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Takahara M, Soga Y, Iida O. Lower extremity arterial disease vs. coronary artery disease: mortality differences after revascularization. Eur Heart J 2024; 45:1634-1643. [PMID: 38693795 DOI: 10.1093/eurheartj/ehae207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/27/2024] [Accepted: 03/19/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND AND AIMS Patients undergoing revascularization for lower extremity arterial disease (LEAD) may face a higher risk of mortality than those with coronary artery disease (CAD). This study aimed to characterize the difference in mortality risk between patients undergoing revascularization for LEAD and CAD and identify associated factors. METHODS The 1-year database of 10 754 patients undergoing revascularization for CAD (n = 6349) and LEAD (n = 4405) was analysed. Poisson regression models were used to characterize interpopulation differences in mortality, adjusting for baseline clinical features, including age, sex, polyvascular disease, comorbidities, medications, and vulnerabilities. RESULTS Individuals with LEAD were older, were more likely to have polyvascular disease, had more comorbidities, and received fewer cardioprotective drugs than those with CAD. Vulnerabilities remained more common in the LEAD group even after adjusting for these clinical features. The crude risk ratio of mortality incidence for LEAD vs. CAD was 2.91 (95% confidence interval, 2.54-3.34), attenuated to 2.14 (1.83-2.50) after controlling for age, sex, and polyvascular disease. The percentage attenuation in the excessive mortality associated with LEAD was 29%. The stepwise addition of comorbidities, medications, and vulnerabilities as adjusting factors attenuated the incidence risk ratio to 1.48 (1.26-1.72), 1.33 (1.12-1.58), and 1.17 (0.98-1.39), respectively, and increased the percentage attenuation to 64%, 73%, and 86%, respectively. CONCLUSIONS Mortality risk was almost three-fold higher in patients undergoing revascularization for LEAD than in those with CAD. The excessive mortality was considerably attributable to inter-group differences in baseline characteristics, including potentially clinically or socially modifiable factors.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka 565-0871, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu City, Japan
| | - Osamu Iida
- Cardiovascular Division, Osaka Police Hospital, Osaka City, Japan
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Spijker JJA. Combining remaining life expectancy and time to death as a measure of old-age dependency related to health care needs. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2023; 23:173-187. [PMID: 35384565 PMCID: PMC8985398 DOI: 10.1007/s10754-022-09328-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 03/12/2022] [Indexed: 05/05/2023]
Abstract
Public concern about the rising number of older dependent citizens is still based mainly on standard population aging indicators. This includes the old-age dependency ratio (OADR), which divides the state pension age population by the working age population. However, the OADR counts neither the dependent elderly nor those who provide for them. This paper builds on previous research to propose several alternative indicators, including the health care (HC) need-adjusted real elderly dependency ratio and the HC need-adjusted dependent population-to-tax rate. These indicators consider improvements in old-age survival and time to death in order to better define the health care needs of the dependent old-age population and to better approximate their financial burden. We define the old-age population dependent on health care as those above the age at which remaining life expectancy is 15 years or less and are expected to die within 5 years. We use data from the US to illustrate differences between the proposed new and standard measures. Results show that, as a share of the total population, the old-age population dependent on health care has virtually not changed since 1950. Moreover, increases in GDP and state tax revenue have outstripped population aging almost continuously since 1970, irrespective of the indicator used, and they are expected to continue to do so during the coming decade. The demand for health care services is therefore not being fueled by population aging but instead by other factors such as progress in medical knowledge and technology, costs of hospitalization, and the increasing use of long-term care facilities.
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Affiliation(s)
- Jeroen J A Spijker
- Centre d'Estudis Demogràfics, Edifici E-2, Carrer de Ca n'Altayò, Campus UAB, 08193, Bellaterra, Spain.
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The measurement of structural ageing – an axiomatic approach. JOURNAL OF POPULATION RESEARCH 2023. [DOI: 10.1007/s12546-023-09300-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
AbstractThe structural ageing of the population is one of the key global trends of the 21st Century. In this paper, we outline four axioms that, along with easy interpretability, we believe should underpin a theoretically valid measure of structural ageing: (1) population size invariance; (2) strong dominance; (3) weak dominance; and (4) age sensitivity. We then present a class of structural ageing indices that satisfy the axioms and are easily interpretable, with root-mean-squared-age (RMSA) as our preferred measure within the class. Using historical and cross-national data from the World Population Prospects, state-level data from the US Census Bureau, and local-authority-level data from New Zealand, we demonstrate that our preferred measure is correlated with conventional measures of structural ageing. Nevertheless, in each case there are large disparities in ranking for some countries, states, or local authorities between the different measures. These ranking disparities could be highly consequential for the allocation of resources, particularly between states or local areas within countries. Our proposed class of measures may help to avoid these disparities due to their axiomatically-consistent nature. Finally, we present considerations for future extensions of this important work, including the development of equivalent measures based on prospective age.
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Applications of new measures of population ageing using quantity and quality of remaining life years to India and selected states. J Biosoc Sci 2022:1-19. [PMID: 36221781 DOI: 10.1017/s0021932022000281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In the latter part of the third stage, India is in demographic transition with declining fertility and mortality. This marked decline in death rates is driven by improvements in health conditions due to medical progress and better living conditions. The conventional measures of ageing do not account for the significant improvements in health and life expectancy, thus leading to a tendency to overestimate the impact of population ageing when these indicators are used. The old-age threshold in the conventional measures of ageing depends on chronological age. The present study estimated the multi-dimensional old-age thresholds (MOAT) based on the remaining life expectancy (RLE), self-rated health, activities of daily living (ADL), handgrip strength, and cognition in India and selected states. The standard population was derived for each dimension for 50 and over in states using the WHO Study on Global AGEing and Adult Health data. Keeping the dimensional characteristics as of the standard population, the estimated MOAT for India was 67 years where Maharashtra stands at the top (68.6), followed by, West Bengal (66.5) and Karnataka (66). A 64 year old woman was similar to 68.8 year old man, and a 66 year old rural person was equivalent to 68 year old urban person. The study suggests implications of MOATs on reducing the burden of ageing and increment in retirement age.
