Dementia-free life expectancy in Belgium

To monitor the influence of dementia on the health of the populationthe concept of Dementia-Free Life Expectancy (DemFLE) was introduced.The DemFLE was estimated using Sullivan's method on the dataof the ERDA study 1991 (Epidemiology Research on Dementia, Antwerp,Belgium). At the age of 65 years, elderly people in Belgiumhad a life expectancy of 16.4 years, a DemFLE of 15.3 years,and 1.1 years with at least moderate dementia. In absolute yearsthe life expectancy with dementia remained constant beyond theage of 65: it was about 1.7 years for women, 0.7 years for men.The proportion of the remaining life that will be lived in ademented state increased with age: 4% and 9% in men and womenat age 65, but 20% and 30% at the age of 85. The results confirmdementia as an important public health problem in the elderly.     

Trends in dementia-free life expectancy among elderly members of a large health maintenance organization

BACKGROUND: This study examined the secular trends of life expectancy without dementia among elderly American members of a health maintenance organization, and observed if an increased life expectancy is accompanied by an increase in the duration of life with dementia. METHODS: The data derived from two chronological 9-year prospective cohort studies of members of the Kaiser Permanente Medical Care Program of Northern California. The first and second cohorts included 2,702 and 2,926 people aged > or =65 years free from dementia at baseline. Life expectancy without dementia or dementia-free life expectancy (DemFLE) is defined as the average number of years a person is expected to live without dementia. Total life expectancy is equal to the sum of DemFLE and life expectancy with dementia. Estimations of DemFLE were based on mortality data and incidence of dementia, using double-decrement life tables. RESULTS: Between the first and second cohorts, all-cause mortality rates declined, while the incidence of dementia remained constant in both men and women. Among the males, total life expectancy increased at a higher rate than DemFLE. Consequently, the duration of life with dementia was extended in the second cohort. Conversely, among the females DemFLE increased at a higher rate than total life expectancy, thus the duration of life with dementia decreased in the second cohort. The median age of dementia onset was postponed by 2-3 years in the second cohort for females, and did not show any specific difference between the two cohorts in males. CONCLUSION: The trends of health expectancies suggest an extension of the duration of life with dementia for males and a compression of dementia for females. A decreased incidence of risk factors for dementia among females in the second cohort such as stroke may explain these trends.     

Disorders requiring nursing care and the period before recognized as needing nursing care (active life expectancy) in relation to nursing care insurance

PURPOSE: To measure the state of health of the elderly population, active and dependent life expectancies were calculated based on the number of people needing nursing care. For this purpose, active life expectancy was defined as the period before nursing care was recognized by insurers as being required. Moreover, to cast light on disorders requiring nursing care, age-adjusted nursing time needed for different ailments per ten thousand elderly population was calculated. SUBJECTS AND METHODS: Subjects were those 65 years or over living in Taihaku-ku, Sendai City, recognized as needing nursing care by nursing care insurers. The period before being recognized as needing nursing care was calculated using the Sullivan method, and termed the active life expectancy. Dependent life expectancy = life expectancy - active life expectancy. The number of those needing nursing care caused by each disorder diagnosed by attending physicians, was also age-adjusted by the reference population and multiplied by the nursing time needed for each level of nursing, resulting in the age-adjusted nursing time needed per ten thousand elderly population. RESULTS: Those recognized as needing nursing care were 7.5% (7.7% after age adjustment) of the male elderly population, and 12.5% of the female population (10.7% after age adjustment). For men, the active life expectancy was 16.1 years for the age of 65, 9.2 years for 75 and 4.4 years for 85, while the dependent one was 2.0-2.1 years for all ages. For women, the active life expectancy was 19.3 years for the age of 65, 11.1 years for 75 and 4.8 years for 85, while the dependent one was 4.6-5.3 years. The age-adjusted nursing time needed per ten thousand elderly population was 874 hours for men and 1,125 hours for women: of the time 51% was for men with cerebrovascular disease (40% for cerebral infarction), 11% for men with dementia; 37% for women with cerebrovascular disease (26% for cerebral infarction), 20% for women with skeletal diseases, 18% for women with dementia. CONCLUSIONS: The active life expectancy for women is longer than for men, by 3.7 years for the age of 65, by 2.3 years for 75 and by 0.5 years for 85. The dependent life expectancy for women is also longer than for men, by 3.2 years for the ages of 65 and 75 and by 2.6 years for 85. Thus, nursing prevention is an urgent issue, especially for women. The disorders requiring particularly long age-adjusted nursing time are carebrovascular disease (particularly cerebral infarction), dementia and skeletal disorders (particularly among women).     

