Developmental determinants in non-communicable chronic diseases and ageing.

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

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

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

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

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

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

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

A new biodemographic model to explain the trajectory of mortality.

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

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

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

The relationship between age and the prevalence of senile dementia: a meta-analysis of recent data.

A linear regression model derived from a meta-analysis of 13 epidemiological studies of senile dementia conducted since 1980, and employing internationally-known case-finding procedures, suggests a much lower general rate of dementia prevalence than has been previously estimated. An exponential increase with age is observed, with senile dementia prevalence diagnosed by Diagnostic and Statistical Manual (DSM-III) criteria doubling every 6 years and senile dementia of the Alzheimer's type (SDAT) every 4.2 years. Studies providing data for the oldest ages indicating a drop in the rate of increase after the age of 80 suggest that senile dementia may be age-related rather than ageing-related. Estimates derived from this model may provide a reasonably accurate means of estimating dementia prevalence in the general population. The limitations of this method for the purposes of prediction and studies of risk factors are discussed in relation to the hypothesized heterogeneity of senile dementia and possible cohort effects.

How good is Sullivan's method for monitoring changes in population health expectancies?

STUDY OBJECTIVE: To compare health expectancies calculated by Sullivan's method and the multistate life table method in order to identify the magnitude of the bias in Sullivan's method and assess how seriously this limits its use for monitoring population health expectancies. DESIGN: A simulation model was used to compare health expectancies calculated using Sullivan's method and the multistate life table method under various scenarios for the evolution of disability over time in populations. The simulation model was based on abridged cohort life tables using data on French mortality from 1825-90 and disability prevalence data from the 1982 French health survey. MAIN RESULTS: The Sullivan method could not detect a sudden change in disability transition rates, but the simulations suggested that it provides a good estimate of the true multistate value if there are smooth and relatively regular changes in disability prevalence over the longer term. When disability incidence rates are increasing or decreasing smoothly over time, the absolute bias in the Sullivan estimate of disability free life expectancy is relatively constant with age. The relative bias thus increases at older ages as disability free life expectancy decreases. CONCLUSIONS: The difference between the estimates produced by the two methods was small for realistic scenarios for the evolution of population health and Sullivan's method is thus generally acceptable for monitoring relatively smooth long term trends in health expectancies for populations.

[Past and present asthma mortality: towards a shift in the secular trend?]. / Le passé et le présent de la mortalité asthmatique: vers une rupture de la tendance séculaire?

In recent years disconcerting observations have been published concerning changes in mortality from asthma in France and other countries. These conclusions are difficult to assess due to uncertainty regarding the underlying asthma mortality trends. We have attempted to address this question by constituting a statistical series of asthma deaths from 1925 to 1989. The 1925 to 1989 mortality trend is clearly decreasing. This decrease follows the same rhythm as the general mortality decline, since the proportion of asthma in total deaths remained between 3 to 4/1000. Three periods are emphasized: from 1925 to 1965 where the decreasing trend is interrupted by an important crisis in mortality, from 1965 to 1980 where the decrease is regular, and the last period since 1980 with an important crisis in 1985 and 1986; crisis applying to all genders and ages. The latest trend is uncertain. Careful epidemiologic surveillance will decide between a change in the secular trend or a transitory crisis and thus determine the cause(s). An effect due to the reinclusion by ICD 9 of a fluctuating component in asthma mortality cannot be excluded.

[Dynamics of asthma mortality in France: seasonal fluctuations and peak mortality in 1985-87]. / Dynamique de la mortalité asthmatique en France: fluctuations saisonnières et crise de mortalité en 1985-87.

In the face of an observed increase in asthma mortality since the end of the 70's an analysis of the time series of the deaths for the period 1979-89 was conducted; which shows a peaking of mortality between 1985 and 1987. A different seasonal component of asthma mortality has been identified for the age group 5-34 and over 34 group. For the later, mortality was found to peak during winter and dropping to the lowest point in summer, well synchronised with the mortality due to respiratory infection. For the former, mortality usually peaks during summer and troughs during the winter, independently of the mortality due to respiratory infection. A bimodal repartition of deaths was observed in the age group 5-34 with a main peak in summer (July) and a secondary peak in autumn (October). Modeling of the deaths series by season shows a dramatic rise in mortality during the years 1985, 1986 and 1987 affecting both age groups. During these 3 years, the global over-mortality is 21%. The increase has affected all the seasons allowing for seasonal variations of each age group. Factors responsible for the death seasonality in each age group are discussed. The temporary action of a non-specific factor was proposed to explain the cross-sectional character of the mortality crisis in the population; namely the influenza epidemics during the 1985 and 1986 winters.

