Health, frailty and disability after ninety: Results of an observational study in France.

BACKGROUND: In spite of their increasing demographic weight, health characteristics of the oldest old remain poorly described in epidemiological studies. OBJECTIVE: To describe the health of people aged 70 years and over included in the SIPAF study, and to compare the prevalence of health indicators including successful aging, frailty, and disability between three age groups including the oldest old. METHODS: The study population is composed of 2350 retired people recruited between 2008 and 2010, of whom 512 are aged 90 and over (21.8%). A comprehensive geriatric assessment was performed at home by trained nurses. The prevalence of health and functional indicators, as well as the distribution of people among successful ageing, frailty, and disability, were described by age group (70-79, 80-89, 90+) and sex. RESULTS: Compared to their younger counterparts, people aged 90 years and over were more likely to experience functional limitations, sensory impairment, cognitive impairment, poor mood, and frailty. One third of the nonagenarians needed help in at least one basic activity of daily living and 25% met the frailty criteria. In contrast, the prevalence of most chronic diseases did not increase after ninety. Successful ageing concerned 9% of the oldest old. Women were less likely to experience successful ageing and more likely to be frail or dependent. CONCLUSION: This study shows the diversity of health states in very old age and points out that one quarter of the people aged 90 and over said frail are likely to take advantage of preventive actions of disability.

Operational Definition of Active and Healthy Ageing (AHA): A Conceptual Framework.

Health is a multi-dimensional concept, capturing how people feel and function. The broad concept of Active and Healthy Ageing was proposed by the World Health Organisation (WHO) as the process of optimizing opportunities for health to enhance quality of life as people age. It applies to both individuals and population groups. A universal Active and Healthy Ageing definition is not available and it may differ depending on the purpose of the definition and/or the questions raised. While the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) has had a major impact, a definition of Active and Healthy Ageing is urgently needed. A meeting was organised in Montpellier, France, October 20-21, 2014 as the annual conference of the EIP on AHA Reference Site MACVIA-LR (Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon) to propose an operational definition of Active and Healthy Ageing including tools that may be used for this. The current paper describes the rationale and the process by which the aims of the meeting will be reached.

Developmental determinants in non-communicable chronic diseases and ageing.

Prenatal and peri-natal events play a fundamental role in health, development of diseases and ageing (Developmental Origins of Health and Disease (DOHaD)). Research on the determinants of active and healthy ageing is a priority to: (i) inform strategies for reducing societal and individual costs of an ageing population and (ii) develop effective novel prevention strategies. It is important to compare the trajectories of respiratory diseases with those of other chronic diseases.

Records needed for orthodontic diagnosis and treatment planning: a systematic review.

BACKGROUND: Traditionally, dental models, facial and intra-oral photographs and a set of two-dimensional radiographs are used for orthodontic diagnosis and treatment planning. As evidence is lacking, the discussion is ongoing which specific records are needed for the process of making an orthodontic treatment plan. OBJECTIVE: To estimate the contribution and importance of different diagnostic records for making an orthodontic diagnosis and treatment plan. DATA SOURCES: An electronic search in PubMed (1948-July 2012), EMBASE Excerpta Medica (1980-July 2012), CINAHL (1982-July 2012), Web of Science (1945-July 2012), Scopus (1996-July 2012), and Cochrane Library (1993-July 2012) was performed. Additionally, a hand search of the reference lists of included studies was performed to identify potentially eligible studies. There was no language restriction. STUDY SELECTION: The patient, intervention, comparator, outcome (pico) question formulated for this study was as follows: for patients who need orthodontic treatment (P), will the use of record set X (I) compared with record set Y (C) change the treatment plan (O)? Only primary publications were included. DATA EXTRACTION: Independent extraction of data and quality assessment was performed by two observers. RESULTS: Of the 1041 publications retrieved, 17 met the inclusion criteria. Of these, 4 studies were of high quality. Because of the limited number of high quality studies and the differences in study designs, patient characteristics, and reference standard or index test, a meta-analysis was not possible. CONCLUSION: Cephalograms are not routinely needed for orthodontic treatment planning in Class II malocclusions, digital models can be used to replace plaster casts, and cone-beam computed tomography radiographs can be indicated for impacted canines. Based on the findings of this review, the minimum record set required for orthodontic diagnosis and treatment planning could not be defined. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42012002365.

Excess male mortality and age-specific mortality trajectories under different mortality conditions: a lesson from the heat wave of summer 2003.

