Late-Life Decline in Well-Being across Adulthood in Germany, the UK, and the US: Something Is Seriously Wrong at the End of Life

Throughout adulthood and old age, levels of well-being appear to remain relatively stable. However, evidence is emerging that late in life well-being declines considerably. Using long-term longitudinal data of deceased participants in national samples from Germany, the UK, and the US, we examine how long this period lasts. In all three nations and across the adult age range, well-being was relatively stable over age, but declined rapidly with impending death. Articulating notions of terminal decline associated with impending death, we identified prototypical transition points in each study between three and five years prior to death, after which normative rates of decline steepened by a factor of three or more. The findings suggest that mortality-related mechanisms drive late-life changes in well-being and highlight the need for further refinement of psychological concepts about how and when late-life declines in psychosocial functioning prototypically begin.Selective mortality, successful aging, differential aging, psychosocial factors, well-being, multiphase growth model

Changes in total and disability-free life ex-pectancy among older adults in China: Do they portend a compression of morbidity?

The purpose of this research is to determine whether disability-free life expectancy (DFLE) in China has been increasing more rapidly than total life expectancy (TLE). Such a scenario would be consistent with a compression of morbidity, a situation that is especially desirable in a country experiencing rapid population aging and gains in old-age longevity. Us-ing the Chinese Longitudinal Healthy Longevity Study, an exponential survival regression is used to calculate TLE. The Sullivan method is then employed for computing DFLE. Results for a 65 and older sample are compared across data collected during two periods, the first with a 2002 baseline and a 2005 follow-up (N=15,641) and the second with a 2008 baseline and a 2011 follow-up (N=15,622). The first comparison is by age and sex. The second comparison divides the sample further by rural/urban residence and education. The ratio of DFLE/TLE across periods provides evidence of whether older Chinese are living both longer and healthier lives. The findings are favorable for the total population aged 65+, but improvements are only statistically significant for females. Results also suggest heterogeneous compression occurring across residential status with the urban population experiencing more favorable changes than their rural counterparts. Results both portend a compression of morbidity and continuing dis-advantage for rural residents who may not be participating in population-wide improvements in health

Age-related inequalities in colon cancer treatment persist over time: a population-based analysis.

BACKGROUND: Older people experience poorer outcomes from colon cancer. We examined if treatment for colon cancer was related to age and if inequalities changed over time. METHODS: Data from the UK population-based Northern and Yorkshire Cancer Registry on 31 910 incident colon cancers (ICD10 C18) diagnosed between 1999-2010 were obtained. Likelihood of receipt of: (1) cancer-directed surgery, (2) chemotherapy in surgical patients, (3) chemotherapy in non-surgical patients by age, adjusting for sex, area deprivation, cancer stage, comorbidity and period of diagnosis, was examined. RESULTS: Age-related inequalities in treatment exist after adjustment for confounding factors. Patients aged 60- 69, 70-79 and 80+ years were significantly less likely to receive surgery than those aged <60 years (multivariable ORs (95% CI) 0.84(0.74 to 0.95), 0.54(0.48 to 0.61) and 0.19(0.17 to 0.21), respectively). Age-related differences in receipt of surgery and adjuvant chemotherapy (but not chemotherapy in non-surgical patients) narrowed over time for the 'younger old' (aged <80 years) but did not diminish for the oldest patients. CONCLUSIONS: Age inequality in treatment of colon cancer remains after adjustment for confounders, suggesting age remains a major factor in treatment decisions. Research is needed to better understand the cancer treatment decision-making process, and how to influence this, for older patients

What are older smokers' attitudes to quitting and how are they managed in primary care? An analysis of the cross-sectional English Smoking Toolkit Study.

OBJECTIVES: To investigate whether age is associated with access to smoking cessation services. DESIGN: Data from the Smoking Toolkit Study 2006-2015, a repeated multiwave cross-sectional household survey (n=181 157). SETTING: England. PARTICIPANTS: Past-year smokers who participated in any of the 102 waves stratified into age groups. OUTCOME MEASURES: Amount smoked and nicotine dependency, self-reported quit attempts and use of smoking cessation interventions. Self-report of whether the general practitioner (GP) raised the topic of smoking and made referrals for pharmacological support (prescription of nicotine replacement therapies (NRTs)) or other support (counselling or support groups). RESULTS: Older smokers (75+ years) were less likely to report that they were attempting to quit smoking or seek help from a GP, despite being less nicotine-dependent. GPs raised smoking as a topic equally across all age groups, but smokers aged 70+ were more likely not to be referred for NRT or other support (ORs relative to 16-54 years; 70-74 years 1.27, 95% CI 1.03 to 1.55; 75-79 years 1.87, 95% CI 1.43 to 2.44; 80+ years 3.16, 95% CI 2.20 to 4.55; p value for trend <0.001). CONCLUSIONS: Our findings suggest that there are potential missed opportunities in facilitating smoking cessation in older smokers. In this large population-based study, older smokers appeared less interested in quitting and were less likely to be offered support, despite being less addicted to nicotine than younger smokers. It is unclear whether this constitutes inequitable access to services or reflects informed choices by older smokers and their GPs. Future research is needed to understand why older smokers and GPs do not pursue smoking cessation. Service provision should consider how best to reduce these variations, and a stronger effectiveness evidence base is required to support commissioning for this older population so that, where appropriate, older smokers are not missing out on smoking cessation therapies and the health benefits of cessation at older ages