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Lian Z, Zhu C, Yuan H, Chen Y. Combined impact of lifestyle-related factors on total mortality among the elder Chinese: a prospective cohort study. BMC Geriatr 2022; 22:325. [PMID: 35418015 PMCID: PMC9009055 DOI: 10.1186/s12877-022-02982-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/28/2022] [Indexed: 11/27/2022] Open
Abstract
Background The combined impact of healthy lifestyle factors on total mortality among elder Chinese is unclear. This study aimed to investigate the overall impact of lifestyle factors on total mortality in a senior Chinese population, and determine whether these associations were consistent in the presence of different characteristics, including physical comorbidities. Methods The Chinese Longitudinal Healthy Longevity Survey (CLHLS) is a large population-based prospective cohort study in 22 of 31 provinces from mainland China. We included 15,163 adults aged ≥65 years recruited from 1998- to 2002 and followed-up until 2014. A healthy lifestyle score was calculated considering five lifestyle factors (exercise, smoking, dietary diversity, body mass index and drinking). The scores ranged from zero to five points and were classified into the following three categories: unhealthy (0-1 point), intermediate (2-3 points) and healthy (4-5 points). Cox proportional hazards regression analyses were used to assess the associations between the combined healthy lifestyle score and total mortality, adjusting for demographic characteristics and physical comorbidities, as appropriate. Stratification analyses and interaction analyses were further performed. Results Among the 15,163 participants, the mean age (SD) was 86.2 (11.6) years. During an average follow-up period of 12.5 (SD = 3.9) years, 9655 deaths occurred. The adjusted hazard ratios (HRs) of total mortality decreased as the number of healthy lifestyle factors increased. Compared to the unhealthy lifestyle group, the healthy lifestyle group had a HR and 95% CI of 0.78 and 0.72-0.83. The population attributable risk of total death among those without a healthy lifestyle was 25.2%. A healthier lifestyle pattern was associated with a lower total mortality risk among individuals with different severities of physical comorbidities, although the associations were stronger among those with fatal physical comorbidities (p-interaction < .001). Conclusions In this large-scale study, a healthier lifestyle measured by regular exercise participation, never smoking, never drinking, good dietary diversity and normal weight, was inversely associated with total mortality, regardless of physical comorbidity status. These findings support the necessity of multiple lifestyle modifications to prevent premature death in both general elderly populations and those with physical comorbidities. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02982-z.
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Affiliation(s)
- Zhiwei Lian
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Jinan District, Fuzhou, 350014, China
| | - Chunsu Zhu
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Jinan District, Fuzhou, 350014, China.
| | - Haowen Yuan
- School of Public Health, Peking University, 100191, Beijing, China
| | - Ying Chen
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Jinan District, Fuzhou, 350014, China
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Clarke G, Chapman E, Crooks J, Koffman J, Ahmed S, Bennett MI. Does ethnicity affect pain management for people with advanced disease? A mixed methods cross-national systematic review of 'very high' Human Development Index English-speaking countries. BMC Palliat Care 2022; 21:46. [PMID: 35387640 PMCID: PMC8983802 DOI: 10.1186/s12904-022-00923-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Racial disparities in pain management have been observed in the USA since the 1990s in settings such as the emergency department and oncology. However, the palliative care context is not well described, and little research has focused outside of the USA or on advanced disease. This review takes a cross-national approach to exploring pain management in advanced disease for people of different racial and ethnic groups. METHODS Mixed methods systematic review. The primary outcome measure was differences in receiving pain medication between people from different racial and ethnic groups. Five electronic databases were searched. Two researchers independently assessed quality using JBI checklists, weighted evidence, and extracted data. The quantitative findings on the primary outcome measure were cross-tabulated, and a thematic analysis was undertaken on the mixed methods studies. Themes were formulated into a conceptual/thematic matrix. Patient representatives from UK ethnically diverse groups were consulted. PRISMA 2020 guidelines were followed. RESULTS Eighteen papers were included in the primary outcome analysis. Three papers were rated 'High' weight of evidence, and 17/18 (94%) were based in the USA. Ten of the eighteen (56%) found no significant difference in the pain medication received between people of different ethnic groups. Forty-six papers were included in the mixed methods synthesis; 41/46 (89%) were based in the USA. Key themes: Patients from different ethnically diverse groups had concerns about tolerance, addiction and side effects. The evidence also showed: cultural and social doctor-patient communication issues; many patients with unmet pain management needs; differences in pain assessment by racial group, and two studies found racial and ethnic stereotyping. CONCLUSIONS There was not enough high quality evidence to draw a conclusion on differences in receiving pain medication for people with advanced disease from different racial and ethnic groups. The mixed methods findings showed commonalities in fears about pain medication side effects, tolerance and addiction across diverse ethnic groups. However, these fears may have different foundations and are differently prioritised according to culture, faith, educational and social factors. There is a need to develop culturally competent pain management to address doctor-patient communication issues and patients' pain management concerns. TRIAL REGISTRATION PROSPERO- CRD42020167890 .
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Affiliation(s)
- Gemma Clarke
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK.
| | - Emma Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Jodie Crooks
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Jonathan Koffman
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, England, UK
| | - Shenaz Ahmed
- Division of Psychological & Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
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7
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Tawiah R, Jagger C, Anstey KJ, Kiely KM. Lifecourse socioeconomic position and cohort differences in health expectancy in Australia: a longitudinal cohort study. THE LANCET PUBLIC HEALTH 2022; 7:e347-e355. [DOI: 10.1016/s2468-2667(22)00026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 10/18/2022] Open
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8
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Tan MP. Healthcare for older people in lower and middle income countries. Age Ageing 2022; 51:6563041. [PMID: 35373815 DOI: 10.1093/ageing/afac016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/05/2021] [Indexed: 11/13/2022] Open
Abstract
Two-thirds of the world's population aged 60 years and over will reside in lower and middle income countries (LMIC) by 2050. Many LMICs are experiencing rapid population ageing at a faster rate than in Western Europe and North America, but may not have the resources to respond to the World Health Organization's call to action. As population ageing is a global issue, effective and sustainable global solutions are much needed. Proposed strategies include stemming the outflow of trained healthcare workers to high-income nations where migrants from LMICs often contribute to the work force caring for older people. Public education, preventive measures and innovative approaches to training are additional proposed solutions. Higher income countries have a responsibility to contribute towards the development of healthcare services for older people in LMICs.
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Affiliation(s)
- Maw Pin Tan
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Ageing and Age-Associated Disorders Research Group, Health and Wellbeing Research Cluster, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Department of Healthcare and Medical Sciences, Faculty of Health Sciences, Sunway University, Bandar Sunway, Malaysia
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Yip PSF, Zheng Y, Wong C. Demographic and epidemiological decomposition analysis of global changes in suicide rates and numbers over the period 1990-2019. Inj Prev 2021; 28:117-124. [PMID: 34400542 DOI: 10.1136/injuryprev-2021-044263] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/09/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Suicide presents an ongoing public health challenge internationally. Nearly 800 000 people around the world lose their life to suicide every year, and many more attempt suicide. METHODS A decomposition analysis was performed using global suicide mortality and population data from the Global Burden of Disease Study 2019. RESULTS Despite a significant decrease in age-specific suicide rate between 1990 and 2019 (-4.01; from 13.8% to 9.8% per 100 000), the overall numbers of suicide deaths increased by 19 897 (from 738 799 to 758 696) in the same time period. The reductions in age-specific suicide rates (-6.09; 152%) contributed to the overall reductions in suicide rates; however, this was offset by overtime changes in population age structure (2.08; -52%). The increase in suicide numbers was partly attributable to population growth (300 942; 1512.5%) and population age structure (189 512; 952.4%), which was attenuated by the significant reduction in overall suicide rates (-470 556; 2364.9%). The combined effect of these factors varied across the World Bank income level regions. For example, in the upper-middle-income level region, the effect of the reduction in age-specific suicide rates (-289 731; -1456.1%) exceeded the effect of population age structure (124 577; 626.1%) and population growth (83 855; 421.4%), resulting in its substantial decline in total suicide deaths (-81 298; -408.6%). However, in lower-middle income region, there was a notable increase in suicide death (72 550; 364.6%), which was related to the net gain of the reduction in age-specific suicide rates (-115 577; -580.9%) and negated by the increase in the number of suicide deaths due to population growth (152 093; 764.4%) and population age structure (36 034; 181.1%). CONCLUSION More support and resources should be deployed for suicide prevention to the low-income and middle-income regions in order to achieve the reduction goal. Moreover, suicide prevention among older adults is increasingly critical given the world's rapidly ageing populations in all income level regions.
