Recent Declines in Chronic Disability in the Elderly U.S. Population: Risk Factors and Future Dynamics

Mantón, Kenneth G.

doi:10.1146/annurev.publhealth.29.020907.090812

Cited by 167 publications

(114 citation statements)

References 95 publications

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“…Currently, there is no conclusive evidence on whether people will age in good or bad health in the future (Bonneux et al, 2012;Lafortune G et al, 2007;Manton 2008). The large baby boom cohorts will push up social services spending, but the extent and amount of such spending growth will depend on whether or not there will be a compression of morbidity and disability in the elderly (Fries et al, 2011;European Commission, 2012;DG ECFIN, 2006;Manton et al, 2007;Spillman, 2004).…”

Section: Resultsmentioning

confidence: 99%

“…Although the baseline is very different between countries and the evolution of the health status of their populations is uncertain, the demographic evolution of European countries in the forthcoming decades is expected to pose significant pressure on public budgets regarding pension benefits, health care and LTC costs (DG ECFIN, 2006;Economic Policy Committee, 2009). The evolution of LTC expenditures will be conditioned by several distinct factors: demographics (percentage of the population over 65), institutions (organization of the LTC system, tradeoff between formal and informal care and support for the latter type of care) and health (Spillman, 2004;European Commission, 2007;Lafortune et al, 2007;Manton et al, 2007;Manton, 2008;de Meijer et al, 2011;Jiménez-Martín and Vilaplana-Prieto, 2012). Therefore, ageing of the population will not only challenge the organisation of health care systems but also imply a redefinition of LTC systems in the years to come.…”

Section: Introductionmentioning

confidence: 99%

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Inequity in long-term care use and unmet need: Two sides of the same coin

García-Gómez

Hernández-Quevedo²,

Jiménez-Rubio

et al. 2015

Journal of Health Economics

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International studies have shown evidence on inequity in use of health services of different kinds, depending on the type of health care service analysed. However, equity in the access to long-term care (LTC) services has received much less attention. We investigate the determinants of several LTC services and the existence of unmet need by the disabled population using unique data from a survey conducted on the disabled population in Spain in 2008. We further measure the level of horizontal inequity using methods based on the Concentration Index, a widely used indicator of income-related inequality in health. At the time of the analysis, only those respondents with the highest dependency level were covered by the recently introduced universal LTC system, which allows us to explore whether inequities remain for this subgroup of the population. In addition, we compare results using self-reported versus a more objective indicator of unmet needs. Evidence suggests that after controlling for a wide set of need variables, there is not an equitable distribution of use and unmet need of LTC services in Spain, with socioeconomic status being an important factor in access to LTC. We find that individuals at the higher end of the income distribution utilize a relatively larger share of formal services (provided by a professional), while intensive informal care (provided by friends and family) is concentrated among the worst-off. In terms of unmet needs for LTC services, their distribution depends on the service considered as well as on whether we focus on subjective or objective measures. Interestingly, for the population covered by the new universal LTC system, inequities in most LTC services and unmet needs remain statistically significant and even increase for certain services, in particular, formal services provided by professionals. JEL classification codes: I14, 138, J14

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Inequity in long-term care use and unmet need: Two sides of the same coin

García-Gómez

Hernández-Quevedo²,

Jiménez-Rubio

et al. 2015

Journal of Health Economics

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“…The elderly subjects included in our analysis may however exhibit worse health states than the baby booming cohort will when reaching the same age in the future. Recent supportive evidence of the "Compression of Morbidity" paradigm [25] points to a later onset of many diseases and disability, which has far exceeded the rise in life expectancy during the same period [26-29]. Younger cohorts in developed countries tend to live longer, whereas the time of serious morbidity and especially disability is increasingly getting compressed into the last years of life [30-32].…”

Section: Discussionmentioning

confidence: 99%

Health status of the advanced elderly in six european countries: results from a representative survey using EQ-5D and SF-12

König

Heider

Lehnert

et al. 2010

Health Qual Life Outcomes

109

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Background Due to demographic change, the advanced elderly represent the fastest growing population group in Europe. Health problems tend to be frequent and increasing with age within this cohort. Aims of the study To describe and compare health status of the elderly population in six European countries and to analyze the impact of socio-demographic variables on health. Methods In the European Study of the Epidemiology of Mental Disorders (ESEMeD), representative non-institutionalized population samples completed the EQ-5D and Short Form-12 (SF-12) questionnaires as part of personal computer-based home interviews in 2001-2003. This study is based on a subsample of 1659 respondents aged ≥ 75 years from Belgium (n = 194), France (n = 168), Germany (n = 244), Italy (n = 317), the Netherlands (n = 164) and Spain (n = 572). Descriptive statistics, bivariate- (chi-square tests) and multivariate methods (linear regressions) were used to examine differences in population health. Results 68.8% of respondents reported problems in one or more EQ-5D dimensions, most frequently pain/discomfort (55.2%), followed by mobility (50.0%), usual activities (36.6%), self-care (18.1%) and anxiety/depression (11.6%). The proportion of respondents reporting any problems increased significantly with age in bivariate analyses (age 75-79: 65.4%; age 80-84: 69.2%; age ≥ 85: 81.1%) and differed between countries, ranging from 58.7% in the Netherlands to 72.3% in Italy. The mean EQ VAS score was 61.9, decreasing with age (age 75-79: 64.1; age 80-84: 59.8; age ≥ 85: 56.7) and ranging from 60.0 in Italy to 72.9 in the Netherlands. SF-12 derived Physical Component Summary (PCS) and Mental Component Summary (MCS) scores varied little by age and country. Age and low educational level were associated with lower EQ VAS and PCS scores. After controlling for socio-demographic variables and reported EQ-5D health states, mean EQ VAS scores were significantly higher in the Netherlands and Belgium, and lower in Germany than the grand mean. Conclusions More than two thirds of the advanced elderly report impairment of health status. Impairment increases rapidly with age but differs considerably between countries. In all countries, health status is significantly associated with socio-demographic variables.

