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Longer Life and Healthy Ageing

Beijing, China 22-27 October 2001
Organised by the IUSSP Committee on Longevity and Health

Report

The seminar on Longevity and Health was sponsored by the IUSSP Committee on Longevity and Health chaired by Jean-Marie Robine. It was the second scheduled activity of the Committee in its four-year programme for 1999-2003. The seminar was held on 22-24 October 2001 in Beijing, China and was co-organized by China Population Association and Healthy Ageing and Family Studies Center of Peking university. The conference included ten sessions that covered the following topics: healthy ageing (I, II); methods of computing healthy life expectancy; healthy ageing in the world (I, II); determinants of healthy ageing (I -IV) and centenarians. One or various papers were presented in each session, and a discussion followed. The key outcome of the conference will be a book based on the papers presented.

1. Healthy Ageing (I)

The first session of the seminar was on Healthy Ageing chaired by Professor Jean-Marie Robine. The two theoretical papers presented in this session raised questions in the definition, measurement and other aspects of ’healthy aging’ and ’disability’, respectively. In the first paper, "Can we live longer, healthier lives?", Carol Jagger firstly discussed the creation of broad and precise definition of healthy ageing (or successful ageing) and its components in detail. She then raised some issues around the measurement of the different components of healthy ageing, concentrating on the difficulty in defining the delineation between healthy ageing and normal ageing as well as the changing milieu in which activities are performed. The paper discussed whether the current measurement instruments are still applicable to future cohorts and argued that healthy ageing seemed to be best measured by no restrictions in IADLs or ADLs. Finally the evidence on the determinants of healthy ageing was reviewed and the potential for increasing both the numbers of older people who age healthily and the length of time they do so were prospected.

Lois M. Verbrugge’s paper entitled "Disability questions: number, meaning, and uses" was about some issues in designing questions about disability for large-scale surveys. The author presented 9 examples and weaved through them issues of the number, meaning, and uses of disability items before turned to healthy ageing. Suggestions were made in designing questions including: (i) always create the minimal set of questions; (ii) create questions when nothing "on the shelf" fits the goal; and (iii) every question should have known-in-advance analytic use.

2. Healthy Ageing (II)

Professor Zeng Yi chaired the second session on healthy ageing.

The paper "Healthy ageing" coauthored by J-P Michel, F Herrmann and J-M Robine looked at ageing from life course perspectives. The paper asserted that growth and ageing constitute a continuing process which involve genetics, economics, environment and culture. Each of these elements is major determinant of the individual life cycle. This fundamental background of life determines the various processes constituting the life itself: Human anatomy and physiological conditions change all along life. The physiological ageing process itself is extremely variable between individuals. This ageing process is modified by the mental and physical activities performed from the childhood to the late stages of life. Positive and negative risk factors interfere with the ageing process itself and related diseases. Progressive or acute onset of disease can disrupt the life cycle. It argued that the analysis of this ageing process will not be complete without stressing the major impact of the individual well being. The quality of life is one of the trickiest parts of human sciences. Whatever scientists’ effort, its evaluation stays very approximate. Healthy ageing is perhaps a good thing for the individual and for the society, but the best process, is without any doubt, a successful ageing with a good appreciation of what the individual did during his life, absent of remorse and desire for himself and for his affective surrounding to continue to have projects and enjoy life.

In the paper "Age Differences in Allostatic Load: An Index of Healthy Ageing", Eileen Crimmins, Melanie Wong, Mark Hayward and Teresa Seeman examined, using National Health Examination and Nutrition Survey data, age difference in the population in a summary indicator of physiological risk - allostatic load; and age differences in the cross section to look at variability in physiological risk age. The results showed that allostatic load increase with age up to age 70 and is highly related to mortality. Also mortality works to keep the physiological risk of the older population from increasing with older age as might be expected. This analysis begins to show the potential reasons for decreasing rate of increase in mortality at the oldest ages.

3. Methods of Computing Healthy Life Expectancy

This session was chaired by Professor Shiro Horiuchi.

Nicolas Brouard presented a study on "Methods of computing healthy life expectancy". The author firstly explained what is "healthy life expectancy" and then made a comparison between "life expectancy" and "healthy life expectancy". This study discussed in detail health expectancy models. Examples were given to illustrate how to make better predictions.

The paper ’Effects of Diabetes on healthy life expectancy: shorter lives with more disability for both women and men’ coauthored by James and Sarah Laditka investigated differences in life expectancy, disability free life expectancy, and disabled life expectancy between groups of people with and without diabetes, using united States’ data from the 1984-1990 Longitudinal Study of Ageing. Results showed that the impact of diabetes on health expectancies is substantial. In addition, while the distributions of remaining total and unimpaired life are approximately normal for individuals without diabetes, corresponding distributions for those with the disease are notably skewed toward fewer years of both total and unimpaired life. Results highlighted the health burden of diabetes throughout the older life course, and the differential impact of the disease both between and within groups. Given projections of a global epidemic of diabetes, these findings support policies promoting lifestyle changes that postpone and control this disease.