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Affiliation(s)
- Paul Siu Fai Yip
- HKJC Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Yan Zheng
- The School of Nursing, The Hong Kong Polytechnic University, Kowloon, People's Republic of China
| | - Clifford Wong
- Social Work and Social Administration, The University of Hong Kong, Hong Kong, People's Republic of China
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Tawiah R, Jagger C, Anstey KJ, Kiely KM. Trends in disability-free life expectancy at age 50 years in Australia between 2001 and 2011 by social disadvantage. J Epidemiol Community Health 2021; 75:1056-1062. [PMID: 33910959 DOI: 10.1136/jech-2020-214906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 02/15/2021] [Accepted: 04/11/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The aims of this study were (1) to estimate 10-year trends in disability-free life expectancy (DFLE) by area-level social disadvantage and (2) to examine how incidence, recovery and mortality transitions contributed to these trends. METHODS Data were drawn from the nationally representative Household Income and Labour Dynamics in Australia survey. Two cohorts (baseline age 50+ years) were followed up for 7 years, from 2001 to 2007 and from 2011 to 2017, respectively. Social disadvantage was indicated by the Socio-Economic Indexes for Areas (SEIFA). Two DFLEs based on a Global Activity Limitation Indicator (GALI) and difficulties with activities of daily living (ADLs) measured by the 36-Item Short Form Survey physical function subscale were estimated by cohort, sex and SEIFA tertile using multistate models. RESULTS Persons residing in the low-advantage tertile had more years lived with GALI and ADL disability than those in high-advantage tertiles. Across the two cohorts, dynamic equilibrium for GALI disability was observed among men in mid-advantage and high-advantage tertiles, but expansion of GALI disability occurred in the low-advantage tertile. There was expansion of GALI disability for all women irrespective of their SEIFA tertile. Compression of ADL disability was observed for all men and for women in the high-advantage tertile. Compared to the 2001 cohort, disability incidence was lower for the 2011 cohort of men within mid-advantage and high-advantage tertiles, whereas recovery and disability-related mortality were lower for the 2011 cohort of women within the mid-advantage tertile. CONCLUSION Overall, compression of morbidity was more common in high-advantage areas, whereas expansion of morbidity was characteristic of low-advantage areas. Trends also varied by sex and disability severity.
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Affiliation(s)
- Richard Tawiah
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
| | - Carol Jagger
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
| | - Kim M Kiely
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia .,Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
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Whitley E, Benzeval M, Popham F. Population Priorities for Successful Aging: A Randomized Vignette Experiment. J Gerontol B Psychol Sci Soc Sci 2020; 75:293-302. [PMID: 29878183 PMCID: PMC6974399 DOI: 10.1093/geronb/gby060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Indexed: 01/03/2023] Open
Abstract
Objectives Aging populations have led to increasing interest in “successful aging” but there is no consensus as to what this entails. We aimed to understand the relative importance to the general population of six commonly-used successful aging dimensions (disease, disability, physical functioning, cognitive functioning, interpersonal engagement, and productive engagement). Method Two thousand and ten British men and women were shown vignettes describing an older person with randomly determined favorable/unfavorable outcomes for each dimension and asked to score (0–10) how successfully the person was aging. Results Vignettes with favorable successful aging dimensions were given higher mean scores than those with unfavorable dimensions. The dimensions given greatest importance were cognitive function (difference [95% confidence interval {CI}] in mean scores: 1.20 [1.11, 1.30]) and disability (1.18 [1.08, 1.27]), while disease (0.73 [0.64, 0.82]) and productive engagement (0.58 [0.49, 0.66]) were given the least importance. Older respondents gave increasingly greater relative importance to physical function, cognitive function, and productive engagement. Discussion Successful aging definitions that focus on disease do not reflect the views of the population in general and older people in particular. Practitioners and policy makers should be aware of older people’s priorities for aging and understand how these differ from their own.
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Affiliation(s)
- Elise Whitley
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK
| | | | - Frank Popham
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK
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Mucchiani C, Cacchione P, Torres W, Johnson MJ, Yim M. Exploring Low-Cost Mobile Manipulation for Elder Care Within a Community Based Setting. J INTELL ROBOT SYST 2020. [DOI: 10.1007/s10846-019-01041-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gietel-Basten S, Scherbov S. Better way to measure ageing in Oceania that takes life expectancy into account. Australas J Ageing 2019; 38:e98-e102. [PMID: 31250971 DOI: 10.1111/ajag.12692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/22/2019] [Accepted: 05/26/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to improve the measurement of ageing in Oceania taking into account characteristics of populations and, in particular, changes in life expectancy. METHOD Using past and projected life tables, we calculated prospective old age dependency ratios (POADRs) to 2060, placing the boundary to old age at a moving point with a fixed remaining life expectancy (RLE) for thirteen territories of Oceania. RESULTS In some territories, POADRs grow less rapidly than old age dependency ratios (OADRs). For example, in Australia and Guam, the OADR is forecast to increase from 0.20 and 0.07 in 1980, respectively, to 0.45 and 0.39 in 2050-55, while the POADR is forecast to increase from 0.17 and 0.07 to 0.19 and 0.19, respectively, over the same period. CONCLUSION Policymakers may consider this more rational approach to measurement when considering holistic policy responses to both current issues relating to ageing and mitigating against future challenges.
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Affiliation(s)
- Stuart Gietel-Basten
- Division of Social Science, The Hong Kong University of Science and Technology, Kowloon, Hong Kong SAR
| | - Sergei Scherbov
- World Population Program, International Institute for Applied Systems Analysis, Laxenburg, Austria
- Laboratory on Demography and Human Capital, Russian Presidential Academy of National Economy and Public Administration, Moscow, Russian Federation
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Pan W, Zhang K, Li H, Wu M, Weng J. Older adults are prioritized in terms of waiting time under the emergency triage system in Guangzhou, China. Geriatr Gerontol Int 2019; 19:786-791. [PMID: 31199567 DOI: 10.1111/ggi.13714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/24/2019] [Accepted: 05/11/2019] [Indexed: 11/27/2022]
Abstract
AIM To assess whether elderly patients are prioritized under the emergency triage system in Guangzhou, China. METHODS This was a cross-sectional survey of clinical data from adult visitors to the emergency department of the Third Affiliated Hospital of Sun Yat-sen University between 1 August 2015 and 31 December 2017. The primary end-point was receiving the first medical service within the target waiting time, which varied according to the triage level of the patient. Multivariate logistic regression was used to determine whether age was an independent predictor of a shorter waiting time. RESULTS Data from 262 282 emergency patients were analyzed. The mean age of patients was 35.97 years, and 7.5% were aged ≥65 years. In total, 88.3% of patients received medical service within the target waiting time, and 87.4% of elderly patients received medical service within the target waiting time. Multivariate logistic regression analysis showed that advanced age was independently associated with receiving medical service within the target waiting time (adjusted odds ratio 1.258, 95% confidence interval 1.198-1.321; P < 0.001). The triage level, type of emergency subdivision, availability of outpatient services and time of day were also associated with receiving medical service within the target waiting time. CONCLUSION Under the emergency triage system of the hospital, older adults are more likely to receive medical service within the target waiting time than younger patients. Geriatr Gerontol Int 2019; 19: 786-791.