INTRODUCTION: Our objective was to study the impact of an identical additional stress on male and female mortality with a quasi-experimental study design, using natural variations in summer mortality, including the massive heat wave that struck Europe in 2003. MATERIAL AND METHODS: The summer daily mortality rates of the population aged 65 and over living in 16 European countries were computed by single age from 1998 to 2003. Using the method of Tukey, we established five categories summarizing the summer daily conditions of mortality (exceptionally high values, minor extremely high values, common values, minor extremely low values, and exceptionally low values). RESULTS: Whatever the mortality conditions during the summer months, the mortality trajectories by age are exponential for both sexes: males die twice more than females at the age of 65 and their level of mortality linearly converges around the age of 97 to that of the females. DISCUSSION: Being male remains a major risk factor of mortality during heat waves. This issue was missed by previous epidemiological studies because almost all of them focused only on the relative increase in mortality and not on the sex specific mortality rates which implies being able to estimate the population at risk.

Design, recruitment, logistics, and data management of the GEHA (Genetics of Healthy Ageing) project.

In 2004, the integrated European project GEHA (Genetics of Healthy Ageing) was initiated with the aim of identifying genes involved in healthy ageing and longevity. The first step in the project was the recruitment of more than 2500 pairs of siblings aged 90 years or more together with one younger control person from 15 areas in 11 European countries through a coordinated and standardised effort. A biological sample, preferably a blood sample, was collected from each participant, and basic physical and cognitive measures were obtained together with information about health, life style, and family composition. From 2004 to 2008 a total of 2535 families comprising 5319 nonagenarian siblings were identified and included in the project. In addition, 2548 younger control persons aged 50-75 years were recruited. A total of 2249 complete trios with blood samples from at least two old siblings and the younger control were formed and are available for genetic analyses (e.g. linkage studies and genome-wide association studies). Mortality follow-up improves the possibility of identifying families with the most extreme longevity phenotypes. With a mean follow-up time of 3.7 years the number of families with all participating siblings aged 95 years or more has increased by a factor of 5 to 750 families compared to when interviews were conducted. Thus, the GEHA project represents a unique source in the search for genes related to healthy ageing and longevity.

Gender differences in health of EU10 and EU15 populations: the double burden of EU10 men.

This study compares gender differences in Healthy Life Years (HLY) and unhealthy life years (ULY) between the original (EU15) and new member states (EU10). Based on the number of deaths, population and prevalence of activity limitations from the Statistics of Living and Income Conditions Survey (SILC) survey, we calculated HLY and ULY for the EU10 and EU15 in 2006 with the Sullivan method. We used decomposition analysis to assess the contributions of mortality and disability and age to gender differences in HLY and ULY. HLY at age 15 for women in the EU10 were 3.1 years more than those for men at the same age, whereas HLY did not differ by gender in the EU15. In both populations ULY at age 15 for women exceeded those for men by 5.5 years. Decomposition showed that EU10 women had more HLY because higher disability in women only partially offset (-0.8 years) the effect of lower mortality (+3.9 years). In the EU15 women's higher disability prevalence almost completely offset women's lower mortality. The 5.3 fewer ULY in EU10 men than in EU10 women mainly reflected higher male mortality (4.5 years), while the fewer ULY in EU15 men than in EU15 women reflected both higher male mortality (2.9 years) and higher female disability (2.6 years). The absence of a clear gender gap in HLY in the EU15 thus masked important gender differences in mortality and disability. The similar size of the gender gap in ULY in the EU-10 and EU-15 masked the more unfavourable health situation of EU10 men, in particular the much stronger and younger mortality disadvantage in combination with the virtually absent disability advantage below age 65 in men.

Healthy working life expectancies at age 50 in Europe: a new indicator.

OBJECTIVES: The absence of disease or disability and active involvement in society are considered as essential dimensions of successful ageing. To assess these concepts, we propose a new indicator the Healthy Working Life Expectancy (HWLE) that associates health status and productive engagement, in order to compare various situations in Europe. DESIGN: The study population is drawn from the European Community Household Panel (ECHP) which is the unique source of longitudinal data, providing comparable information between 1995 and 2001 on health and work statuses for a sample of some 60,000 household's representative of the population of: Austria, Belgium, Denmark, Finland, France, Germany, the United Kingdom, Greece, Italy, the Netherlands, Portugal, and Spain. Based on the multi-state life table approach conventionally used for calculating healthy life expectancies, the HWLE corresponds to the number of years spent between the ages of 50 and 70 both in good health and at work. RESULTS: In average, among the 20 years available between age 50 and age 70, the HWLE is 7.5 years for men and 4.8 years for women, ie, one half and one third respectively of the number of years spent in good health (14.1 and 13.5 years). The countries where the healthy working life expectancy of seniors is the highest are also the countries where the levels of employment of seniors are higher. Conversely, health status has only a weak influence on the HWLE indicator. CONCLUSION: These findings suggest the existence of a reservoir of healthy years which can be used to increase the length of the working life expectancy. They underline also the essential role that employment maintenance and retirement policies should have to increase the number of healthy years spent at work, and therefore guarantee a successful ageing for the seniors in Europe.

