Evolution of the "fourth stage" of epidemiologic transition in people aged 80 years and over: population-based cohort study using electronic health records.

BACKGROUND: In the "fourth stage" of epidemiological transition, the distribution of non-communicable diseases is expected to shift to more advanced ages, but age-specific changes beyond 80 years of age have not been reported. METHODS: This study aimed to evaluate demographic and health transitions in a population aged 80 years and over in the United Kingdom from 1990 to 2014, using primary care electronic health records. Epidemiological analysis of chronic morbidities and age-related impairments included a cohort of 299,495 participants, with stratified sampling by five-year age group up to 100 years and over. Cause-specific proportional hazards models were used to estimate hazard ratios for incidence rates over time. RESULTS: Between 1990 and 2014, nonagenarians and centenarians increased as a proportion of the over-80 population, as did the male-to-female ratio among individuals aged 80 to 95 years. A lower risk of coronary heart disease (HR 0.54, 95% confidence interval [CI]: 0.50-0.58), stroke (0.83, 0.76-0.90) and chronic obstructive pulmonary disease (0.59, 0.54-0.64) was observed among 80-84 year-olds in 2010-2014 compared to 1995-1999. By contrast, the risk of type II diabetes (2.18, 1.96-2.42), cancer (1.52, 1.43-1.61), dementia (2.94, 2.70-3.21), cognitive impairment (5.57, 5.01-6.20), and musculoskeletal pain (1.26, 1.21-1.32) was greater in 2010-2014 compared to 1995-1999. CONCLUSIONS: Redistribution of the over-80 population to older ages, and declining age-specific incidence of cardiovascular and respiratory diseases in over-80s, are consistent with the "fourth stage" of epidemiologic transition, but increases in diabetes, cancer, and age-related impairment show new emerging epidemiological patterns in the senior elderly.

Condição de saúde bucal autopercebida, capacidade mastigatória e longevidade em idosos / Self-perceived oral health status, chewing ability and longevity in the elderly

Resumo O objetivo deste artigo é verificar a condição bucal e a capacidade mastigatória autopercebidas em idosos longevos (≥ 80 anos). Foram utilizados dados do estudo multicêntrico FIBRA. A amostra foi composta por 2.341 indivíduos com ausência de déficit cognitivo, com idade ≥ 65 anos, no período entre 2008 e 2009, quando os idosos foram submetidos à coleta de dados. Quanto ao desfecho, a idade foi dicotomizada em 65-79 e 80 anos ou mais. A associação entre longevidade e as variáveis sociodemográficas, comportamentais, de saúde geral e bucal e a capacidade mastigatória autopercebida foram avaliadas pela regressão de Poisson. Dados completos disponíveis para 2.126 idosos. A idade média foi 70,91 (DP = ±4,11) anos entre os idosos jovens e 82,70 (DP = ±2,61) entre os longevos. A amostra de idosos com idade ≥ 80 anos foi de 11,7%. Baixa escolaridade, estado civil solteiro e ausência de trabalho estiveram associados à longevidade, assim como autorrelato de não possuir dentes naturais e dificuldade ou dor ao mastigar alimentos duros. Os resultados sugerem a associação entre longevidade com características sociodemográficas e de saúde bucal.

Abstract The scope of this article is to assess the oral health conditions and self-perceived chewing ability among the elderly seniors (≥ 80 years). Data from the FIBRA multicentric study were used. The sample consisted of 2,341 individuals with no cognitive impairment, aged ≥ 65 years, between 2008 and 2009, where the elderly were subjected to data collection. Regarding the outcome, age was dichotomized into 65-79 and 80 and over. The association between longevity and the socio-demographic and behavioral variables, general and oral health and self-perceived chewing ability was assessed by Poisson regression. Complete data are now available for 2,126 seniors. The mean age was 70.91 (SD =± 4.11) years among the young elderly and 82.70 (SD =± 2.61) among the elderly seniors. The sample of individuals aged ≥ 80 years was 11.7%. Low education, single marital status and lack of work were associated with longevity, as well as self-reporting of having no natural teeth and difficulty or pain when chewing hard foods. The results suggest an association between longevity with sociodemographic characteristics and oral health.