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). In the context of population aging, four elements were introduced with their implications: 1) an increase in the survival rates of sick persons, which would explain the expansion of morbidity, 2) a control of the progression of chronic diseases, which would explain a subtle equilibrium between the decrease in mortality and the increase in disability, 3) an improvement of the health status and health behaviors of new cohorts of elderly people, which would explain the compression of morbidity, and eventually 4) an emergence of very old and frail populations, which would explain a new expansion of morbidity. Obviously, all these elements coexist today, and future trend scenarios—expansion or compression of disability—depend on their respective weights leading to the need of elaborating "a general theory on population aging.” This theory has to be based on a world harmonization of functional decline measurements and a periodic "International Aging Survey” to monitor global aging through a sample of carefully selected countrie

The compression of deaths above the mode

Kannisto (2001) has shown that as the frequency distribution of ages at death has shifted to the right, the age distribution of deaths above the modal age has become more compressed. In order to further investigate this old-age mortality compression, we adopt the simple logistic model with two parameters, which is known to fit data on old-age mortality well (Thatcher 1999). Based on the model, we show that three key measures of old-age mortality (the modal age of adult deaths, the life expectancy at the modal age, and the standard deviation of ages at death above the mode) can be estimated fairly accurately from death rates at only two suitably chosen high ages (70 and 90 in this study). The distribution of deaths above the modal age becomes compressed when the logits of death rates fall more at the lower age than at the higher age. Our analysis of mortality time series in six countries, using the logistic model, endorsed Kannisto’s conclusion. Some possible reasons for the compression are discussed.compression of mortality, lexis model, logistic model, modal age of death, oldest old mortality decline, standard deviation

Contribution of chronic conditions to the disability burden across smoking categories in middle-aged adults, Belgium

Introduction : Smoking is considered the single most important preventable cause of morbidity and mortality worldwide, contributing to increased incidence and severity of disabling conditions. The aim of this study was to assess the contribution of chronic conditions to the disability burden across smoking categories in middle-aged adults in Belgium. Methods : Data from 10,224 individuals aged 40 to 60 years who participated in the 1997, 2001, 2004, or 2008 Health Interview Surveys in Belgium were used. Smoking status was defined as never, former (cessation >= 2 years), former (cessation = 20 cigarettes/day). To attribute disability to chronic conditions, binomial additive hazards models were fitted separately for each smoking category adjusted for gender, except for former (cessation <2 years) and occasional light smokers due to the small sample size. Results : An increasing trend in the disability prevalence was observed across smoking categories in men (never = 4.8%, former (cessation >= 2 years) = 5.8%, daily light = 7.8%, daily heavy = 10.7%) and women (never = 7.6%, former (cessation >= 2 years) = 8.0%, daily light = 10.2%, daily heavy = 12.0%). Musculoskeletal conditions showed a substantial contribution to the disability burden in men and women across all smoking categories. Other important contributors were depression and cardiovascular diseases in never smokers; depression, chronic respiratory diseases, and diabetes in former smokers (cessation >= 2 years); chronic respiratory diseases, cancer, and cardiovascular diseases in daily light smokers; cardiovascular diseases and chronic respiratory diseases in men and depression and diabetes in women daily heavy smokers. Conclusions : Beyond the well-known effect of smoking on mortality, our findings showed an increasing trend of the disability prevalence and different contributors to the disability burden across smoking categories. This information can be useful from a public health perspective to define strategies to reduce disability in Belgium

