Hospital care for the elderly in the final year of life: a population based study.

OBJECTIVES--To determine whether among people aged 65 and over those who died at advanced old age spent more of their last year of life in hospital than those who died younger, and whether the increase in longevity in the elderly between 1976 and 1985 was accompanied by increased time spent in hospital in the last year of life. DESIGN--Linkage of death records to abstracts of records of hospital inpatient care in the preceding year of patients'' lives. SETTING--Six health districts in England covered by the Oxford record linkage study. RESULTS--People who died at advanced ages (85 and over) were less likely than people who died at younger ages (65-84) to have been admitted to hospital in the last year of life. Once admitted the very old tended to spend longer in hospital than others. The mean total time spent in hospital by the elderly in the year before death (based on all deaths including those among people not admitted at all) showed no appreciable change over time. The median time in hospital based on all deaths increased by about three days between 1976 and 1985. During that time there was a gain in life expectancy in the population of about one year from the age of 65. CONCLUSION--The gain in life expectancy in this population was not at the expense of any substantial increase in time spent in hospital in the final year of life.     

Navajo tribal mortality: A life table analysis of the leading causes of death

Abstract

The five leading causes of death for Navajo males and females are analyzed by life table methods. Navajo male and female life expectancy at birth were 58.8 and 71.8 years, respectively. The greatest increase in Navajo male life expectancy would result from the elimination of motor vehicle accidents (5.17 years at birth, and 3.11 years for working ages 15–65). The life expectancy of Navajo females would be lengthened the most (3.70 years) by elimination of circulatory system disease. For working‐ages gains for both sexes, however, the greatest benefit would result from elimination of motor vehicle accidents. The implications of the results are discussed in relation to the various public health programs and health planning efforts for the Navajo Nation.     

The importance of considering age when quantifying wild animals’ welfare

Wild animals experience different challenges and opportunities as they mature, and this variety of experiences can lead to different levels of welfare characterizing the day-to-day lives of individuals of different ages. At the same time, most wild animals who are born do not survive to adulthood. Individuals who die as juveniles do not simply experience a homogeneous fraction of the lifetimes of older members of their species; rather, their truncated lives may be characterized by very different levels of welfare. Here, I propose the concept of welfare expectancy as a framework for quantifying wild animal welfare at a population level, given individual-level data on average welfare with respect to age. This concept fits conveniently alongside methods of analysis already used in population ecology, such as demographic sensitivity analysis, and is applicable to evaluating the welfare consequences of human interventions and natural pressures that disproportionately affect individuals of different ages. In order to understand better and improve the state of wild animal welfare, more attention should be directed towards young animals and the particular challenges they face.     

The use of mortality data in setting priorities for disease prevention

The examination of specific disease mortality by five-year age groups helps identify health problems as problems of people and how they live. Traditional methods of examining data in broad classifications tend to obscure etiological factors and the importance of behaviour. Violence, a major cause of death in young adults, gives way to so-called diseases of indulgence in middle age, especially among men who have a much higher death rate than women. Male life expectancy at age 40 has increased only marginally in the past 40 years. Health-related human behaviour must be considered within an ecological framework since social, cultural and physical environmental differences as well as personal factors influence life-style. The responsibility for prevention rests more with the individual and society at large than with health workers. Probability tables, Health Hazard Appraisal (a system of personal risk assessment) and personal counselling can reinforce healthful life-styles and help correct hazardous ones.     

Narrowing sex differentials in life expectancy in the industrialized world: Early 1970's to early 1990's

Abstract

Between the early 1970's and 1990's, twelve industrialized nations experienced for the first time a narrowing of their sex differences in life expectancy at age zero. In another set of countries, the differential has not yet reached a stage of convergence, although in some of these nations the female advantage appears to be increasing at a slower pace than ever before. We discuss the demographic and epidemiologic conditions for this new and largely unanticipated trend, as well as its applied and theoretical implications in the context of the following questions: (1) Is the observed change a function of males’ faster pace of gains in life expectancy since the early 1970s? (2) What is the relationship between country differences in socioeconomic development (as measured by GNP) and the degree of convergence in the sex gap in average length of life? (3) What is the degree of association between temporal change in age‐sex specific death rates and change in the sex gap in life expectancy over the twenty‐year interval between the early 1970s and early 1990s? Our results indicate that where some convergence has taken place, in relation to women, men have experienced more rapid gains in survival; the higher a nation's level of social and economic development, the greater the amount of convergence in male and female life expectancies. The most pronounced age‐specific association with the changing sex gap in longevity is that of ages 25–59, where the greater reductions in male mortality, as compared to that for females, contributed to a significant portion of the observed convergence in life expectancy across industrialized nations.     