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Affiliation(s)
- Wen Pan
- Department of Emergency, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kouxing Zhang
- Department of Emergency, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haitao Li
- Information Section, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Miaolue Wu
- Department of Emergency, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianping Weng
- Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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15
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Schram JLD, Schuring M, Oude Hengel KM, Burdorf A. Health-related educational inequalities in paid employment across 26 European countries in 2005-2014: repeated cross-sectional study. BMJ Open 2019; 9:e024823. [PMID: 31154297 PMCID: PMC6549613 DOI: 10.1136/bmjopen-2018-024823] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The study investigates the trends in health-related inequalities in paid employment among men and women in different educational groups in 26 countries in 5 European regions. DESIGN Individual-level analysis of repeated cross-sectional annual data (2005-2014) from the EU Statistics on Income and Living Conditions. SETTING 26 European countries in 5 European regions. PARTICIPANTS 1 844 915 individuals aged 30-59 years were selected with information on work status, chronic illness, educational background, age and gender. OUTCOME MEASURES Absolute differences were expressed by absolute differences in proportion in paid employment between participants with and without a chronic illness, using linear regression. Relative differences were expressed by prevalence ratios in paid employment, using a Cox proportional hazard model. Linear regression was used to examine the trends of inequalities. RESULTS Participants with a chronic illness had consistently lower labour force participation than those without illnesses. Educational inequalities were substantial with absolute differences larger within lower educated (men 21%-35%, women 10%-31%) than within higher educated (men 5%-13%, women 6%-16%). Relative differences showed that low-educated men with a chronic illness were 1.4-1.9 times (women 1.3-1.8 times) more likely to be out of paid employment than low-educated persons without a chronic illness, whereas this was 1.1-1.2 among high-educated men and women. In the Nordic, Anglo-Saxon and Eastern regions, these health-related educational inequalities in paid employment were more pronounced than in the Continental and Southern region. For most regions, absolute health-related educational inequalities in paid employment were generally constant, whereas relative inequalities increased, especially among low-educated persons. CONCLUSIONS Men and women with a chronic illness have considerable less access to the labour market than their healthy colleagues, especially among lower educated persons. This exclusion from paid employment will increase health inequalities.
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Affiliation(s)
- Jolinda L D Schram
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Merel Schuring
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Karen M Oude Hengel
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
- Netherlands Organization for Applied Scientific Research TNO, Leiden, The Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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16
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Balachandran A, James K. A multi-dimensional measure of population ageing accounting for Quantum and Quality in life years: An application of selected countries in Europe and Asia. SSM Popul Health 2019; 7:100330. [PMID: 30581965 PMCID: PMC6287061 DOI: 10.1016/j.ssmph.2018.100330] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 11/02/2022] Open
Abstract
Population ageing measured through a fixed old-age threshold like 60+ or 65+ ignores the other important dimensions of ageing. There has been changes among the older persons in multiple dimensions that corresponds to quantity of life years lived as well as the quality of life. The existing multi-dimensional measures also consider the characteristics within a fixed old-age threshold framework which does not account for significant improvements in life expectancy over the years. We propose a new Multidimensional Old Age Threshold (MOAT) measure that accommodates different dimensions of quantity and quality of older persons. We achieve this through a modified framework of the Characteristic Approach. Our measure incorporates a forward-looking approach to measure ageing and specifies an old-age threshold for different countries after accounting for different dimensions of life expectancy, health and human capital. This method is more suitable for comparison across countries with distinct demographic and health achievements. The empirical application of our method using selected countries from Europe and Asia shows that the relative performance of countries differs in terms of MOAT in comparison to estimates based on existing measures, primarily due to the inclusion of the quality dimensions. Countries that have better performance in life expectancy, health and human capital have higher values of MOAT and a lower 'burden' of older persons in a cross-country perspective in comparison to the existing measures.
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Affiliation(s)
- Arun Balachandran
- Population Research Centre, University of Groningen, The Netherlands
- Institute for Social and Economic Change, Bengaluru, India
| | - K.S. James
- Centre for Study of Regional Development, Jawaharlal Nehru University, New Delhi, India
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17
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Komp-Leukkunen K. Capturing the diversity of working age life-courses: A European perspective on cohorts born before 1945. PLoS One 2019; 14:e0212400. [PMID: 30794599 PMCID: PMC6386340 DOI: 10.1371/journal.pone.0212400] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 02/03/2019] [Indexed: 11/22/2022] Open
Abstract
Life-courses describe people's activities from the cradle to the grave. Because life-courses are typically complex, models are used to simplify their description. The most commonly used model is tripartite, representing lives in subsequent periods of education, work, and retirement. However, researchers criticize this model as limited in the activities considered, overly simplistic in the activity sequence, and blind to variation between life-courses. This article explores working age life-courses, which typically show high diversity. Multichannel sequence and cluster analyses are conducted on people's activities from age 15 to 65. Data stem from the life-history interviews of the Survey of Health, Ageing and Retirement in Europe, capturing cohorts born before 1945. Findings show that three out of four working age life-courses are in line with the tripartite model. This share is particularly high among men, the cohort born 1935 to 1944, and in Northern and Eastern Europe. In contrast, a considerable share of women spent their working age on homemaking, especially women born before 1935, and those living in Southern Europe. Finally, a smaller number of men spent their working age on paid work, followed by a period of illness or of non-employment. The working age life-course patterns identified are used to develop alternative life-course models. However, for a parsimonious solution, the use of two models suffices. A combination of the tripartite model and the model equating middle age to homemaking captures the lives of more than nine out of ten older Europeans. The prevalence of working age life-course patterns in a population is country-specific, and the country differences align with the welfare regimes. This perspective makes working age life-courses characteristics of a society that can be used to map social inequalities at the macro-level and capture social change over time.
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18
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Whitelaw S, Clark D. Palliative care and public health: an asymmetrical relationship? Palliat Care 2019; 12:1178224218819745. [PMID: 30814842 PMCID: PMC6383085 DOI: 10.1177/1178224218819745] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 11/30/2022] Open
Abstract
Interest in the potential for public health and palliative care to work together is now widely established. Based on a mapping review of existing literature, we describe for the first time the ways in which public health has entered palliative care policy and practice and how this has been specifically articulated. We then go on to pursue analytical and critical lines of enquiry that are largely absent from the existing literature. We do this in three ways: (i) by considering why the link between public health and palliative care has become so ubiquitous within palliative care policy; (ii) by establishing how this has been constructed; and (iii) by exploring public health as a 'reference discipline' from which its 'secondary deployment' can become embedded inside another disciplinary field. From this, we develop a range of critical perspectives on the relationship between public health and palliative care by scrutinising its claims of utility and effectiveness and questioning the strength of the interdisciplinary interaction between the two disciplines. We see their relationship in a 'cross disciplinary' context which is still largely symbolic and tactical in nature. We conclude by considering the significance of these insights for policy and practice, with two possible scenarios. If the use of public health is essentially figurative and its resources are not unique, the particular and exclusive use of the term becomes insignificant. Progressive and effective policy and practice is possible, independent of any explicit public health label. If however public health is considered to have intrinsic and definable worth, we suggest that this currently asymmetrical association needs to be significantly developed with much higher levels of theoretical, practical and critical engagement between the two disciplines. Such work would result in more reflective and robust policy and practice.
