national household survey. Nevertheless, the tool has a limitation in the application among very young children and cognitively impaired people. As HALE is understandable to the general public and policy makers, it has a potential use in monitoring population health. FundingThai Health Promotion Foundation (ThaiHealth) and National Health Security Office.

Diet & Nutrition in Geriatric Patients - A Matter of Concern?

One of the major challenges of the success of health sciences is the increasing number of geriatric population in the society. It is estimated that by the year 2050, nearly 1.2 billion of 1.5 billion geriatric people of age 65 or above will reside in 1 today's less developed regions. Also, 20% of the total 1 geriatric population of the world would be in India. This can be attributed to the improved quality and widespread implementation of health care systems in developing countries like India. We definitely need to congratulate the developing countries for this success. However, we also need to introspect honestly, whether the increased life expectancy means better life or just more number of years of poor health. We need to constantly remind ourselves of the phrase that 'it is 1 important to add life to years and not years to life'. One important aspect of providing quality life to the geriatric population is by ensuring that they receive quality nutrition and a balanced diet. A balanced diet must contain carbohydrates, proteins, fats, vitamins, minerals and fibers. Each of these nutrients has a vital role in the all round growth and development of children and is equally imperative to geriatric individuals for maintaining health. It is important that all nutrients be present in the required amount in a balanced diet because lack of one or more nutrients can lead to nutritional deficiencies. Awareness about diet and nutritional requirement and its role in health maintenance is significantly low in the Indian population as compared to developed countries. Geriatric malnutrition is a fact and indeed a very serious issue. It is important to make the geriatric patients aware of it and to be motivated to take corrective measures. Various factors affect the nutritional status in geriatric patients such as change in metabolism, chronic diseases, diminished absorption, chronic periodontal diseases, partial or complete loss of teeth, multiple carious teeth, physical disabilities etc. Many health related problems of aging can be prevented and treated successfully if the status of diet and nutrition is balanced in every geriatric patient. Improvement in nutritional status will result in optimizing functional status and general well-being. The geriatric population is a very important asset of our society, their experience and guidance in real life is invaluable. As dental surgeons, we always think what we can give back to the society? One of the answers is acquiring detailed knowledge of diet and nutrition and guide our patients during our long and repeated dental appointments. This way, dental surgeons can strike a correct balance between work and their responsibility towards society at large and obtain professional happiness.

Public health programme and policy options for improving health equitably

Compared with other Western European countries, Scotland has the highest mortality rate and lowest life expectancy. Scotland is also characterised by marked inequalities, with men from the poorest communities dying 13 years earlier and experiencing seven more years in poor health than men from the most affluent communities. 1

Trends in disability-free life expectancy at age 65 in France: consistent and diverging patterns according to the underlying disability measure.

Disability-free life expectancy estimates (DFLE) are summary measures to monitor whether a longer life expectancy (LE) is associated with better health or whether additional years of life are years of poor health or disability. Disability is a generic term defined as the impact of disease or injury on the functioning of individuals. It covers various situations from the rather common functional limitations to restrictions in daily activities and finally dependency. Disentangling these dimensions is essential to monitor future needs of care and assistance; but this is not always feasible since surveys do not systematically cover a large range of disability dimensions in their questionnaires. This study aims to cover different disability dimensions by using data from different French population surveys. We computed ten disability-free life expectancies, based on both specific and generic disability indicators from four population health surveys, in order to describe and compare trends and patterns for France over the 1980s and the 1990s. We used the Sullivan method to combine prevalence of disability and life tables. In 2000, two thirds of total LE at age 65 are years with physical or sensory functional limitations and 10% are years with restrictions in personal care activities. Trends in DFLE over the two last decades seem to have remained stable for moderate levels of disability and to have increased for more severe levels of disability or activity restrictions. We found that patterns are consistent from one survey to the other when comparing indicators reflecting similar disability situations.

What is healthy aging in the 21st century?