Years of life lived with and without dementia in Australia, 2004–2006: a population health measure

Objective: To estimate the fraction of remaining life lived with and without dementia among Australian males and females at later life. Method: Analysis was performed by applying the life table technique that integrates mortality and morbidity statistics to derive a single population health indicator. Observed prevalence rates were used to calculate life expectancy with dementia. Results: At the age of 65 years, males are expected to live an additional 18 years, of which 6% would be lived with dementia. Females surviving to 65 years, are likely to live a further 22 years, 9% of which is expected to be lived with dementia. At the age of 85 years, males live a further six years; one‐sixth of this life spent with dementia. Females surviving to this age would live an additional seven years, with one‐fourth of that life with dementia. The portion of life lived with dementia out of total remaining years of life increases with age at the rate of 20 to 30% every five years beyond the age of 65. Conclusion. The extension of life expectancy is associated with increased duration of life lived with dementia. As females live longer than males, they experience a greater impact of dementia.     

上海市居民期望寿命与健康期望寿命的差异分析

目的:分析不同年龄、性别的上海市居民期望寿命和健康期望寿命的差异。方法:分析比较上海市和全球长寿国家/地区期望寿命的变化趋势;利用全球疾病负担研究建立的疾病和健康结局的失能权重,应用Sullivan法测算上海市居民健康期望寿命,并分析不同年龄、性别人群的健康寿命损失。结果:近40年,上海市期望寿命增长了10.86岁,2...     

上海市成年人健康期望寿命测算研究

目的:评价上海市居民健康状况,测算健康期望寿命,分析影响居民健康相关因素,为卫生决策提供有力的信息和依据。方法:采用多阶段分层随机抽样方法随机抽取上海市≥18岁户籍居民作为调查对象,采用WHO在世界健康调查中使用的自评健康调查问卷,进行居民自评健康状况调查。应用CHOHT模型校正自评健康调查数据,获得人群自报伤残测度,...     

Socioeconomic status and the expectation of disability in old age: estimates for England

OBJECTIVES: The longer life expectancy in old age of more privileged socioeconomic groups is well established, but less clear is whether the net effect of additional years of life is a lengthened, stable or reduced duration of disability. Estimates of healthy and disabled life expectancy (using definitions including dependency in activities of daily living and cognitive impairment) were made, contrasting occupational classes I and II (professional and managerial) with the rest. DESIGN: Disability prevalence was estimated from the Medical Research Council Cognitive Function and Ageing study. Sullivan's method was used to calculate health expectancy. SUBJECTS: 10,377 people aged 65 years or over in Cambridgeshire, Newcastle, Nottingham and Oxford. Subjects were classified as disabled if they had evidence of dementia (using the Automated Geriatric Examination Computer Assisted Taxonomy) or scored 11 or more on the modified Townsend Disability scale, at baseline screen. RESULTS: The prevalence of disability overall and need for "constant care" was lower in both men and women in social classes I and II compared with the rest. Men aged 65 to 69 in classes I and II can expect nearly 14 years of life free of disability compared with 11.5 years for those in classes III to V: for women the equivalent expectations are 15.5 and 13.8 years. Men aged 65 to 69 in classes I and II can also expect a shorter duration of disability: 1 year compared with 1.6 years for classes III to V. In women expectation of disability is higher overall, but shows little difference by occupational class. CONCLUSIONS: Relatively privileged socioeconomic groups in England, especially men, can expect fewer years of disability despite longer overall life expectancy. These findings lend weight to optimistic scenarios for the future numbers of older people with disability.     

Dementia-free life expectancy in France.