4. Healthy Ageing in the World (I)

This session was chaired by Yves Carriere.

The first paper on "Review of studies on health expectancy in Asian countries" was presented by Yasuhiko Saito. The paper reviewed studies on health expectancy conducted in Japan, China, Taiwan, Korea, Thailand, Singapore, Philippines and Indonesia. According to Saito, the Sullivan method is the most prevalent method of computing health expectancy in Asian countries due to data limitations. In order to apply other methods, longitudinal surveys are required. The author called for more studies, more data and common measures at the end.

The second paper titled ’Ageing and disability in Taiwan: prevalence and transitions from a panel study’ was presented by Ming-cheng Chang. using panel data from the "1989 Survey of Health and Living Status of the Elderly in Taiwan’ with follow-up in 1993, 1996, and 1999 (N=4,049, age=60+), this study examined changes in the prevalence of functional difficulties and disability-free life expectancy in each two waves. It showed that regardless of the decreased, the prevalence rates of functional limitations had reduced between 1989 and 1993, but increased either between 1993 and 1996 or between 1996 and 1999. Similarly, the disability-free life expectancy from IMaCh (Interpolation of Markov Chains) is longest for the earlier period (1989 to1993), followed by the two later periods (1993 to1996 and 1996 to 1999) in order. The mixed results seemed to suggest the Depression of morbidity for the earlier period and the Expansion of morbidity for the later periods. Such a transition is somewhat related to the implementation of health insurance program for all people in 1995, which has provided more access to medical care.

5. Healthy Ageing in the World (II)

Professor Elieen Crimmins chaired this session.

The paper by Roberto Ham Chande on ’Healthy ageing in Latin American’ firstly gave a general description of Latin American and its population dynamics based on averages for the whole region. It then pointed out that the great geographical and socio-economic diversity contributes to different demographic transitions, which leads to distinct levels and speeds in population ageing. The related epidemiological transition is polarized, since prevalence of communicable diseases are still significant but existing concurrently with fast shifts towards chronic illness and disabilities. Increases in life expectancies, particularly for older ages, are implying the quest for healthy expectancies. It concluded that the problems that are emerging are not isolated but in a high interrelationship with the rest of socio-economic variables. Solutions might be found only if the process is approached as the multifaceted system that it is.

Russell Wilkins in the paper ’Healthy life expectancy in low mortality countries: the Canadian experience’ reviewed the healthy expectancy work with Canada as the target population, based on published sources, including conference proceedings. The paper focused on original population-based research with health expectancy indicators as outcomes, with additional concern for work on the component disability and mortality processes. The paper summarized five main characteristics of health expectancy work for Canada and then discussed problems of the existing work include (i) a certain lack of consistency over time in survey and census disability questions, (ii) insufficient data on institutional residents, (iii) need for additional data to better understand the correlates of successful as well as unsuccessful ageing, (iv) difficulty in attributing loss of health expectancy by causes defined by disease, where outcomes are defined by disability or dependency and (v) absence of socio-economic data on vital statistics and health administrative databases. In the end, possible future directions for health expectancy work in Canada were pointed out and relevance of the Canadian experience to healthy ageing in low mortality countries was also discussed.

6. Determinants of Healthy Ageing (I)

The first session on Determinants of healthy ageing was chaired by Professor Jean-Marie Robine.

Emily Grundy’s paper entitled ’Gender and healthy ageing’ examined social differentials in health ageing for both men and women, based on analyses of data from developed countries, particularly Britain. It examined further the gender differences in contacts with kin and intergenerational exchanges and the extent to which these may benefit women. The contribution of gender to forms of disability and changes in this over time was considered as well. The paper concluded that women have fewer material resources in later life, but more social ones. However women also have greater needs for assistance. In the conclusion cohort differences in gender influences and histories and the implications of these for future generations of older people were discussed.

Emmanuelle Cambois in the paper ’Social inequalities in mortality at old ages in France: how late life occupational mobility can change the estimated differentials’ recorded, using a longitudinal sample set up on the basis of population census, mortality over the period 1975-1980. Being longitudinal, the sample allowed estimation of relative risks of mortality regarding occupational status at two points in time (1975 and 1968). Such a double estimation shows that occupational differentials in mortality are smaller for elderly than for the whole adult population, and mobility is less frequent in elderly population than in whole adult but still exists. It also shows that occupational pathways are associated with differentiated mortality risks which might influence the magnitude of the differentials. The data used show that mobility has been small over the study period, due to the fact that most of the sample is already retired at first point; therefore, the impact of mobility on the estimated differentials is negligible. Nevertheless, the study shows that mortality and mobility are correlated in male population while it is not in female population.