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Affiliation(s)
- Sandy Whitelaw
- School of Interdisciplinary Studies, University
of Glasgow, Dumfries, UK
| | - David Clark
- School of Interdisciplinary Studies, University
of Glasgow, Dumfries, UK
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19
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Balachandran A, de Beer J, James KS, van Wissen L, Janssen F. Comparison of Population Aging in Europe and Asia Using a Time-Consistent and Comparative Aging Measure. J Aging Health 2019; 32:340-351. [PMID: 30651037 PMCID: PMC7322980 DOI: 10.1177/0898264318824180] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: We compare population aging in Europe and Asia using a measure that is both consistent over time and appropriate for cross-country comparison. Method: Sanderson and Scherbov proposed to estimate the old-age threshold by the age at which the remaining life expectancy (RLE) equals 15 years. We propose an adjustment of this measure, taking into account cross-national differences in the exceptionality of reaching that age. Results: Our old-age threshold was lower than 65 years in 2012 in Central Asia, Southern Asia, Southeastern Asia, and many Eastern European countries. These populations also experienced a higher share of elderly compared with the RLE15 method. Our method revealed more geographical diversity in the shares of elderly. Both methods exhibited similar time trends for the old-age thresholds and the shares of elderly. Discussion: Our prospective and comparative measure reveals higher population aging estimates in most Asian and Eastern European countries and more diversity in aging.
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Affiliation(s)
- Arun Balachandran
- University of Groningen, The Netherlands
- Institute for Social and Economic Change, Bengaluru, India
| | - Joop de Beer
- University of Groningen, The Netherlands
- Netherlands Interdisciplinary Demographic Institute, The Hague, The Netherlands
| | - K. S. James
- Jawaharlal Nehru University, New Delhi, India
| | - Leo van Wissen
- University of Groningen, The Netherlands
- Netherlands Interdisciplinary Demographic Institute, The Hague, The Netherlands
| | - Fanny Janssen
- University of Groningen, The Netherlands
- Netherlands Interdisciplinary Demographic Institute, The Hague, The Netherlands
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20
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Flennert M, König HH, Hajek A. The association between voluntary work and health care use among older adults in Germany. BMC Health Serv Res 2019; 19:39. [PMID: 30646900 PMCID: PMC6334381 DOI: 10.1186/s12913-019-3867-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 01/03/2019] [Indexed: 11/10/2022] Open
Abstract
Objective While most studies focused on the relation between volunteering and health-related outcomes, little attention has been given on the association between volunteering and the use of health care services. Thus, with this analysis we aimed at exploring whether and how the voluntary work of older adults is related to the utilization of health care services in Germany. Methods The analysis was based on data from the German Ageing Survey (DEAS), a nationally representative, longitudinal study of the German population aged 40 years and older. Focusing on volunteering, data from the waves 2002, 2008 and 2011 was used. Voluntary work in groups and organizations (yes/no) was used as explanatory variable. To quantify health care utilization, visits to general practitioners and specialists as well as nights in the hospital in the past 12 months were used. Fixed effects regressions were applied to estimate the association between volunteering and the outcome variables. Results Regressions revealed that the onset of volunteer involvement was associated with an increase in specialist visits, whereas volunteering did not affect visits to general practitioners and the probability of hospitalization significantly. Conclusion Our findings emphasize the relation between volunteering and specialist visits. Future research is needed to examine the impact of volunteering on health care use, taking more detailed information regarding the specific context of volunteering as well as personality factors and personal background into consideration. This might be reasonable in advancing the knowledge about this association and in developing planned interventions. Electronic supplementary material The online version of this article (10.1186/s12913-019-3867-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maike Flennert
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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21
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Aging Human Populations: Good for Us, Good for the Earth. Trends Ecol Evol 2018; 33:851-862. [PMID: 30340868 DOI: 10.1016/j.tree.2018.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/22/2018] [Accepted: 08/31/2018] [Indexed: 12/18/2022]
Abstract
As the nations of the world grapple with the task of creating sustainable societies, ending and in some cases reversing population growth will be necessary to succeed. Yet stable or declining populations are typically reported in the media as a problem, or even a crisis, due to demographic aging. This is misguided, as economic analyses show that the costs connected with aging societies are manageable, while the economic, social, and environmental benefits of smaller populations are substantial. Earth's human-carrying capacity has been exceeded; hence, population growth must end and aging societies are unavoidable. They should be embraced as part of a just and prosperous future for people and the other species with whom we share our planet.
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22
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Neville S, Adams J, Montayre J, Larmer P, Garrett N, Stephens C, Alpass F. Loneliness in Men 60 Years and Over: The Association With Purpose in Life. Am J Mens Health 2018; 12:730-739. [PMID: 29458295 PMCID: PMC6131432 DOI: 10.1177/1557988318758807] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Loneliness as a consequence of getting older negatively impacts on the health and
well-being of men as they age. Having a purpose in life may mitigate loneliness and
therefore positively impact on health and well-being. Limited research into loneliness and
purpose in life has been undertaken in older men. This study seeks to understand the
relationship between loneliness and purpose in life in a group of older men. Using data
from a cross-sectional survey of 614 men aged 60 years and over living in New Zealand,
bivariate and multivariate analyses were undertaken to examine the relationship between
loneliness and purpose in life using a range of demographic, health, and social connection
variables. Bivariate analysis revealed that being unpartnered and having low socioeconomic
status, limited social networks, low levels of participation, and mental health issues
were associated with loneliness. Multivariate analysis showed that having poor mental
health and lower purpose in life were indicators of loneliness. Consequently, improving
mental health and purpose in life are likely to reduce loneliness in at-risk older men. As
older men are a heterogeneous group from a variety of sociocultural and ethnic
backgrounds, a multidimensional approach to any intervention initiatives needs to
occur.
