Survival, disabilities in activities of daily living, and physical and cognitive functioning among the oldest-old in China: a cohort study

Abstract

Background The oldest-old (≥80 years) are the most rapidly growing age group globally, and they are most in need of health care and assistance. The aim of this study was to explore whether increased longevity is leading to populations of healthier oldest-old (compression of disability; benefits of success), or to less healthy and disabled oldest-old (expansion of disability, costs of success). Methods Data are from Chinese Longitudinal Healthy Longevity Study (CLHLS). Three pairs of cohorts aged 80–89, 90–99 and 100–105 (in total 19,528 oldest-old participants) were examined; the two cohorts in each pair were born ten years apart, with the same age at the time of the assessment in the CLHLS 1998 and 2008 surveys. Findings Controlling for various confounding factors, compared to cohorts born 10-years earlier, death rates at oldest-old ages among later cohorts were substantially reduced annually by 0.2%–1.3%, and their disabilities of Activities of Daily Living had significantly reduced annually by 0.8%–2.6%; however, the later cohorts’ cognitive impairment rates increased annually by 0.7%–2.2% and objective physical performance capacity (stand-up from a chair, pick-up a book from floor, turning around 360°) decreased annually by 0.4%–3.8%. We also found that mortality of female oldest-old was substantially lower, but their functional capacities in ADL, cognition and physical performance were worse, compared to their male counterparts (mostly P<0.001). Interpretation These empirical findings can be explained by the theoretical framework of mixed effects of two opposing processes: advances in medications, lifestyle and socioeconomics may compress ADL disability, that is, “benefits of success”, but lifespan extension may expand disability of physical and cognitive functioning as more frail elderly survive with health problems, that is “costs of success”. Recent improvements in living standards and availability of facilities for daily living among Chinese elderly may also contribute to the contrasting trends of ADL disability and physical performance.

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