La démographie des nonagénaires et des centenaires en Suisse

L'objectif de cette étude est d'explorer l'augmentation du nombre des personnes très âgées en Suisse, de dater et préciser l'ampleur et la vitesse de cette augmentation, ainsi que de fournir quelques indications sur les mécanismes démographiques qui en sont à l'origine. L'étude, qui met en oeuvre des méthodes démographiques standard, utilise l'ensemble des données disponibles pour la Suisse depuis I860, recensements, estimations annuelles de la population et statistiques de mortalité. Les indicateurs utilisés tendent à montrer que l'accroissement du nombre des centenaires en Suisse a été l'un des plus forts au monde. Il est surtout dû à la diminution de la mortalité au-delà de l'âge de 80 ans, diminution qui s'accélère à partir des années 1950. L'amélioration massive des conditions socio-économiques après la Seconde Guerre mondiale pourrait expliquer les tendances observées. De nouveaux indicateurs doivent être mis au point pour surveiller la qualité de la vie de cette population très âgée, émergente, constituée de nonagénaires et de centenaires. [Auteurs] [Abstract] The aim of this study is to examine the increase in the number of very elderly persons in Switzerland, to date and detail the extent and rapidity of this increase, and to point to some of the underlying demographic mechanisms involved. The study, which applies standard demographic methods, uses all available data for Switzerland since 1860, including censuses, annual population estimates and mortality statistics. The indicators used tend to show that the increase in the number of centenarians in Switzerland has been one of the strongest in the world. This increase is mainly due to the decline in the death rate over the age of 80, a decline that has been accelerating since the 1950s. The massive improvement in socioeconomic conditions after the Second World War could explain the trends observed. New indicators should be developed to monitor the quality of life of this newly emerging, very elderly population, comprised of nonagenarians and centenarians. [Authors]]]> Aged, 80 and over ; Demography ; Switzerland oai:serval.unil.ch:BIB_AE03FA37B7D3 2022-05-07T01:24:59Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_AE03FA37B7D3 PATTERNS OF CHORIOCAPILLARIS FLOW SIGNAL VOIDS IN CENTRAL SEROUS CHORIORETINOPATHY: An Optical Coherence Tomography Angiography Study. info:doi:10.1097/IAE.0000000000002271 info:eu-repo/semantics/altIdentifier/doi/10.1097/IAE.0000000000002271 info:eu-repo/semantics/altIdentifier/pmid/30028410 Matet, A. Daruich, A. Hardy, S. Behar-Cohen, F. info:eu-repo/semantics/article article 2019-11 Retina, vol. 39, no. 11, pp. 2178-2188 info:eu-repo/semantics/altIdentifier/eissn/1539-2864 urn:issn:0275-004X <![CDATA[To investigate choriocapillaris flow signal void distribution on optical coherence tomography (OCT) angiography in central serous chorioretinopathy (CSCR) and its correlation to choroidal vessel morphology. Fifty-three CSCR eyes (48 patients) and 34 healthy control eyes were included, retrospectively. Exclusion criteria were refractive error &gt;2D, previous laser or photodynamic therapy, low-quality OCT angiography, or excessive shadowing artifacts. Choriocapillaris OCT angiography scans were processed by local-threshold binarization to identify signal voids, and extract their cumulative area. The locations of the two largest voids in each eye were reported on the corresponding enhanced depth imaging OCT raster scan. Choriocapillaris thickness and diameter of underlying outer choroidal vessels were measured at the level of flow voids and of adjacent outer choroidal vessels, not colocalizing with voids. There were 22 acute, 16 recurrent, and 15 chronic CSCR eyes. Total flow void area was larger in CSCR than control eyes. In univariate analysis, the total flow void area on OCT angiography increased with age (P = 0.0002), duration since CSCR diagnosis (P = 0.004), extension of autofluorescence alterations (P = 0.016), and CSCR severity (P &lt; 0.0001). In multivariate analysis, age (P = 0.014) and CSCR type (P = 0.046) influenced independently the total flow void area. On enhanced depth imaging OCT, outer choroidal vessel diameter was higher (P &lt; 0.0001), and choriocapillaris was thinner (P &lt; 0.0001) at flow voids compared with adjacent sites, independently from eccentricity from the fovea. Choriocapillaris flow voids colocalize with choriocapillaris thinning and deep choroidal vessel dilation in CSCR eyes. Age and CSCR severity influence choriocapillaris flow, a key contributor to CSCR pathophysiology and clinical expression

L’allongement de l’espérance de vie en Europe

Depuis une trentaine d’années, face à l’allongement de l’espérance de vie, chercheurs et acteurs de santé publique s’interrogent sur les répercussions attendues sur la santé : gagne-t-on des années de bonne santé ou vit-on plus longtemps avec des maladies ? Ces interrogations découlent d’une augmentation de la survie aux grands âges, plus exposés aux problèmes de santé, mais aussi de la plus grande survie avec certaines maladies et incapacités dont la létalité diminue. En réponse à ces questions, les indicateurs d’espérance de vie en santé ont apporté la dimension qualitative au décompte des années de vie. Et les « années de vie en bonne santé », basées sur une mesure de la santé fonctionnelle, ont été ajoutées à la liste des indicateurs structurels de l’Union européenne. Calculées annuellement depuis 2008, elles permettent de suivre l’évolution concomitante de l’espérance de vie et des années vécues avec et sans limitation d’activité dans les pays européens et d’éclairer les disparités entre pays.Over the last thirty years, researchers and public health actors have been investigating the potential health impact of increasing life expectancy : are we gaining healthy years or do we live longer with diseases ? These questions arise as a consequence of increased survival to older ages at which health problems are common, and increased survival with diseases and disabilities whose lethality has decreased. In response to these questions, health expectancy indicators now provide a measure of both the quantitative and the qualitative dimensions of the years lived. And “healthy life years”, based on a functional health measurement, have been added to the European Union’s list of structural indicators. Calculated annually since 2008, they track the concomitant changes in life expectancy and years lived with and without activity limitations in European countries and shed light on the disparities between countries