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Affiliation(s)
- Stephen Neville
- 1 Department of Nursing, Auckland University of Technology, Auckland, New Zealand
| | - Jeffery Adams
- 2 SHORE & Whariki Research Centre, Massey University, Auckland, New Zealand
| | - Jed Montayre
- 1 Department of Nursing, Auckland University of Technology, Auckland, New Zealand
| | - Peter Larmer
- 3 School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nick Garrett
- 4 Department of Biostatistics and Epidemiology, Auckland University of Technology, Auckland, New Zealand
| | - Christine Stephens
- 5 School of Psychology, Massey University, Palmerston North, New Zealand
| | - Fiona Alpass
- 5 School of Psychology, Massey University, Palmerston North, New Zealand
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23
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Sadeghipour Roudsari M, Nedjat S, Foroughan M, Momammadi Shahboulaghi F, Rashedi V, Haghi M, Chehrehnegar N, Mansouri T. Protective Psychosocial Factors of Geriatric Depression in Community Dwelling Older Adults: A Review Article. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2018; 12. [DOI: 10.5812/ijpbs.10652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
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24
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Affiliation(s)
- A. Mark Clarfield
- Medical School for International Health Faculty of Health Sciences Ben‐Gurion University of the Negev Beer‐sheva Israel
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25
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Abstract
The Great Recession of 2007–2008 saw the largest period of economic downturn since the Second World War or the Great Depression of the 1930s. Recessions, however, tend not to have a significant impact on population health. Rather it is how society and governments respond to a recession that has a larger impact on their populations. The dominant political response to the Great Recession was the introduction of austerity programmes aimed at reducing the size of the state. In this Commentary, I briefly review the state of evidence on the changes in population health during austerity. Although the negative impact of austerity on overall population health has been well documented across Europe, there remains a paucity of evidence on within-country differences in health. The slowing down of improvements in life expectancy, correlated to the level of austerity, raises uncomfortable questions as to whether we are beginning to transition from the era of consistently improving population health to a new age characterised by an instability in population health largely dictated by the social and political determinants of health.
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Affiliation(s)
- Mark A. Green
- Department of Geography & Planning, University of Liverpool, UK
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26
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Mahoney K. More wounds, less time to treat them: 1717 nurses discuss the challenges in wound care in a series of study days. Br J Community Nurs 2017; 22:S33-S38. [PMID: 28570136 DOI: 10.12968/bjcn.2017.22.sup6.s33] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Kirsten Mahoney
- Clinical Nurse Specialist, Wound Healing Cardiff and Vale University Health Board and Clinical Operational and Procurement Lead, Welsh Wound Innovation Centre
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27
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Kjærgaard S, Canudas-Romo V. Potential support ratios: Cohort versus period perspectives. Population Studies 2017; 71:171-186. [PMID: 28514876 DOI: 10.1080/00324728.2017.1310919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The 'prospective potential support ratio' has been proposed by researchers as a measure that accurately quantifies the burden of ageing, by identifying the fraction of a population that has passed a certain measure of longevity, for example, 17 years of life expectancy. Nevertheless, the prospective potential support ratio usually focuses on the current mortality schedule, or period life expectancy. Instead, in this paper we look at the actual mortality experienced by cohorts in a population, using cohort life tables. We analyse differences between the two perspectives using mortality models, historical data, and forecasted data. Cohort life expectancy takes future mortality improvements into account, unlike period life expectancy, leading to a higher prospective potential support ratio. Our results indicate that using cohort instead of period life expectancy returns around 0.5 extra younger people per older person among the analysed countries. We discuss the policy implications implied by our cohort measures.
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28
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Kashnitsky I, de Beer J, van Wissen L. Decomposition of regional convergence in population aging across Europe. GENUS 2017; 73:2. [PMID: 28546643 PMCID: PMC5423923 DOI: 10.1186/s41118-017-0018-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 03/27/2017] [Indexed: 11/10/2022] Open
Abstract
In the face of rapidly aging population, decreasing regional inequalities in population composition is one of the regional cohesion goals of the European Union. To our knowledge, no explicit quantification of the changes in regional population aging differentiation exist. We investigate how regional differences in population aging developed over the last decade and how they are likely to evolve in the coming three decades, and we examine how demographic components of population growth contribute to the process. We use the beta-convergence approach to test whether regions are moving towards a common level of population aging. The change in population composition is decomposed into the separate effects of changes in the size of the non-working-age population and of the working-age population. The latter changes are further decomposed into the effects of cohort turnover, migration at working ages, and mortality at working ages. European Nomenclature of Territorial Units for Statistics (NUTS)-2 regions experienced notable convergence in population aging during the period 2003-2012 and are expected to experience further convergence in the coming three decades. Convergence in aging mainly depends on changes in the population structure of East-European regions. Cohort turnover plays the major role in promoting convergence. Differences in mortality at working ages, though quite moderate themselves, have a significant cumulative effect. The projections show that when it is assumed that net migration flows at working ages are converging across European regions, this will not contribute to convergence of population aging. The beta-convergence approach proves useful to examine regional variations in population aging across Europe.
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Affiliation(s)
- Ilya Kashnitsky
- Netherlands Interdisciplinary Demographic Institute, University of Groningen, Groningen, The Netherlands
- National Research University Higher School of Economics, Moscow, Russia
| | - Joop de Beer
- Netherlands Interdisciplinary Demographic Institute, University of Groningen, Groningen, The Netherlands
| | - Leo van Wissen
- Netherlands Interdisciplinary Demographic Institute, University of Groningen, Groningen, The Netherlands
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29
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Lay-Yee R, Pearson J, Davis P, von Randow M, Kerse N, Brown L. Changing the balance of social care for older people: simulating scenarios under demographic ageing in New Zealand. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:962-974. [PMID: 27709717 DOI: 10.1111/hsc.12394] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2016] [Indexed: 06/06/2023]
Abstract
The demographic ageing of New Zealand society, as elsewhere in the developed world, has dramatically increased the proportion of older people (aged 65 years and over) in the population. This has major policy implications for the future organisation of social care. Our objective was to test the effects on social care use, first, of putative changes in the overall disability profile of older people, and second, of alterations to the balance of their care, i.e. whether it was community-based or residential. In order to undertake these experiments, we developed a microsimulation model of the later life course using individual-level data from two official national survey series on health and disability, respectively, to generate a synthetic version which replicated original data and parameter settings. A baseline projection under current settings from 2001 to 2021 showed moderate increases in disability and associated social care use. Artificially decreasing disability levels, below the baseline projection, only moderately reduced the use of community care (both informal and formal). Scenarios implemented by rebalancing towards informal care use moderately reduced formal care use. However, only moderate compensatory increases in community-based care were required to markedly decrease the transition to residential care. The disability impact of demographic ageing may not have a major negative effect on system resources in developed countries like New Zealand. As well as healthy ageing, changing the balance of social care may alleviate the impact of increasing demand due to an expanding population of older people.
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Affiliation(s)
- Roy Lay-Yee
- Centre of Methods and Policy Application in the Social Sciences (COMPASS), University of Auckland, Auckland, New Zealand
| | - Janet Pearson
- Centre of Methods and Policy Application in the Social Sciences (COMPASS), University of Auckland, Auckland, New Zealand
| | - Peter Davis
- Centre of Methods and Policy Application in the Social Sciences (COMPASS), University of Auckland, Auckland, New Zealand
| | - Martin von Randow
- Centre of Methods and Policy Application in the Social Sciences (COMPASS), University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Laurie Brown
- National Centre for Social and Economic Modelling (NATSEM), University of Canberra, Canberra, ACT, Australia
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30
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Abstract
The article proposes a Gender Politics of Aging approach to the study of aging societies. The approach recognizes the feminization of old age, ageism's roots in sexist discourse, and the need to recognize the role of politics in driving demographic debates. Drawing together arguments from feminist gerontology and political demography, the article argues that the intersection of politics and gender must be considered if appropriate responses to an older, feminized demography are to be produced. I conclude that the work of aging feminists provides a rich vein of research and praxis from which a gender politics of aging approach can draw.
