Looking forward to a general theory on population aging

The main theories on population aging based on recent data on human longevity, life expectancy, morbidity changes, disability trends, and mortality decrease are presented and discussed within their own geographic, cultural, socioeconomic, and medical contexts. The complex interactions between all these components do not facilitate trend forecasting of aging population (healthy aging versus disability pandemic)

A meta-analysis of genome-wide association studies identifies multiple longevity genes

Human longevity is heritable, but genome-wide association (GWA) studies have had limited success. Here, we perform two meta-analyses of GWA studies of a rigorous longevity phenotype definition including 11,262/3484 cases surviving at or beyond the age corresponding to the 90th/99th survival percentile, respectively, and 25,483 controls whose age at death or at last contact was at or below the age corresponding to the 60th survival percentile. Consistent with previous reports, rs429358 (apolipoprotein E (ApoE) ε4) is associated with lower odds of surviving to the 90th and 99th percentile age, while rs7412 (ApoE ε2) shows the opposite. Moreover, rs7676745, located near GPR78, associates with lower odds of surviving to the 90th percentile age. Gene-level association analysis reveals a role for tissue-specific expression of multiple genes in longevity. Finally, genetic correlation of the longevity GWA results with that of several disease-related phenotypes points to a shared genetic architecture between health and longevity

Impact of Question Wording on the Measurement of Activity Limitation: Evidence From a Randomized Test in France.

&lt;p&gt;&lt;b&gt;OBJECTIVE: &lt;/b&gt;The Global Activity Limitation Indicator (GALI), a single question measuring disability, had been introduced in various European surveys since 2004. The complexity of its wording has been questioned. Our study compares alternative variants aiming to simplify the wording.&lt;/p&gt;&lt;p&gt;&lt;b&gt;METHOD: &lt;/b&gt;We used the Health-Related Opinion Survey run in 2014 in France (N = 3,009). Its split sample design allows testing four variants of the questions. We analyzed the prevalence of activity limitation (AL) resulting from the four different constructs of the GALI using multinomial logistic regressions, adjusted for background variables and functional limitations (FLs).&lt;/p&gt;&lt;p&gt;&lt;b&gt;RESULTS: &lt;/b&gt;The alternative GALI variants result in significantly different prevalences compared with the original question, in particular for people with FL. The current variant is more inclusive than the routed variants.&lt;/p&gt;&lt;p&gt;&lt;b&gt;DISCUSSION: &lt;/b&gt;Our study suggests limited benefits of changing the GALI construct which do not outweigh the costs of breaking the established chronological series of the current variant.&lt;/p&gt;</p

The joint action on healthy life years (JA: EHLEIS)

BACKGROUND:Life expectancy has been increasing during the last century within the European Union (EU). To measure progress in population health it is no longer sufficient to focus on the duration of life but quality of life should be considered. Healthy Life Years (HLY) allow estimating the quality of the remaining years that a person is expected to live, in terms of being free of long-standing activity limitation. The Joint Action on Healthy Life Years (JA: EHLEIS) is a joint action of European Member States (MS) and the European Union aiming at analysing trends, patterns and differences in HLY, as well as in other Summary Measures of Population Health (SMPH) indicators, across the European member states.METHODS:The JA: EHLEIS consolidates existing information on life and health expectancy by maximising the European comparability; by analysing trends in HLY within the EU; by analysing the evolution of the differences in HLY between Member States; and by identifying both macro-level as micro-level determinants of the inequalities in HLY. The JA: EHLEIS works in collaboration with the USA, Japan and OECD on the development of new SMPHs to be used globally. To strengthen the utility of the HLY for policy-making, annual meetings with policy-makers are planned.RESULTS:The information system allows the estimation of a set of health indicators (morbidity and disability prevalence, life and health expectancies) for Europe, Member States and shortly their regional levels. An annual country report on HLY in the national languages is available. The JA: EHLEIS is developing statistical attribution and decomposition tools which will be helpful to determine the impact of specific diseases, life styles or other determinants on differences in HLY. Through a set of international workshops the JA: EHLEIS aims to develop a blueprint for an international harmonized Summary Measure of Population Health.CONCLUSION:The JA: EHLEIS objectives are to monitor progress towards the headline target of the Europe 2020 strategy of increasing HLY by 2 years by 2020 and to support policy development by identifying the main determinants of active and healthy ageing in Europe</p

A “New” General Theory of Population Ageing

The main theories of population ageing based on recent data on human longevity, life expectancy, morbidity changes, disability trends and fall in mortality show co-existing contradictory tendencies in disability and functioning. These contradictions reflect differences in geographic, cultural, socio-economic, political and medical contexts, for instance:• an increase in the survival rates of sick persons which would explain the expansion of morbidity and/or disability that is now taking place in Taiwan,• control of the progression of chronic diseases which would explain the subtle equilibrium between the fall in mortality and the increase in disability currently observed in the U.K.,• an improvement in the health status and health behaviours of the new cohorts of old people which would explain the reduction in morbidity and/or disability now found in France, Switzerland and the U.S. The Geneva Papers on Risk and Insurance (2004) 29, 667–678. doi:10.1111/j.1468-0440.2004.00309.x

International Handbook of Health Expectancies

This handbook presents global research on health expectancies, a measure of population health that examines the interaction between quantity and quality of life. With data from Europe, North America, Asia, and beyond, it explains how to define and measure health and morbidity and how to integrate these measurements with mortality. Coverage first highlights long-term trends in longevity and health. It also considers variations across and within countries, inequalities, and social gaps as well as micro and macro-level determinants. Next, the handbook deals with the methodological aspects of calculating health expectancies. It compares results from different methods and introduces tools, such as decomposition tool for decomposing gaps, an attrition tool for attributing a medical cause to reported disability, and a tool for measuring policy impact on health expectancies. It introduces methods of forecasting health expectancies. The handbook then goes on to examine the synergies and/or trade-off between longevity and health as well as considers such topics as the compression versus the expansion of morbidity/disability and the health-survival paradox. The last section considers new concepts and dimensions of health and, more broadly, well being which can be used in summary measures of population health, including psychological factors. Researchers, clinicians, demographers, and health planners will find this handbook an essential resource to this increasingly important public health and social policy tool. It will help readers gain insight into changes in health over time as well as inequalities between countries, regions, and population subgroups

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.


Keywords: healthy life expectancy; aging; disabilit

Impact of smoking on the contribution of chronic diseases to the disability burden in Belgium, 1997-2008

Smoking is considered the single most important preventable cause of morbidity and mortality worldwide. Moreover, smoking can increase the incidence and severity of disabling conditions. In this study, the aim was to assess the impact of smoking on the contribution of chronic diseases to the disability burden in Belgium.</p