OBJECTIVES. Increasing concern with the quality of gains in life years has led to the development of a new synthetic indicator of population health:health expectancy. Until now, calculations have been made for physical disabilities only. A first estimate of mental health expectancy is presented: dementia-free life expectancy. METHODS. Sullivan's method was used to calculate dementia-free life expectancy for a random representative sample of 4134 persons over 65 years of age in the Bordeaux region of France. The diagnosis of senile dementia was made in two stages, based on Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria. RESULTS. At 65 years of age, a person's dementia-free life expectancy is 16.9 years within a total life-expectancy of 17.7 years; it decreases with age in parallel with the decrease in total life expectancy so that life expectancy with dementia stays constant at 0.8 years. Although dementia prevalence increases with age, if the prevalence is adjusted for mortality, the largest number of persons with dementia are in their early eighties. At each age women have a higher dementia-free life expectancy. CONCLUSIONS. Trends in dementia-free life expectancy are similar to those found in disability-free life expectancy. Because the dementia prevalence rates used in this estimate resemble a general model derived from meta-analysis, it can be assumed that similar results will be found in other Western countries with similar mortality rates.     

上海市静安区老年人健康期望寿命及影响因素

[目的 ]　计算静安区 60岁以上老年人的健康期望寿命 ,分析健康期望寿命的主要影响因素。　 [方法 ]　杜克法评价日常活动能力 ,Sullivan法计算健康期望寿命与期望寿命损失率。　 [结果 ]　本地区男、女性 60～ 65岁老年人的健康期望寿命分别为 14 .5 7岁和 14 .67岁 ,期望寿命损失率分别为 3 3 .3 %和 40 .7%。 60岁以上女性的期望寿命损失率高于男性。家庭经济收入、文化程度、是否合理体育锻炼、家庭居住条件、是否得到及时帮助可影响健康期望寿命。中风导致的期望寿命平均损失率最大 ,其他依次为精神障碍、糖尿病、高血压、慢性支气管炎和肺气肿、视力障碍和心脏病。　 [结论 ]　本地区 60岁以上老年人的健康期望寿命高于我国其他一些地区。为了提高老年人的健康期望寿命 ,应加强老年人尤其是女性老年人的健康保健服务和改善老年人的社会经济状况     

The burden of mortality of obesity at middle and old age is small. A life table analysis of the US Health and Retirement Survey

The evidence of effect of overweight and obesity on mortality at middle and old age is conflicting. The increased relative risk of cardiovascular disease and diabetes for overweight and obese individuals compared to normal weight is well documented, but the absolute risk of cardiovascular death has decreased spectacularly since the 1980s. We estimate the burden of mortality of obesity among middle and old aged adults in the Health and Retirement Survey (HRS), a US prospective longitudinal study. We calculate univariate and multivariate age-specific probabilities and proportional hazard ratios of death in relation to self-reported body mass index (BMI), smoking and education. The life table translates age specific adjusted event rates in survival times, dependent on risk factor distributions (smoking, levels of education and self reported BMI). 95% confidence intervals are calculated by bootstrapping. The highest life expectancy at age 55 was found in overweight (BMI 25-29.9), highly educated non smokers: 30.7 (29.5-31.9) years (men) and 33.2 (32.1-34.3) (women), slightly higher than a BMI 23-24.9 in both sexes. Smoking decreased the population life expectancy with 3.5 (2.7-4.4) years (men) and 1.8 (1.0-2.5) years (women). Less than optimal education cost men and women respectively 2.8 (2.1-3.6) and 2.6 (1.6-3.6) years. Obesity and low normal weight decreased population life expectancy respectively by 0.8 (0.2-1.3) and 0.8 (0.0-1.5) years for men and women in a contemporary, US population. The burden of mortality of obesity is limited, compared to smoking and low education.     

城市老年人日常生活活动和健康期望寿命的研究

文章通过随机、分层、整群抽样方法,对合肥市、铜陵市3198名老年人的日常生活活动进行了现况调查.结果显示,城市老年人日常生活活动功能丧失率为7.2%,男性6.2%,女性8.1%;且随年龄增大,功能丧失率逐渐升高(P＜0.01),ADL各项功能丧失率较高是洗澡(7.1%)、上厕所(4.8%)和室内走动(4.6%),较低是进食(1.2%)和穿衣(3.1%);60～64岁年龄组健康期望寿命为14.73岁,男性15.29岁,女性14.22岁,且随年龄增长而缩短,健康期望寿命占期望寿命比例男性为87.0%,女性为75.8%,且随年龄增大,比例逐渐下降,女性健康期望寿命占期望寿命的比例明显低于男性.     