7. Determinants of Healthy Ageing (II)

This session was chaired by Shiro Horiuchi

With data from the Chinese healthy longevity survey on oldest old persons aged 80+ conducted in 1998 and 2000, the paper entitled ’Gender differentials of the oldest old in China’ by Zeng Yi, Liu Yuzhi and Linda George found that female oldest old persons of all age groups are more likely to live with their children because elderly women are more likely to be widowed and economically dependent. The gender differentials in education attainment among Chinese oldest old are enormous: many more women are illiterate. Based on the cross-sectional data, the authors are confident in concluding that the female oldest old in China are seriously disadvantaged in ADL, physical performance, MMSE and self-reported health, as compared with their male counterparts; these gender differences are more marked with advancing age. The conclusion called for very careful attention to the large gender differential among the Chinese oldest old to ensure that any old age insurance and service programs to be developed or reformed will benefit older women and men equally.

The second paper entitled ’Socio-demographic factors associated with the use of formal and/or informal support networks at older ages in Canada’ by Yves Carriere, Laurent Martel, Lucie Morin and Jacques Legare identified the socio-demographic factors associated with the use of formal and/or informal support networks and who is using both. Special attention was paid to the nature, extent and availability of the family network. The authors concluded that the family network of tomorrow’s oldest old will be smaller compared to today’s oldest old. All things being equal, this will increase the pressure on formal home care services if we want to ensure quality of life of this population. In addition, it argued that one of the most effective ways of reducing this expected added pressure would be to work on increasing the proportion of healthy years within life expectancy. This would improve the quality of life of the oldest-old and their family network.

8. Determinants of Healthy Ageing (III)

This session was chaired by Yves Carriere.

The paper titled ’Neuropathology of Healthy ageing: findings from the Nun study’ by Suzanne Tyas and co-authors developed new criteria for healthy ageing and conceptualised it as a range of levels, which also showed a strong association with both mortality and neuropathology. The paper investigated the role of these two pathologic conditions (Alzheimer’s neuropathology and brain infarcts) in healthy aging, the opposite end of the functional continuum. It was concluded that healthy aging is strongly associated with reduced all-cause mortality. In addition, brain infarcts and significant Alzheimer’s pathology have a substantial impact on the level of healthy aging.

9. Determinants of Healthy Ageing (IV)

This session was chaired by Professor Zeng Yi.

The paper ’Determinants of healthy ageing: ageing without dementia’ was presented by the first author Pascale Barberger-Gateau. Research results from this paper confirmed that incidence of dementia increased dramatically with age, in particular in women after age 75. Results also suggested that increasing educational level, promoting healthy food habits and engagement in social and leisure activities could contribute to healthy cognitive aging.

The paper by Yongyi Li on ’Disability patterns for U.S. nursing home residents over two decades: findings from the 1973 to 1997 National Nursing Home Surveys’ analysed the trend of nursing home residents’ health status change across the four waves of NNHS, using the full range of diseases and impairment measures of the nursing home population. It concluded that the demand for more intensive care and the cost of nursing home services will rise sharply.

10. Centenarians

The last session of this seminar was chaired by Professor Eileen Crimmins.

Karen Andersen-Ranberg and Bernard Jeune reported their research results of the health characteristics of an unselected population of Danish centenarians in ’The Danish longitudinal centenarian study’. In contrast to most previous studies it concluded that today’s centenarians have not survived due to a healthy life, nor are they healthy at the age of 100 years. They have a high prevalence of common diseases and chronic conditions, with consequent functional limitations. However, in spite of the presence of several diseases, a minor proportion can be identified as cognitively intact and well-functioning.

Zhenglian Wang ’s paper entitled ’Association of socio-economic factors with functional capacity and self-reported health of centenarians in China’ was based on interviews to 208 centenarians in Beijing, Hangzhou, and Chendu. It found that male urban centenarians tend to be more dependent than urban female centenarians are; urban centenarians are more dependent than those in the rural areas are. Male centenarians tend to report better health than females do. Educational attainment is positively and significantly associated with centenarians’ self-reported health and well-being. It confirmed that current economic status is associated with centenarians’ self-reported health. Centenarians who have better current economic conditions tend to self-report better health. Also, childhood economic condition is positively associated with centenarians’ self-reported health and well-being. Speech impairment is significantly associated with centenarians’ well-being; hearing impairment does not significantly associate with an individual’s self-reported health and activities of daily living.

Xia Du

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