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“…Increased awareness of healthier lifestyles and medical advancements have created a generation of more active and physiologically fit elderly [3,6,7]. Freedman et al [7] demonstrated in a systematic review that prevalence of disability and functional limitations is declining among the US population, and Manton [14] concluded that chronic disability declined by 2.2% per year from 1999 to 2004. Consequently, an 80-year-old physically active patient may have more physiologic reserve to withstand the stresses of a femoral neck fracture than a deconditioned 80-year-old individual.…”

Section: Introductionmentioning

confidence: 99%

“…Frailty has been associated with short-and long-term all-cause mortality in hospitalized patients older than 64 years [17] and is an accessible tool for estimating individual risks of mortality [16]. In the surgical setting, frailty increases postoperative complications, institutional discharge, inhospital mortality, and length of stay [14,17,23]. The idea of frailty has yet to be applied to mortality after elderly femoral neck fracture.…”

Section: Introductionmentioning

confidence: 99%

Association of a Modified Frailty Index With Mortality After Femoral Neck Fracture in Patients Aged 60 Years and Older

Patel

Brennan

et al. 2014

Clinical Orthopaedics &Amp; Related Research

134

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Background Frailty, a multidimensional syndrome entailing loss of energy, physical ability, cognition, and health, plays a significant role in elderly morbidity and mortality. No study has examined frailty in relation to mortality after femoral neck fractures in elderly patients. Questions/purposes We examined the association of a modified frailty index abbreviated from the Canadian Study of Health and Aging Frailty Index to 1-and 2-year mortality rates after a femoral neck fracture. Specifically we examined: (1) Is there an association of a modified frailty index with 1-and 2-year mortality rates in patients aged 60 years and older who sustain a low-energy femoral neck fracture? (2) Do the receiver operating characteristic (ROC) curves indicate that the modified frailty index can be a potential tool predictive of mortality and does a specific modified frailty index value demonstrate increased odds ratio for mortality? (3) Do any of the individual clinical deficits comprising the modified frailty index independently associate with mortality? Methods We retrospectively reviewed 697 low-energy femoral neck fractures in patients aged 60 years and older at our Level I trauma center from 2005 to 2009. A total of 218 (31%) patients with high-energy or pathologic fracture, postoperative complication including infection or revision surgery, fracture of the contralateral hip, or missing documented mobility status were excluded. The remaining 481 patients, with a mean age of 81.2 years, were included. Mortality data were obtained from a state vital statistics department using date of birth and Social Security numbers. Statistical analysis included unequal variance t-test, Pearson correlation of age and frailty, ROC curves and area under the curve, Hosmer-Lemeshow statistics, and logistic regression models. Results One-year mortality analysis found the mean modified frailty index was higher in patients who died (4.6 ± 1.8) than in those who lived (3.0 ± 2; p \ 0.001), which was maintained in a 2-year mortality analysis (4.4 ± 1.8 versus 3.0 ± 2; p\0.001). In ROC analysis, the area under the curve was 0.74 and 0.72 for 1-and 2-year mortality, respectively. Patients with a modified frailty index of 4 or greater had an odds ratio of 4.97 for 1-year mortality and an odds ratio of 4.01 for 2-year mortality as compared with patients with less than 4. Logistic regression models demonstrated that the clinical deficits of mobility, respiratory, renal, malignancy, thyroid, and impaired cognition were independently associated with 1-and 2-year mortality. Conclusions Patients aged 60 years and older sustaining a femoral neck fracture, with a higher modified frailty index, had increased 1-and 2-year mortality rates, and the ROC Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of...

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Recent Declines in Chronic Disability in the Elderly U.S. Population: Risk Factors and Future Dynamics

Cited by 167 publications

References 95 publications

Inequity in long-term care use and unmet need: Two sides of the same coin

Inequity in long-term care use and unmet need: Two sides of the same coin

Health status of the advanced elderly in six european countries: results from a representative survey using EQ-5D and SF-12

Association of a Modified Frailty Index With Mortality After Femoral Neck Fracture in Patients Aged 60 Years and Older

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