Social gradient in life expectancy and health expectancy in Denmark

Summary Objectives: Health status of a population can be evaluated by health expectancy expressed as average lifetime in various states of health. The purpose of the study was to compare health expectancy in population groups at high, medium and low educational levels.Methods: Health interview data were combined with life table figures using Sullivans method.Results: Life expectancy was 4.3 years longer for 30-year-old men with a high educational level than for those with a low level. At age 30, the proportion of expected lifetime in self-rated good health was 67.7%, 76.1% and 82.3% for men with a low, medium and high educational level, respectively. Among women, life expectancy differed by 2.7 years between low and high educational level, and the proportion of expected lifetime in self-rated good health was 62.5% at the low and 80.5% at the high educational level.Conclusions: Educational level and life expectancy are clearly related. The social gradient in terms of health expectancy is even greater than that in terms of life expectancy.     

中国大陆地区健康期望寿命研究现状调查

目的 通过对中国大陆地区已发表的健康期望寿命文献进行计量分析,了解国内健康期望寿命研究现况,为国家卫生行政部门制定相关政策提供参考。方法 采用文献计量法对纳入文献从时间、地区、类型、健康期望寿命研究结果等方面进行描述性统计分析。结果 51篇已发表的文献中,2016年发表文献最多,占比17.6%。从地区上看,全国性研究最多,占比23.5%,其次为东部沿海地区,占比43.1%;直辖市发表文献较多于一般省份。从研究的人群看,60岁以上老年人的自评自理健康期望寿命研究相对较多,占比54.9%。从健康期望寿命的计算结果上看,大部分研究女性健康期望寿命高于男性。结论 中国大陆地区健康期望寿命研究处于初步阶段,对老年人群健康较为重视,且存在区域差异,经济较发达的东部地区,尤其是直辖市开展的研究较多。不同研究间的可比性较差,需建立统一的计算方法,增强不同地区间的可比性,以及同一地区不同年份的纵向可比性。     

Life expectancy and the need for nursing care in Germany

Effects of further gains in life expectancy on the health and autonomy of the elderly population are a matter of controversy. Health indicators, which integrate information on both mortality and morbidity could help to clarify whether the additional years are spent in health or disease. Since the introduction of a statutory long-term care insurance in Germany, national data on the prevalence of dependency are available. These data were used for the calculation of dependency-free life expectancy and life expectancy in a state of dependency according to Sullivans method. The calculations are based on 71.5 million insured at mid-year 1999 and on the period life-table for the years 1995/97. At the age of 65 the average duration of dependency is 15.4 months for men and 29.4 months for women. Men can expect to spend 91.4% of their remaining lifetime dependency-free, whereas the dependency-free proportion among women is only 86.9%. The distribution of severity grades of dependency is similar for both sexes. Women, however, spend 35.4% of the total duration of dependency in institutional care (10.4 months), men only 22.1% (3.5 months). Information from long-term care insurance appears suitable for the monitoring of time trends in the health of the elderly population and for projections of future needs for health and social services.     

江苏省与内蒙古自治区人均期望寿命对比分析

目的了解江苏省与内蒙古自治区城市、镇和乡村不同居民的人均期望寿命及其两个省（区）的差别。方法采用简略寿命表方法,对死亡概率、人均期望寿命等进行描述,并作对比分析。结果江苏省总人口人均期望寿命为76．01岁,男性73．72岁,女性78．36岁,女性比男性高4．64岁。内蒙古总人口人均期望寿命为71．23岁,男性69．60岁,女性73．21岁,女性比男性高3．61岁。结论江苏省的人均期望寿命高于内蒙古自治区相对应的地区,两个省均为城市人均期望寿命高于镇,镇高于村,女性高于男性。     

Dementia-free life expectancy in Australia

Abstract: Dementia-free life expectancy is a synthetic indicator of an important aspect of mental health which may have considerable use in public health decision making. Dementia expectancies were derived from senile dementia prevalence rates in Australia in 1991–1992 in conjunction with national life tables using Sullivan's method. Dementia-free life expectancy for Australian women aged 70 years was found to be 14 years within a total life expectancy of 15 years, and 11 years for men within a total life expectancy of 12 years. Between 70 and 85 years there is a constant average expectation of about one year of life expectancy with dementia. The age at which the largest number of persons with dementia is found is 82 years. Australians appear to have very similar dementia-free life expectancies to those reported in the European studies, with small differences probably due to sampling variation or to differences in case-finding methods.     

