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.

Are men aging as oaks and women as reeds? A behavioral hypothesis to explain the gender paradox of French centenarians.

Since the 1990s, several studies involving French centenarians have shown a gender paradox in old age. Even if women are more numerous in old age and live longer than men, men are in better physical and cognitive health, are higher functioning, and have superior vision. If better health should lead to a longer life, why are men not living longer than women? This paper proposes a hypothesis based on the differences in the generational habitus between men and women who were born at the beginning of the 20th century. The concept of generational habitus combines the generation theory of Mannheim with the habitus concept of Bourdieu based on the observation that there exists a way of being, thinking, and doing for each generation. We hypothesized that this habitus still influences many gender-linked behaviours in old age. Men, as "oaks," seem able to delay the afflictions of old age until a breaking point, while women, as "reeds," seem able to survive despite an accumulation of health deficits.

Persistence of abnormal cortisol levels in elderly persons after recovery from major depression.

BACKGROUND: Cortisol hypersecretion is characteristic of acute clinical depression, but little is known in fully recovered, non-treated elderly persons with a lifetime history of depression. This study was designed to examine patterns of diurnal cycle of cortisol in an elderly cohort without current depression or treatment for depression according to whether the person has or has not experienced a previous episode of depression or co-morbid depression with anxiety. METHODS: Cortisol secretion was evaluated in 162 community-dwelling elderly on a stressful and a non-stressful day (basal level). Past depression and anxiety disorders were assessed using a standardized psychiatric examination based on DSM-IV criteria (the Mini International Neuropsychiatric Interview). RESULTS: Antidepressant-free persons with a history of non-co-morbid major depression (6.8% of the sample) showed basal cortisol hypersecretion compared to those with depression and anxiety (8.6%) or controls. Several hours after exposure to a stressful situation, controls showed a sustained increase in cortisol secretion, which was not observed in persons with a history of depression. Persons with a history of depression with anxiety showed a similar cortisol secretion at baseline to controls but a heightened response to stressful situation; a pattern comparable to that observed in subjects with pure anxiety disorders (16.7%). CONCLUSION: An abnormal HPA response persists even after effective treatment for depression. A history of co-morbid depression and anxiety gives rise to changes characteristic of anxiety alone. Our findings suggest that cortisol abnormalities may be trait markers for vulnerability to depression and for the differentiation of depression and depression with co-morbid anxiety.

Abnormal reactions to environmental stress in elderly persons with anxiety disorders: evidence from a population study of diurnal cortisol changes.

BACKGROUND: Cortisol secretion in elderly persons with anxiety disorders exposed to common stressful situations has not been evaluated. METHODS: Salivary-free cortisol levels were evaluated at 8, 15, and 22 h, in 201 elderly subjects during stressful and non-stressful days. Psychiatric symptomatology was assessed by a standardized psychiatric examination (MINI). RESULTS: Elderly subjects without psychiatric disorder showed a sustained increase in cortisol secretion several hours after the exposure to a stressful situation. In comparison, subjects with anxiety disorders showed a greater increase in cortisol secretion in the stressful situation, with lowered recuperation capacity. This effect was dose-dependent as a function of anxiety co-morbidity. Persons reporting lifetime major trauma with intrusions exhibited lowered continuous basal cortisol associated with efficient recuperation capacity. Independently of psychopathology, women appeared more reactive to stressful environmental conditions. LIMITATIONS: Exclusion of institutionalized persons and benzodiazepine users may have led to sampling of less severe anxiety symptoms. CONCLUSIONS: Dysregulation of the hypothalamic-pituitary-adrenal axis was observed in elderly persons with anxiety disorders experiencing environmental stress. A common pattern of up-regulated diurnal cortisol secretion was observed in anxious subjects with lifetime and current anxiety disorder irrespective of sub-type (generalized anxiety, phobias) suggesting a stable trait and a common "core" across disorders. Elderly persons who had experienced trauma with subsequent intrusions showed a distinct pattern with down-regulated activity.