The use of the global activity limitation Indicator and healthy life years by member states and the European Commission

Background: In 2005, the European Union (EU) started to use a disability-free life expectancy, known as Healthy Life Years (HLY), to monitor progress in the strategic European policies such as the 2000 Lisbon strategy. HLY are based on the underlying measure: the Global Activity Limitation Indicator (GALI). Twelve years after its implementation, this study aims to assess its current use in EU Member States and the European Commission. Methods: In March 2017, a questionnaire was sent to 28 Member states and the European Commission. The questionnaire inquired how the GALI and HLY are used to set policy targets, in which surveys the GALI has been introduced since 2005, how the GALI and HLY are presented, and what the capacity in each country is to investigate the GALI and HLY. Results: The survey was answered by 22 Member States and by the Commission. HLY are often used to set targets and develop strategies in health such as national health plans. Analysis of HLY has even led to policy change. In some countries, HLY have become the main indicator for health, gaining more importance than life expectancy. More recently, the GALI and HLY have also been used for policy targets outside the health sector such as in the area of pension and retirement age or in the context of sustainable development. Regarding surveys, the GALI is mostly obtained from the EU-SILC, SHARE and EHIS, but is also increasingly introduced in national surveys. National health reporting systems usually present HLY on their national statistics websites. Most countries have up to three specialists working on the GALI and HLY, which has been consistent through time. Others have increased their capacity over various institutions. Conclusion: HLY is an indicator that is systematically used to monitor health developments in most EU countries. The SHARE, EU-SILC and EHIS are commonly used to assess HLY through the GALI. The results are then described in reports and presented on national statistics websites and used in different policy settings. Expertise to analyse the GALI and HLY is available in most countries

Harmonising summary measures of population health using global survey instruments.

measures of population health-health expectancies in particular-have become a standard for quantifying and monitoring population health. To date, cross-national comparability of health expectancies is limited, except within the European Union (EU). To advance international comparability, the European Joint Action on Healthy Life Years (JA: EHLEIS) set up an international working group. The working group discussed the conceptual basis of summary measures of population health and made suggestions for the development of comparable health expectancies to be used across the EU and Organisation for Economic Co-operation and Development (OECD) members. In this paper, which summarises the main results, we argue that harmonised health data needed for health expectancy calculation can best be obtained from 'global' survey measures, which provide a snapshot of the health situation using 1 or a few survey questions. We claim that 2 global measures of health should be pursued for their high policy relevance: a global measure of participation restriction and a global measure of functional limitation. We finally provide a blueprint for the future development and implementation of the 2 global measures. The blueprint sets the basis for subsequent international collaboration, having as a core group Member States of the EU, the USA and Japan. Other countries, in particular OECD members, are invited to join the initiative

Evaluating the performance of a climate-driven mortality model during heat waves and cold spells in Europe.

The impact of climate change on human health is a serious concern. In particular, changes in the frequency and intensity of heat waves and cold spells are of high relevance in terms of mortality and morbidity. This demonstrates the urgent need for reliable early-warning systems to help authorities prepare and respond to emergency situations. In this study, we evaluate the performance of a climate-driven mortality model to provide probabilistic predictions of exceeding emergency mortality thresholds for heat wave and cold spell scenarios. Daily mortality data corresponding to 187 NUTS2 regions across 16 countries in Europe were obtained from 1998-2003. Data were aggregated to 54 larger regions in Europe, defined according to similarities in population structure and climate. Location-specific average mortality rates, at given temperature intervals over the time period, were modelled to account for the increased mortality observed during both high and low temperature extremes and differing comfort temperatures between regions. Model parameters were estimated in a Bayesian framework, in order to generate probabilistic simulations of mortality across Europe for time periods of interest. For the heat wave scenario (1-15 August 2003), the model was successfully able to anticipate the occurrence or non-occurrence of mortality rates exceeding the emergency threshold (75th percentile of the mortality distribution) for 89% of the 54 regions, given a probability decision threshold of 70%. For the cold spell scenario (1-15 January 2003), mortality events in 69% of the regions were correctly anticipated with a probability decision threshold of 70%. By using a more conservative decision threshold of 30%, this proportion increased to 87%. Overall, the model performed better for the heat wave scenario. By replacing observed temperature data in the model with forecast temperature, from state-of-the-art European forecasting systems, probabilistic mortality predictions could potentially be made several months ahead of imminent heat waves and cold spells