[Risk and risk factors of disability in the aged]. / Risque et facteur de risque d'incapacité aux âges élevés.

Since 1978 the INSERM's Research (Unit-164) has been conducting a research programme on risk factors of mortality and disability. This study is based on a 5-year follow up of 4,200 elderly persons 60 and over in three regions of France. The aim is to provide the first results on 1082 people 65 and over living in upper Normandy. Initial level of disability appears the best predictive factor of 3-year mortality. Other predictive variables are age, sex, dyspnea during exertion and recent hospitalization. Pathologies reported by general practitioners are less informative on 3-year survival probability than variables related to frailty of subjects. The 5-year mortality is predicted by such pathologies as mental deterioration or cardio-respiratory diseases and age, sex, institutionalization and early smoking habits. The incidence of disability within 3 years is essentially predicted by pathologies: osteo-articular diseases (osteo-arthritis), mental deterioration and respiratory track diseases. These results favour a model of slow sequential decrease of health status, with mortality occurring after a long period of disability.

[Indicators of disability-free life expectancy. Global indicators of the health status of populations]. / Les indicateurs d'espérance de vie sans incapacité (EVSI). Des indicateurs globaux de l'état de santé des populations.

Disability free life expectancy (DFLE) is an index of mean length of healthy life. It aims at measuring the evolution in the populations state of health. The first calculations were achieved at the end of the 60s and about ten experimental calculations have been made until now, mostly in the United States, Canada, Japan and France. Nowadays this index is very well accepted. Its major qualities are its usefulness for setting health targets and determining the present and future needs. Is DFLE destined for becoming a conjonctural index of health state? The circumstances are undoubtedly propitious. Nevertheless, in order to be used in routine the DFLE index must answer three conditions, which the current approach does not fulfil i.e. the viability of disability measurement for comparisons in time; a registration of period data which is based on the incidence of entrance in disability; a calculation which is adapted to the disability whether it is reversible or not.

[Professional housekeeping aide for elderly persons. Needs, demand and beneficiaries]. / Aide-ménagère professionnelle aux personnes âgées. Besoin, demande, bénéficiaires.

Professional home help services (aide- menag ère) in France is one of the principal means to permit the disabled elderly to remain at home. For this reason, an evaluative study was conducted on existent needs of the inhabitants of one region: Upper-Normandy. The authors considered both demand and effective need among people concerned. At the time of the study (1979), 4.2% of the population 65 and older were beneficiaries of the service. The proportion of those who would have desired the service was then 14.7%--or 3.5 times higher. But the study of effective need provided a very different perspective: it concerned those unable to perform household tasks and also having no possibilities of help from the immediate family. If home assistance were limited to those not bedridden, having restricted ability to perform household tasks, and living alone, it would affect 17% of the elderly and would require 64,000 hours weekly, against 43,000 provided at the time of the survey. If other tasks were included (personal hygiene care, or care of the bedridden or of those unable to go out), the service would affect 24% of the population and would require 153,000 hours weekly. Based on the criteria applied, it appears that 20% of the service goes to those without effective need. Also, almost two-thirds of those needing the service state that they do not want it. The development of home help services in France must be considered in the framework of a global planning process of all services designed to enable the dependent elderly to remain at home.

[Study of the factors associated with the inability to perform household tasks among aged persons on the Ile-de-France. Application to the sub-regional planning of home-help services]. / Etude des facteurs liés à l'incapacité pour les tâches domestiques chez les personnes âgées en Ile-de-France. Application à la planification infra-régionale des services d'aide ménagère.

The aim of this paper is to present the preliminary results of a planning project in the area of health and social services for the elderly, which makes it possible to estimate the number of persons likely to seek help from such services at the administrative area levels with decisional powers. This involves identifying predictors of disability from raw data routinely available in the census and at various administrative area levels, the municipality being the preferred level. From the epidemiological data collected at the regional level, an indicator of disability has been constructed. Initially, those factors possibly associated with disabilities were identified by regrouping the variables in four dimensions (discriminant analysis): socio-economic, physical environment, human environment, local administrative area environment (district data from census, medical-social services offered in the area, ect.). Subsequently, a logistic regression made it feasible to calculate the coefficients attached to these predictors of disability. In our sample, sex, age and level of housing amenities in the dwelling place appear to be predictors of disability. The application of the coefficients obtained at the region level--by means of an epidemiological approach to distributions by sex, age and dwelling amenities characterizing a municipality or group of municipalities (territorial approach)--enabled us to estimate the number of persons 65 and over likely to seek help from home-assistance services at whatever administrative area level chosen. In certain of its quantitative aspects, this mixed approach (individual and area) helps in determining need, the first step in the planning process.