Survival in a cohort of social services placements in nursing and residential homes: factors associated with life expectancy and mortality

The aim of this study was to examine the life expectancy of elderly people in nursing and residential care over a 20-month period and its relationship to specific risk factors. Using a retrospective cohort design, data obtained on 1888 residents placed between 1 July 1997 and 30 April 1999 in residential, nursing and dual registered homes within Nottingham Health Authority boundaries were examined. Additional data on physical and mental disability at placement were available for 514 residents. Main outcome measures comprised survival rate overall, and in relation to gender, age, home type (nursing, residential or dual), source of placement (hospital or community) and various disability factors.One-year survival rates were: overall, 66%; nursing homes, 59%; dual homes, 58%; and residential homes 76%. Median survival in nursing homes was 541 days, but was not reached in residential homes. Male gender, admission to nursing or dual registered homes, placement from hospital, decreased mobility and increased age were associated with decreased life expectancy. Although no association was found between length of survival and level of cognitive function, lack of cognitive impairment was associated with lower survival. In conclusion, mortality is high in nursing, dual and residential homes where life expectancy has been shown to be associated with gender, home type, origin of placement and mobility. Rates of survival are related to higher comorbidity and disability. Important data for planning and assessing care needs can be yielded through the analysis of mortality data.     

中国流动老人的健康期望寿命研究

目的 了解流动老人的健康期望寿命,包括自评健康期望寿命和生活自理期望寿命, 并探索其影响因素。方法 利用2015年流动人口动态监测调查中的老年人数据,采用Sullivan法分析流动老人的自评健康期望寿命和生活自理期望寿命,logistic回归分析其影响因素。结果 60～64岁流动老人的自评健康期望寿命约为17.7岁,生活自理期望寿命约为20.6岁。女性的健康期望寿命比男性高,但是健康期望寿命损失率也比男性高。慢性病会对老年人的健康产生重要的负面影响, 家庭收入高、教育水平高、流动范围大、参加健康体检、有伴侣、本地朋友多、锻炼时间长都是流动老人健康的保护因素。结论 流动老人健康状况整体较好,相关部门需要提升流动老人卫生服务的利用率,加强对流动老人的慢病管理,鼓励老年人养成健康的生活方式。对高龄女性、社会经济地位低、无伴侣、少数民族的流动老人应给予重点关注。     

Stroke and active life expectancy in the United States, 1999–2009

BackgroundStroke reduces active life expectancy, both years lived and their proportion without disability. However, active life expectancy studies have provided limited information about strokes in the United States, those occurring throughout older life, or those affecting African Americans.ObjectiveTo measure associations between strokes throughout older life and active life expectancy for African American and White women and men.MethodsUsing data from the Panel Study of Income Dynamics, 1999–2009 (n = 1862, 13,603 person-years), we estimated monthly probabilities of death and disability in activities of daily living with multinomial logistic Markov models adjusted for age, sex, ethnicity, stroke in the past two years, earlier stroke, and education. A random effect accounted for the panel data repeated measures. Microsimulation created large populations with stroke incidence throughout older life, identifying life expectancy and the proportions of remaining life with and without disability. We matched individuals with strokes with randomly selected persons without strokes by age at first stroke, sex, ethnicity, and previous disability.ResultsAverage age at first stroke was higher for women, lower for African Americans. African American and White women were disabled for about two-thirds of life after stroke; results for men were 61.8% for African Americans and 37.2% for Whites. Compared to matched participants, those with strokes lived 33% fewer remaining years (95% confidence interval, CI 30.9%–34.7%) with a 31.6% greater proportion of remaining life with disability (CI 14.4%–55.6%).ConclusionsStroke greatly reduces both life expectancy and the proportion of life without disability, particularly for women and African Americans.     

Development of an education integrated design framework for the physical space of nursing homes in relation to life expectancy of the older people

The purpose of this research is to find design variables effective on education integration with physical spaces of nursing homes in association with life expectancy of older people. Delphi technique was used to obtain the design variables by which the education integration with physical spaces of nursing homes can be achieved. Subsequently, in order to investigate the modifying effect of education integrated physical space on life expectancy of the elderly, questionnaires were sent to 50 local researchers and experts in the field of ageing. Results showed a significant and positive correlation between education integrated physical space and life expectancy indicators (p < .05). The results suggest that as per expert opinions, designing a physical space integrated with education could increase the life expectancy of older people.