In the coming years, human aging will be one of the biggest challenges faced by industrialized countries. The average life expectancy is continuously increasing and we may be faced with spending more years in poor health. Because aging is a relatively modern phenomenon, we lack knowledge for a proper understanding of this process. Current biological thinking emphasizes that organisms are encoded for early survival and reproduction, humans not excluded. Aging is not programmed nor is it inevitable. Life span is the result of the interactions between genes and the environment in which we live. In the original habitat, genes encoding early survival and reproduction were optimized in an everlasting attempt to increase fitness and prevent the species from extinction. Aging is best explained as a cost of optimizing fitness because investments in body maintenance and repair cannot be maximized. The environment also determines how a gene influencing life span is expressed over a lifetime. When the conditions in which we live significantly improve, mortality decreases, evolutionary pressures for early survival and reproduction relax, and further resources can be invested in body maintenance and repair, which increases both average life expectancy and maximum life span. Increasing our understanding of the aging process and applying available interventions will help to protect and preserve healthy aging.

Comparing Risks and Benefits of Colorectal Cancer Screening in Elderly Patients

In patients with limited life expectancy, the risks of colorectal cancer screening may outweigh the benefits. The aim of this study was to quantify risks and benefits of different screening strategies in elderly patients with varying life expectancies. We examined risks and benefits of screening in patients aged 70-94 years with differing health status using 3 strategies: annual fecal occult blood tests, flexible sigmoidoscopy every 5 years, or colonoscopy every 10 years. We compared the number needed to screen to prevent one cancer-related death and the number needed to encounter one screening-related complication for different strategies. The potential benefit from screening varied widely with age, life expectancy, and screening modality. One cancer-related death would be prevented by screening 42 healthy men aged 70-74 years with colonoscopy, 178 healthy women aged 70-74 years with fecal occult blood tests, 431 women aged 75-79 years in poor health with colonoscopy, or 945 men aged 80-84 years in average health with fecal occult blood tests. Colonoscopy screening had the greatest benefit but the highest risk of complications. The potential for screening-related complications was greater than estimated benefit in some population subgroups aged 70 years and older. At all ages and life expectancies, the potential reduction in mortality from screening outweighed the risk of colonoscopy-related death. The potential benefits and risks of screening vary in elderly patients of different life expectancies. For any individual patient, the potential for harm from screening must be weighed against the likelihood of benefit, especially with shorter life expectancy.

Socio-economic inequalities in health expectancy in Belgium

Various international studies have demonstrated socio-economic differences in health. Linking the 1991 Census to the National Register and using the Health Interview Survey 1997 has enabled assessment of the association between the level of education and health in Belgium using the composite indicator ‘health expectancy’. The Sullivan method was used to calculate health expectancy on the basis of current probability of death and prevalence of perceived health. Two measures of educational attainment were used: absolute educational attainment and the position on a relative hierarchical educational scale obtained by a regression-based method. The latter measure enables international comparisons. Differences in health expectancy by education were spread over the whole range of the educational hierarchy, and were consistently larger among females than males. At 25 years of age, the difference in health expectancy between different levels of education reached up to 17.8 and 24.7 years in males and females, respectively. Compared with people with the highest educational attainment, males and females at the lowest level of education spent more than 10 and 20 additional years in poor perceived health, respectively. Between ages 25 and 75 years, the difference in health expectancy between people with the lowest and highest levels of education was 17 years among males and 21 years among females. Compared with people at the top of the relative educational scale, males and females at the bottom of the scale had 13.6 and 19.7 additional years in poor perceived health, respectively. The conclusions of this study in Belgium are consistent with studies in other countries. People with a low level of education have shorter lives than people with a higher level of education. They also have fewer years in good perceived health, and can expect more years in poor health in their shorter lives. The inequality in health expectancy seems to be greater in females than males.

Expectations of Health, Independence, and Quality of Life Among Aging Spinal Cord-Injured Adults

While our understanding of aging and mortality in spinal cord injury is evolving, precise estimates are still not available to assist people with spinal cord injuries in knowing what to expect as they grow older. The work of a number of authors suggests that the life expectancy of those with spinal cord injuries is improving. However, little is known about the conditions in which individuals may expect to spend their remaining years of life. This study used information from a 50-year database on spinal cord injury, in combination with national mortality statistics and new survey information, to estimate the number of remaining years that individuals could expect to spend in a variety of states of health, independence, and quality of life. The study showed that expectations of health are similar to those found in the general population. Regardless of total life expectancy, individuals could expect to spend about six of their remaining years in poor health, presumably near the end of life. Expectations of independence varied depending on lesion level. Those with paraplegia became less independent over time, moving from complete to modified independence. Those with quadriplegia appeared to have a greater expectation of independence over time; however, in actuality, only those who were most independent survived to report outcomes at older ages. Expectations of quality of life remained high until the fifth decade postinjury.