Male/female ratio in centenarians: a possible role played by population genetic structure.

All the demographic surveys on the centenarians have highlighted that females outnumber males. The centenarians' male/female (M/F) ratio reported by most studies ranges between 1:4 and 1:7. A puzzling 1:2 ratio was observed in Calabria, a Southern Italian region. To our knowledge only in Sardinia a similar phenomenon had been previously observed. We have therefore used the data of the Italian Institute of Statistics to figure out the centenarians' M/F ratio in the Italian regions. We found that this ratio gradually decreases from South to North. Such a result is certainly due to many factors. Thus, we have explored the possibility, it is also influenced by the genetic structure of the Italian population. In fact, the distribution of the centenarians' M/F ratio turned out to be significantly correlated with the genetic structure of the Italian population as outlined by the principal component analysis.

Social inequalities in disability-free life expectancy in the French male population, 1980-1991.

We calculate aggregate indicators of population health for occupational groups to gauge changes in health disparities during the 1980-1991 period. The study is based on the experiences of French adult men in three major occupational classes: managers, manual workers, and an intermediary occupational group. Life table models show that managers have longer life expectancy and disability-free life expectancy (DFLE) than manual workers, and a shorter life expectancy with disability. The concurrent increases in life expectancy and DFLE during the period maintained the occupational disparities in health; the years lived with disability, however, declined for all groups, as for the entire French population.

[Contribution of disability-free life expectancy indicators to the study of social inequities in health]. / Apport des indicateurs d'espérance de vie sans incapacité à l'étude des inégalités sociales de santé.

In looking at increases in disability-free life expectancy we examine the scope and evolution of social inequalities in health. As early as the end of the 18th century, Moheau had already emphasised the differences in life expectancy according to profession but it wasn't until much later that official statistics could confirm them. Despite the growing concern related to this phenomenon, the data are lacking for tracking its evolution and understanding its causes. The indicators of disability-free life expectancy that we established for socio-professional groups allowed us to respond to certain outstanding questions. The results of this study are summarised in this article. They serve to re-open the debate around the problems involved in measuring social inequalities and their place in public health.

A new biodemographic model to explain the trajectory of mortality.

Since Buffon's time (1749), biologists and demographers have repeatedly stated that a man in good health will live to be 90, 100 or 110 years old but not longer. For demographers, mortality measures essentially the current conditions: the quality of the ecological and social environment. For biologists, mortality measures mainly the ageing process. Can a biodemographic approach measure the current conditions (i.e. the quality of the environment) and the ageing schedule together, taking into account that human beings spend the greater part of their time improving the quality of their physical and social environment, making it more and more favourable to the realisation of their potential longevity? I propose two measures of the quality of this environment: first at the age when individuals (in average by cohort), in the course of their development, are the most robust and the most resistant to environmental hazards, indicated by the lowest mortality rate recorded; second at the age when individuals (in average by cohort) become frail because of the passage of time, with no or extremely little resistance to environmental hazards, indicated by a constant mortality rate among the oldest old. Between these two measures of the quality of the environment, mortality measures the ageing process leading young vigorous individuals into frail senile elders.

Supercentenarians: slower ageing individuals or senile elderly?

Although the increase in the number of centenarians is well documented today, at least in some countries, this is still not the case for people having reached the age of 110 years or more: the supercentenarians. The supercentenarians emerged in the mid-1960s. Their numbers have regularly increased since the mid-1970s. The current prevalence of known supercentenarians in countries involved in the database is approximately five to six times more than in the mid-1970s. In roughly 20 years the maximum age observed has increased by about 10 years from 112 to 122 years. The annual probability of death at age 110 is as low as 0.52 with the validated data (n=106) or with the exhaustive and validated data (n=73). The probabilities of death stagnate between 110 and 115 years, and all the computed probabilities fall below the ceiling of 0.6. Our results are compatible with the last extrapolations of mortality trajectories using a logistic or a quadratic model.

Health expectancy indicators.

An outline is presented of progress in the development of health expectancy indicators, which are growing in importance as a means of assessing the health status of populations and determining public health priorities.