Constitution and By-Laws of the American Association of Physical Anthropologists

From parent populations (N = 50,000) statistically generated, representing different levels of correlation (r) between the age at death and a hypothetical biological indicator (r = 0.8-0.98), reference samples and target demographic samples are randomly drawn. Two iterative techniques, proportional fitting procedure and Bayesian, are used to estimate from the reference samples the age distribution of the targets. Due to the random fluctuations of the pattern of aging, both in the reference and target samples, these techniques converge only in expectation toward the true value of a distribution, but not in practice for any particular realization. Nevertheless, these techniques allow the estimation of the average of an age distribution, even if its shape is unknown. Under the hypothesis that the target sample is drawn from a stationary population, this average represents the life expectancy at 20 years (plus 20 years). Using this mean age at death for the adults and the juvenility index at death (D5-14/D20-ω), a new set of paleodemographic estimators were derived from 40 archaic life tables. For a hypothesized stable population, they give the life expectancy at birth and at 20 years, and the probability of death at 1 and 5 years. © 1996 Wiley-Liss, Inc.     

A reassessment of demographic estimates for Pecos Pueblo

The original demographic estimates for Pecos Pueblo, New Mexico (Hooton, 1930) indicated a 60/40 male/female adult sex ratio and an average life expectancy at birth of 42.9 years. A reanalysis of sexes and ages for a subsample of the Pecos collection as well as a reevaluation of a more recent report suggests that the adult sex ratio for Pecos is probably closer to 50/50 and that the mean age at death should be greatly reduced, perhaps by as much as 15 to 20 years.     

Melatonin and mitochondria in aging

The worldwide prolongation of mean life expectancy has resulted in a rapid increase of the size of the elderly population, both in numbers and as a proportion of the whole. In addition, the incidence of age-related diseases is obviously increasing as the population ages. Finding means to preserve optimal health in old age has become a primary goal of biomedical research. Aging is a multifactorial process that includes progressive cellular loss, endocrine and metabolic deficits, reduced defense mechanisms and functional losses that increase the risk of death. Mitochondria fulfill a number of essential cellular functions and play a key role in the aging process. Melatonin, which is synthesized in the pineal gland and other organs, plays a role in the biologic regulation of aging. Noctural melatonin serum levels are high during childhood and diminish substantially as people age. Melatonin preserves mitochondrial homeostasis, reduces free radical generation, e.g., by enhancing mitochondrial glutathione levels; it also safeguards proton potential and ATP synthesis by stimulating complex I and IV activities. In this article, we review the role of melatonin and mitochondria in aging.     

Langer leven, langer werken?De rol van gepercipieerde levensverwachting in het uittredeproces

Virtually all Western countries are seeking to bring retirement ages more in line with increases in longevity. The central question in this paper is whether individuals choose a retirement age that fits their life expectancy. This would be ideal from a public policy perspective. The present study aims to test empirically whether retirement planning varies with expectations of survival among a sample of older employees in the Netherlands. Two questions are addressed: (1) What are older employees' expectations of their remaining lifetime, and what factors influence this subjective life expectancy? (2) Are individuals who perceive longer life horizons (high subjective life expectancy) more inclined to retire later than people who expect to live shorter? Using data from a panel study on retirement behaviour in the Netherlands (N=1621 older employees aged 50-60), regression and survival models are estimated to examine the effect of subjective life expectancy on retirement planning and behaviour. The results indicate that subjective life expectancy is a factor that is taken into account in retirement decision making, at least as far as retirement intentions are concerned. Older employees with longer time horizons have a preference for later retirement. When it comes to actual behaviour, however, time horizon does not appear to play a role. The results suggest that particularly employees with a high perceived life expectancy and an intention to work longer do not succeed in carrying their intentions into effect.     

Assessing the contribution of age-sex differentials in causes of death due to infectious and parasitic diseases to the trends in age-sex differentials in life expectancy in Mauritius

This study applies two methodologies to Mauritian life tables and cause-of-death data: (1) the decomposition of sex differentials in life expectancy using Arriaga's approach and (2) the estimation of the effect of marginal reduction in deaths from infectious and parasitic diseases on life expectancy using Keyfitz's methodology on cause-specific entropy and that of Nanjo. The findings in this paper support earlier findings about the importance of the period 1969-1976 in the mortality transition in Mauritius, a period in which sex differentials in life expectancies reached a peak level. The results suggest that the driving force behind those sex differentials in life expectancy was the sex differential in mortality in infectious and parasitic diseases, first among the young (ages below 10 years) and second among the older population (ages above 50 years). If the decline in mortality due to infectious and parasitic diseases was differentially greater in the older ages compared to the younger ages, that difference would have gone a long way toward reducing the magnitude of the historic peak sex differential in life expectancy achieved in 1976.     

