Trends and variation in mild disability and functional limitations among older adults in Norway, 1986–2008

An increase in the number of older adults may raise the demand for health and care services, whereas decreasing prevalence of disability and functional limitations among them might counteract this demographic effect. However, the trends in health are inconsistent between studies and countries. In this article, we estimated the trends in mild disability and functional limitations among older Norwegians and analyzed whether they differ between socio-demographic groups. Data were obtained from repeated cross-sectional surveys conducted in 1987, 1991, 1995, 2002, 2005, and 2008, in total 4,036 non-institutionalized persons aged 67 years or older. We analyzed trends using multivariate logistic regression. On average, the age-adjusted trend in functional limitations was −3.3% per year, and in disability 3.4% per year. The risk for functional limitations or disability was elevated for women compared to men, for married compared to non-married, and was inversely associated with educational level The trends were significantly weaker with increasing age for disabilities, whereas none of the trends differed significantly between subgroups of sexes, educational level or marital status. Both functional limitations free and disability-free life expectancy appeared to have increased more than total life expectancy at age 67 during this period. The analysis suggests downward trends in the prevalence of mild disability and functional limitations among older Norwegians between 1987 and 2008 and a compression of lifetime in such health states. The reduced numbers of older people with disability and functional limitations may have restrained the demand for health and care services caused by the increase in the number of older adults

Recent trends in chronic disease, impairment and disability among older adults in the United States

<p>Abstract</p> <p>Background</p> <p>To examine concurrent prevalence trends of chronic disease, impairment and disability among older adults.</p> <p>Methods</p> <p>We analyzed the 1998, 2004 and 2008 waves of the Health and Retirement Study, a nationally representative survey of older adults in the United States, and included 31,568 community dwelling adults aged 65 and over. Measurements include: prevalence of chronic diseases including hypertension, heart disease, stroke, diabetes, cancer, chronic lung disease and arthritis; prevalence of impairments, including impairments of cognition, vision, hearing, mobility, and urinary incontinence; prevalence of disability, including activities of daily living (ADLs) and instrumental activities of daily living (IADLs).</p> <p>Results</p> <p>The proportion of older adults reporting no chronic disease decreased from 13.1% (95% Confidence Interval [CI], 12.4%-13.8%) in 1998 to 7.8% (95% CI, 7.2%-8.4%) in 2008, whereas the proportion reporting 1 or more chronic diseases increased from 86.9% (95% CI, 86.2%-89.6%) in 1998 to 92.2% (95% CI, 91.6%-92.8%) in 2008. In addition, the proportion reporting 4 or more diseases increased from 11.7% (95% CI, 11.0%-12.4%) in 1998 to 17.4% (95% CI, 16.6%-18.2%) in 2008. The proportion of older adults reporting no impairments was 47.3% (95% CI, 46.3%-48.4%) in 1998 and 44.4% (95% CI, 43.3%-45.5%) in 2008, whereas the proportion of respondents reporting 3 or more was 7.2% (95% CI, 6.7%-7.7%) in 1998 and 7.3% (95% CI, 6.8%-7.9%) in 2008. The proportion of older adults reporting any ADL or IADL disability was 26.3% (95% CI, 25.4%-27.2%) in 1998 and 25.4% (95% CI, 24.5%-26.3%) in 2008.</p> <p>Conclusions</p> <p>Multiple chronic disease is increasingly prevalent among older U.S. adults, whereas the prevalence of impairment and disability, while substantial, remain stable.</p

A national survey of services for the prevention and management of falls in the UK

Background: The National Health Service (NHS) was tasked in 2001 with developing service provision to prevent falls in older people. We carried out a national survey to provide a description of health and social care funded UK fallers services, and to benchmark progress against current practice guidelines. Methods: Cascade approach to sampling, followed by telephone survey with senior member of the fall service. Characteristics of the service were assessed using an internationally agreed taxonomy. Reported service provision was compared against benchmarks set by the National Institute for Health and Clinical Excellence (NICE). Results: We identified 303 clinics across the UK. 231 (76%) were willing to participate. The majority of services were based in acute or community hospitals, with only a few in primary care or emergency departments. Access to services was, in the majority of cases, by health professional referral. Most services undertook a multi-factorial assessment. The content and quality of these assessments varied substantially. Services varied extensively in the way that interventions were delivered, and particular concern is raised about interventions for vision, home hazard modification, medication review and bone health. Conclusion: The most common type of service provision was a multi-factorial assessment and intervention. There were a wide range of service models, but for a substantial number of services, delivery appears to fall below recommended NICE guidance

