The Aging Population in the Twenty-First Century Statistics for Health Policy (1988) / Chapter Skim
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4 Health Transitions and the Compression of Morbidity
4 Health Transitions and the Compression of Morbidity
Pages 94-107
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From page 94... ...
, and other saving plans in assisting the future elderly to pay for a greater share of their future health and long-term care costs? Will income maintenance and social welfare programs be adequate to meet the needs of the elderly with longer life expectancy?
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From page 95... ...
Intraindividual changes in health at later ages involve these age-related changes and the effect of such changes on the manifestations of specific disease processes. Intrinsic to these concerns is the fact that the chronic diseases and conditions tend to manifest a different time scale than acute disease processes more typical at younger ages.
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From page 96... ...
Alternatively, if a chronic disease is atypically manifest at younger ages, it may be due to particularly powerful genetic or other susceptibilities to these disease processes, in which case the natural course of the disease may be dramatically shortened by loss of homeostatic control and death. Thus, health transitions at later ages cannot be described simply in terms of the incidence rate of independent disease events.
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From page 97... ...
Furthermore, the description of the disease process becomes complex and the rate of changes in physiological state may accelerate when homeostatic mechanisms become weaker at advanced ages or due to the accumulation of multiple disease processes. This complexity of disease state may make even the development of crude indicators of health state at advanced ages more difficult (e.g., the need for multiple-cause mortality data rather than underlying-cause mortality data to describe mortality patterns among the oldest-old)
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From page 98... ...
The first, the area between the morbidity and disability survival curves labeled B defines the number of person-years that can be expected to be lived by an individual from the cohort in a morbid, but disability-free, state.
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From page 99... ...
This total area may be viewed therefore as a measure of active or autonomous life expectancy (e.g., Koizumi, 1982; Katz et al., 1983; Wilkins and Adams, 1983~. Certain disease processes will have a magnum effect on active life expectancy; for example, onset of a serious stroke or Alzheimer's disease may immediately produce serious disability.
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From page 100... ...
Since natural death is argued to be due to senescent processes, it is also argued that it will be independent of the chronic disease processes that produce disability. Thus, while the mortality curve is fixed, the age at onset of disease and disability can be delayed by appropriate, independent action.
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From page 101... ...
about what we have experienced. Such arguments do not seem to take into account that to achieve the goals set for the adoption of health promotion and disease prevention measures, major efforts are required in some population subgroups, in particular, lower socioeconomic status groups and in some minority groups such as blacks.
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From page 102... ...
Thus, the total morbid and disabled periods for the population can be compressed by targeting interventions to individuals at high risk of the disease processes with the longest disabled periods (assuming effective interventions for these diseases exist)
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From page 103... ...
It has merit because it helps us to understand the changing relation of those health events in a simple framework. Actual analyses will be more complex dealing with the multiplicity of chronic diseases at advanced ages, the possibility of reversals in chronic morbidity and disability, dependent competing risks, the dynamics of human aging processes and risk factors, systematic mortality selection, and the fact that there is a many-to-one mapping between chronic diseases and the type and level of disability.
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From page 104... ...
Such follow-up data would help us to understand the dynamics of physiological aging processes. For example, we might be able to determine whether certain risk factors such as socioeconomic status and overweight cease to be so strongly associated with disease risks at advanced ages, e.g., such follow-up data are necessary to help us disentangle the effects of systematic mortality selection from basic physiological aging processes.
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From page 105... ...
Adequate samples of morbid subpopulations can be obtained by use of a two-stage design in which a large population is screened in the first stage to identify individuals with certain chronic diseases a target group followed by a second phase of intensive interviewing of the target group. For example, in 1982 and 1984 a survey was conducted of chronically disabled elderly persons.
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From page 106... ...
recommends that standard guidelines be developed for collecting clinical data on comorbidities at advanced ages and that the National Center for Health Statistics and various institutes of the National Institutes of Health promote the collection of such data in regularly funded clinical study programs. A fourth requirement is for data that systematically relate chronic disease diagnoses to level and type of disability.
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From page 107... ...
Probably no single data source is adequate to study detailed health transitions at advanced ages. The interactions of chronic diseases ax, 8 aging changes are such complex phenomena that they can best be studied by using information from multiple data sources.
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