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Affiliation(s)
- Gemma M Carney
- a School of Social Sciences, Education and Social Work , Queen's University Belfast , Belfast , United Kingdom
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31
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King RC, Villeneuve E, White RJ, Sherratt RS, Holderbaum W, Harwin WS. Application of data fusion techniques and technologies for wearable health monitoring. Med Eng Phys 2017; 42:1-12. [PMID: 28237714 DOI: 10.1016/j.medengphy.2016.12.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 12/08/2016] [Accepted: 12/21/2016] [Indexed: 11/26/2022]
Abstract
Technological advances in sensors and communications have enabled discrete integration into everyday objects, both in the home and about the person. Information gathered by monitoring physiological, behavioural, and social aspects of our lives, can be used to achieve a positive impact on quality of life, health, and well-being. Wearable sensors are at the cusp of becoming truly pervasive, and could be woven into the clothes and accessories that we wear such that they become ubiquitous and transparent. To interpret the complex multidimensional information provided by these sensors, data fusion techniques are employed to provide a meaningful representation of the sensor outputs. This paper is intended to provide a short overview of data fusion techniques and algorithms that can be used to interpret wearable sensor data in the context of health monitoring applications. The application of these techniques are then described in the context of healthcare including activity and ambulatory monitoring, gait analysis, fall detection, and biometric monitoring. A snap-shot of current commercially available sensors is also provided, focusing on their sensing capability, and a commentary on the gaps that need to be bridged to bring research to market.
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Affiliation(s)
- Rachel C King
- School of Biological Sciences, Biomedical Engineering, University of Reading, Reading, United Kingdom.
| | - Emma Villeneuve
- University of Exeter, Medical School, Exeter, United Kingdom.
| | - Ruth J White
- School of Biological Sciences, Biomedical Engineering, University of Reading, Reading, United Kingdom.
| | - R Simon Sherratt
- School of Biological Sciences, Biomedical Engineering, University of Reading, Reading, United Kingdom.
| | - William Holderbaum
- School of Biological Sciences, Biomedical Engineering, University of Reading, Reading, United Kingdom.
| | - William S Harwin
- School of Biological Sciences, Biomedical Engineering, University of Reading, Reading, United Kingdom.
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33
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Narayanan L, Murray AD. What can imaging tell us about cognitive impairment and dementia? World J Radiol 2016; 8:240-254. [PMID: 27029053 PMCID: PMC4807333 DOI: 10.4329/wjr.v8.i3.240] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 11/28/2015] [Accepted: 01/07/2016] [Indexed: 02/06/2023] Open
Abstract
Dementia is a contemporary global health issue with far reaching consequences, not only for affected individuals and their families, but for national and global socio-economic conditions. The hallmark feature of dementia is that of irreversible cognitive decline, usually affecting memory, and impaired activities of daily living. Advances in healthcare worldwide have facilitated longer life spans, increasing the risks of developing cognitive decline and dementia in late life. Dementia remains a clinical diagnosis. The role of structural and molecular neuroimaging in patients with dementia is primarily supportive role rather than diagnostic, American and European guidelines recommending imaging to exclude treatable causes of dementia, such as tumor, hydrocephalus or intracranial haemorrhage, but also to distinguish between different dementia subtypes, the commonest of which is Alzheimer’s disease. However, this depends on the availability of these imaging techniques at individual centres. Advanced magnetic resonance imaging (MRI) techniques, such as functional connectivity MRI, diffusion tensor imaging and magnetic resonance spectroscopy, and molecular imaging techniques, such as 18F fluoro-deoxy glucose positron emission tomography (PET), amyloid PET, tau PET, are currently within the realm of dementia research but are available for clinical use. Increasingly the research focus is on earlier identification of at risk preclinical individuals, for example due to family history. Intervention at the preclinical stages before irreversible brain damage occurs is currently the best hope of reducing the impact of dementia.
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Topiwala A, Allan CL, Valkanova V, Zsoldos E, Filippini N, Sexton CE, Mahmood A, Singh-Manoux A, Mackay CE, Kivimäki M, Ebmeier KP. Resilience and MRI correlates of cognitive impairment in community-dwelling elders. Br J Psychiatry 2015; 207:435-9. [PMID: 26338988 PMCID: PMC4629074 DOI: 10.1192/bjp.bp.114.152363] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 01/13/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND The contribution of education and intelligence to resilience against age-related cognitive decline is not clear, particularly in the presence of 'normal for age' minor brain abnormalities. METHOD Participants (n = 208, mean age 69.2 years, s.d. = 5.4) in the Whitehall II imaging substudy attended for neuropsychological testing and multisequence 3T brain magnetic resonance imaging. Images were independently rated by three trained clinicians for global and hippocampal atrophy, periventricular and deep white matter changes. RESULTS Although none of the participants qualified for a clinical diagnosis of dementia, a screen for cognitive impairment (Montreal Cognitive Assessment (MoCA) <26) was abnormal in 22%. Hippocampal atrophy, in contrast to other brain measures, was associated with a reduced MoCA score even after controlling for age, gender, socioeconomic status, years of education and premorbid IQ. Premorbid IQ and socioeconomic status were associated with resilience in the presence of hippocampal atrophy. CONCLUSIONS Independent contributions from a priori risk (age, hippocampal atrophy) and resilience (premorbid function, socioeconomic status) combine to predict measured cognitive impairment.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Klaus P. Ebmeier
- Correspondence: Klaus P. Ebmeier, MD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.
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Luo H, Wong GHY, Lum TYS, Luo M, Gong CH, Kendig H. Health Expectancies in Adults Aged 50 Years or Older in China. J Aging Health 2015; 28:758-74. [PMID: 26491044 DOI: 10.1177/0898264315611663] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study is to understand the functional health of older adults in China and to assess the potential for advancing healthy and active aging. METHOD Data of 13,739 older adults aged 50 years and older from the China Health and Retirement Longitudinal Study in 2011 were analyzed. Life expectancy in good perceived health, chronic-disease-free life expectancy, active life expectancy, and severe impairment-free life expectancy were calculated using Sullivan's method. RESULTS At age 50 years, older adults had a life expectancy in good perceived health of 7.0 and 6.7 years in men and women, respectively. They would remain chronic-disease-free for 8.4 and 8.6 years, without activity limitation for 23.6 and 26.0 years, and severe impairment-free for 21.4 and 24.2 years. DISCUSSION The world's largest aging population was spending a substantial proportion of remaining life years in suboptimal health and well-being, while remaining largely independent in basic self-care without severe impairments.