Stability of Scalar Fields in Warped Extra Dimensions

This work sets up a general theoretical framework to study stability of models with a warped extra dimension where N scalar fields couple minimally to gravity. Our analysis encompasses Randall-Sundrum models with branes and bulk scalars, and general domain-wall models. We derive the Schrodinger equation governing the spin-0 spectrum of perturbations of such a system. This result is specialized to potentials generated using fake supergravity, and we show that models without branes are free of tachyonic modes. Turning to the existence of zero modes, we prove a criterion which relates the number of normalizable zero modes to the parities of the scalar fields. Constructions with definite parity and only odd scalars are shown to be free of zero modes and are hence perturbatively stable. We give two explicit examples of domain-wall models with a soft wall, one which admits a zero mode and one which does not. The latter is an example of a model that stabilizes a compact extra dimension using only bulk scalars and does not require dynamical branes.Comment: 25 pages, 2 figures; v2: minor changes to text, references added, matches published versio

Holography for chiral scale-invariant models

Deformation of any d-dimensional conformal field theory by a constant null source for a vector operator of dimension (d + z -1) is exactly marginal with respect to anisotropic scale invariance, of dynamical exponent z. The holographic duals to such deformations are AdS plane waves, with z=2 being the Schrodinger geometry. In this paper we explore holography for such chiral scale-invariant models. The special case of z=0 can be realized with gravity coupled to a scalar, and is of particular interest since it is related to a Lifshitz theory with dynamical exponent two upon dimensional reduction. We show however that the corresponding reduction of the dual field theory is along a null circle, and thus the Lifshitz theory arises upon discrete light cone quantization of an anisotropic scale invariant field theory.Comment: 62 pages; v2, published version, minor improvements and references adde

On correlation functions of operators dual to classical spinning string states

We explore how to compute, classically at strong coupling, correlation functions of local operators corresponding to classical spinning string states. The picture we obtain is of `fattened' Witten diagrams, the evaluation of which turns out to be surprisingly subtle and requires a modification of the naive classical action due to a necessary projection onto appropriate wave functions. We examine string solutions which compute the simplest case of a two-point function and reproduce the right scaling with the anomalous dimensions corresponding to the energies of the associated spinning string solutions. We also describe, under some simplifying assumptions, how the spacetime dependence of a conformal three-point correlation function arises in this setup.Comment: 27 pages, 3 figures; v2: references and comments added

Exactly Marginal Deformations and Global Symmetries

We study the problem of finding exactly marginal deformations of N=1 superconformal field theories in four dimensions. We find that the only way a marginal chiral operator can become not exactly marginal is for it to combine with a conserved current multiplet. Additionally, we find that the space of exactly marginal deformations, also called the "conformal manifold," is the quotient of the space of marginal couplings by the complexified continuous global symmetry group. This fact explains why exactly marginal deformations are ubiquitous in N=1 theories. Our method turns the problem of enumerating exactly marginal operators into a problem in group theory, and substantially extends and simplifies the previous analysis by Leigh and Strassler. We also briefly discuss how to apply our analysis to N=2 theories in three dimensions.Comment: 23 pages, 2 figure

Holographic three-point functions of semiclassical states

We calculate the holographic three-point functions in N = 4 super-Yang-Mills theory in the case when two of the operators are semiclassical and one is dual to a supergravity mode. We further discuss the transition to the regime when all three operators are semiclassical.Comment: 17 pages, 3 figures; v2: refs. added, discussion in sec. 2.1 expanded; v3: misprint in (2.28) corrected, published versio

Correlation functions of three heavy operators - the AdS contribution

We consider operators in N=4 SYM theory which are dual, at strong coupling, to classical strings rotating in S^5. Three point correlation functions of such operators factorize into a universal contribution coming from the AdS part of the string sigma model and a state-dependent S^5 contribution. Consequently a similar factorization arises for the OPE coefficients. In this paper we evaluate the AdS universal factor of the OPE coefficients which is explicitly expressed just in terms of the anomalous dimensions of the three operators.Comment: 49 pages, 3 figures; v.2 references corrected; v3: corrected discussion in section 5, results unchange

Cohort differences in disease and disability in the young-old: findings from the MRC Cognitive Function and Ageing Study (MRC-CFAS)

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