[Longitudinal study of the functional capacity of aged persons in Upper Normandy, 1978-1985]. / L'enquête longitudinale de Haute-Normandie sur les capacités fonctionnelles des personnes âgées, 1978-1985.

A longitudinal study of 1,082 elderly persons was conducted by INSERM over a six-year period in order to identify risk factor in pathological ageing. Several functional capacities were selected for study on the basis of their relevance to independent daily living. This article describes the methodology and the extent to which research objectives were able to be fulfilled. The initial survey took place in 1978-79. A follow-up study targeted two distinct areas of interest: the monitoring of mortality rates and the re-evaluation of the performance of survivors at three and six year intervals. Re-evaluation of performance involved the exploration of the individual's mobility, capacity to carry out activities of daily living etc. The consistency of the entire data set assembled over the six-year period was assessed in various ways. At six year follow-up survival rate could be determined for 98.8% of the initial cohort, and 87.1% of the survivors were able to be reinterviewed. The different probabilities of healthy survival, by sex and age, are tabulated in the appendices.

[Higher rural mortality or lower urban mortality in France? (author's transl)]. / Surmortalité rurale ou sous-mortalité urbaine en France?

Examination of crude and standardized rates, life expectancies and death probabilities by age shows an excess of mortality for males and females in little towns (less than 10 000 inhabitants) and on the other hand a lower mortality in parisian area. One aspect of the problem--relation between mortality and urbanisation (localities size)--is not the same with the sexes. For males, there is a lower mortality in rural area, on the contrary, for females, mortality is decreasing while the size of the locality is increasing. It would be possible to explain this results by parameters closely connected with urbanisation, such as socio-economic groups, marital status, health system. A next research will take this parameters and medical causes into account.

PIP: The authors examine mortality in France according to urban and rural area. They consider crude and standardized death rates, life expectancies, and death probabilities by age. The relationship between mortality and factors including urbanization, socioeconomic and marital status, and availabiliy of health services is analyzed (SUMMARY IN ENG)

[Factors determining health practices: prenatal care in rural and urban environment]. / Facteurs déterminants des pratiques de santé: exemple de la surveillance de la grossesse en milieu rural et urbain.

A 1978 study of prenatal care patterns in one area of France showed that frequent visits to specialists was the dominant pattern in urban areas, whatever the socioeconomic characteristics, or conditions of health, of the women. In rural areas, however, the patterns adopted varied markedly according to health problems encountered during pregnancy. In the absence of illness, 64% of rural women went to their general practitioner for a reduced number of prenatal visits; when health problems were perceived, however, their practices became more similar to those of city women. These variations remained after allowing for socioeconomic and cultural differences. Overall, patterns adopted varied significantly according to area of residence.

Healthy life expectancy: evaluation of global indicator of change in population health.

OBJECTIVE: To review and evaluate the usefulness of healthy life expectancy as a global indicator of changes in a population's health. DESIGN: Review of all known studies to date from the United States, mainland Europe, Canada, and the United Kingdom that have used Sullivan's method of calculating disability free life expectancy. MAIN OUTCOME MEASURES: Life expectancy and disability free life expectancy. RESULTS: Over the past decade the average healthy life expectancy was 60 years for men and 64 for women, with the proportion of years of disability ranging from 11% to 21% in men and from 14% to 24% in women. At the age of 65 men could expect eight years of disability free life and women 10, with the life expectancy being respectively 14 and 19 years. The difference between the wealthiest and poorest income quintiles was 6.3 years in life expectancy and 14.3 in disability free life expectancy for men and 2.8 and 7.6 respectively for women. These results suggest that disparities in health are greater between social groups than between the sexes. Diseases affect mortality and morbidity differently. The order of importance for affecting life expectancy was circulatory disease, cancer, and accidents and for disability free life expectancy, circulatory disease, locomotor disorders, and respiratory disorders. CONCLUSIONS: Healthy life expectancy is a valuable index for the appreciation of changes in both the physical and the mental health states of the general population, for allocating resources, and for measuring the success of political programmes. Future calculations should also take into account the probability of recovery and thus extend the applicability of the indicator to populations in poor health rather than focusing on the well population.