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Affiliation(s)
- Hao Luo
- Tsinghua University, Beijing, China The University of Hong Kong, Hong Kong
| | | | | | | | - Cathy H Gong
- Australian National University, Canberra, Australia ARC Centre of Excellence in Population Ageing Research, Canberra, Australia
| | - Hal Kendig
- Australian National University, Canberra, Australia ARC Centre of Excellence in Population Ageing Research, Canberra, Australia
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Shi Z, Zhang T, Byles J, Martin S, Avery JC, Taylor AW. Food Habits, Lifestyle Factors and Mortality among Oldest Old Chinese: The Chinese Longitudinal Healthy Longevity Survey (CLHLS). Nutrients 2015; 7:7562-79. [PMID: 26371039 PMCID: PMC4586548 DOI: 10.3390/nu7095353] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 08/19/2015] [Accepted: 09/01/2015] [Indexed: 01/28/2023] Open
Abstract
There are few studies reporting the association between lifestyle and mortality among the oldest old in developing countries. We examined the association between food habits, lifestyle factors and all-cause mortality in the oldest old (≥80 years) using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). In 1998/99, 8959 participants aged 80 years and older took part in the baseline survey. Follow-up surveys were conducted every two to three years until 2011. Food habits were assessed using an in-person interview. Deaths were ascertained from family members during follow-up. Cox and Laplace regression were used to assess the association between food habits, lifestyle factors and mortality risk. There were 6626 deaths during 31,926 person-years of follow-up. Type of staple food (rice or wheat) was not associated with mortality. Daily fruit and vegetable intake was inversely associated with a higher mortality risk (hazard ratios (HRs): 0.85 (95% CI (confidence interval) 0.77–0.92), and 0.74 (0.66–0.83) for daily intake of fruit and vegetables, respectively). There was a positive association between intake of salt-preserved vegetables and mortality risk (consumers had about 10% increase of HR for mortality). Fruit and vegetable consumption were inversely, while intake of salt-preserved vegetables positively, associated with mortality risk among the oldest old. Undertaking physical activity is beneficial for the prevention of premature death.
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Affiliation(s)
- Zumin Shi
- School of Medicine, the University of Adelaide, Level 7 SAHMRI, North Terrace, Adelaide SA 5000, Australia.
| | - Tuohong Zhang
- School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing 100191, China.
| | - Julie Byles
- Priority Research Centre for Gender, Health and Ageing, School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle NSW 2305, Australia.
| | - Sean Martin
- School of Medicine, the University of Adelaide, Level 7 SAHMRI, North Terrace, Adelaide SA 5000, Australia.
| | - Jodie C Avery
- School of Medicine, the University of Adelaide, Level 7 SAHMRI, North Terrace, Adelaide SA 5000, Australia.
| | - Anne W Taylor
- School of Medicine, the University of Adelaide, Level 7 SAHMRI, North Terrace, Adelaide SA 5000, Australia.
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Jolley D. Heads in the sand may leave old age psychiatry looking foolish and vulnerable: Commentary on . . . A memory clinic v. traditional community mental health team service. BJPsych Bull 2015; 39:12-4. [PMID: 26191417 PMCID: PMC4495831 DOI: 10.1192/pb.bp.114.048215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 06/02/2014] [Indexed: 11/24/2022] Open
Abstract
Dementia has been recognised as a major challenge to health, social care and economies. Research by Rubinsztein and colleagues, in this issue, has compared the services provided by memory clinics with those of traditional community mental health team services. They conclude that memory clinics offer a more comprehensive and multidisciplinary service at no extra cost. Here I will question some of their findings and highlight the importance of better continuity of care between primary and secondary services.
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Timmins N. Optimism about the future. HEALTH ECONOMICS, POLICY, AND LAW 2015; 10:107-111. [PMID: 25246104 DOI: 10.1017/s1744133114000279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Narayanan L, Murray AD. What is the role of neuroimaging in dementia? A review. IMAGING 2014. [DOI: 10.1259/img.20120015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ellis G. Timely care for frail older people: the next battleground. Age Ageing 2014; 43:732. [PMID: 24958093 DOI: 10.1093/ageing/afu078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Graham Ellis
- NHS Lanarkshire, Monklands Hospital, Airdrie, Canada
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Filippini N, Zsoldos E, Haapakoski R, Sexton CE, Mahmood A, Allan CL, Topiwala A, Valkanova V, Brunner EJ, Shipley MJ, Auerbach E, Moeller S, Uğurbil K, Xu J, Yacoub E, Andersson J, Bijsterbosch J, Clare S, Griffanti L, Hess AT, Jenkinson M, Miller KL, Salimi-Khorshidi G, Sotiropoulos SN, Voets NL, Smith SM, Geddes JR, Singh-Manoux A, Mackay CE, Kivimäki M, Ebmeier KP. Study protocol: The Whitehall II imaging sub-study. BMC Psychiatry 2014; 14:159. [PMID: 24885374 PMCID: PMC4048583 DOI: 10.1186/1471-244x-14-159] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 05/21/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The Whitehall II (WHII) study of British civil servants provides a unique source of longitudinal data to investigate key factors hypothesized to affect brain health and cognitive ageing. This paper introduces the multi-modal magnetic resonance imaging (MRI) protocol and cognitive assessment designed to investigate brain health in a random sample of 800 members of the WHII study. METHODS/DESIGN A total of 6035 civil servants participated in the WHII Phase 11 clinical examination in 2012-2013. A random sample of these participants was included in a sub-study comprising an MRI brain scan, a detailed clinical and cognitive assessment, and collection of blood and buccal mucosal samples for the characterisation of immune function and associated measures. Data collection for this sub-study started in 2012 and will be completed by 2016. The participants, for whom social and health records have been collected since 1985, were between 60-85 years of age at the time the MRI study started. Here, we describe the pre-specified clinical and cognitive assessment protocols, the state-of-the-art MRI sequences and latest pipelines for analyses of this sub-study. DISCUSSION The integration of cutting-edge MRI techniques, clinical and cognitive tests in combination with retrospective data on social, behavioural and biological variables during the preceding 25 years from a well-established longitudinal epidemiological study (WHII cohort) will provide a unique opportunity to examine brain structure and function in relation to age-related diseases and the modifiable and non-modifiable factors affecting resilience against and vulnerability to adverse brain changes.
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Affiliation(s)
- Nicola Filippini
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Enikő Zsoldos
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Rita Haapakoski
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Claire E Sexton
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Abda Mahmood
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Charlotte L Allan
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Anya Topiwala
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Vyara Valkanova
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Eric J Brunner
- Department of Epidemiology & Public Health, University College London, London, UK
| | - Martin J Shipley
- Department of Epidemiology & Public Health, University College London, London, UK
| | - Edward Auerbach
- Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, USA
| | - Steen Moeller
- Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, USA
| | - Kâmil Uğurbil
- Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, USA
| | - Junqian Xu
- Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Essa Yacoub
- Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, USA
| | - Jesper Andersson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Janine Bijsterbosch
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Stuart Clare
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ludovica Griffanti
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Aaron T Hess
- Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Mark Jenkinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Karla L Miller
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | | | - Natalie L Voets
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Stephen M Smith
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Archana Singh-Manoux
- Department of Epidemiology & Public Health, University College London, London, UK
- Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, INSERM, U1018, 94807 Villejuif, Cedex, France
| | - Clare E Mackay
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Mika Kivimäki
- Department of Epidemiology & Public Health, University College London, London, UK
| | - Klaus P Ebmeier
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
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Sallnow L, Paul S. Understanding community engagement in end-of-life care: developing conceptual clarity. CRITICAL PUBLIC HEALTH 2014. [DOI: 10.1080/09581596.2014.909582] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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