Arts and Ageing; Life Expectancy of Historical Artists in the Low Countries

Practising arts has been linked to lowering stress, anxiety and blood pressure. These mechanisms are all known to affect the ageing process. Therefore, we examine the relation between long-term involvement in arts and life expectancy at age 50 (LE50), in a cohort of 12,159 male acoustic, literary and visual artists, who were born between 1700 and 1899 in the Low Countries. We compared the life expectancy at age 50 of the various artists with the elite and middle class of that time. In the birth cohorts before 1850, acoustic (LE50:14.5–19.5) and literary artists (LE50:17.8–20.8) had a similar life expectancy at age 50 compared to the elite (LE50:18.0–19.0). Only visual artists (LE50:15.5–17.1) had a lower life expectancy at age 50 compared to the elite at that time. For the most recent birth cohorts from 1850 through 1899, the comparison between artists and the elite reversed and acoustic and literary artist had a lower life expectancy at age 50, while visual artists enjoyed a similar life expectancy at age 50. Although artists belonged to the middle socioeconomic class and lived predominantly in urban areas with poor living conditions, they had a life expectancy similar to the elite population. This is in line with observed favourable effects of practicing arts on health in the short-term. From our historical analysis, we hypothesize several mechanisms through which artistic creativity could influence the ageing process and life expectancy. These hypotheses, however, should be formally tested before any definite conclusions on effects of arts on ageing can be drawn.     

Relationship of income and childlessness

ABSTRACT

We investigated the impact of diabetes on US life expectancy by sex and race/ethnicity using a prospective cohort study design. Cohorts were drawn from 1997 to 2009 waves of the National Health Interview Survey and linked to death records through December 31, 2011. We combined data on the prevalence of diabetes among decedents with estimates of the hazard ratios of individuals diagnosed with diabetes to calculate population attributable fractions (PAFs) by age, sex, and race/ethnicity at ages 30 and above. These estimates were then applied to deaths in the official US life table for 2010 to estimate effects of diabetes on life expectancy.

Diabetes was responsible for a reduction of 0.83 years of life expectancy for men at age 30 and 0.89 years for 30-year-old women. The impact was greatest among Black women at 1.05 years. Estimates based on traditional demographic and actuarial methods using the frequency with which a disease appears as an underlying cause of death on death certificates produced a reduction in life expectancy at age 30 of only 0.33 years.

We conclude that diabetes is substantially reducing US longevity and that its effect is seriously underestimated when using data on underlying causes of death.     

Marriage and mortality: a life table analysis

This paper examines the effects of age at marriage and differential mortality of males and females on the incidence of widowhood between the sexes. Abridged life tables constructed from marital status and death registration data of a rural area of Bangladesh for the period 1974-79 were used. The difference in life expectancy between males and females varies from 0.4 to 2.2 years at the ages 0 to 65 years and over. The mortality differentials show that the probabilities of a male or a female surviving the other spouse would be approximately the same, were there no other influence. But the incidence of widows is about ten times that of widowers. Other relevant factors, under a given regime of mortality, are age at marriage and age difference between husband and wife.     

Threshold Levels of Infant and Under-Five Mortality for Crossover between Life Expectancies at Ages Zero,One and Five in India: A Decomposition Analysis

Objectives

Under the prevailing conditions of imbalanced life table and historic gender discrimination in India, our study examines crossover between life expectancies at ages zero, one and five years for India and quantifies the relative share of infant and under-five mortality towards this crossover.

Methods

We estimate threshold levels of infant and under-five mortality required for crossover using age specific death rates during 1981–2009 for 16 Indian states by sex (comprising of India’s 90% population in 2011). Kitagawa decomposition equations were used to analyse relative share of infant and under-five mortality towards crossover.

Findings

India experienced crossover between life expectancies at ages zero and five in 2004 for menand in 2009 for women; eleven and nine Indian states have experienced this crossover for men and women, respectively. Men usually experienced crossover four years earlier than the women. Improvements in mortality below ages five have mostly contributed towards this crossover. Life expectancy at age one exceeds that at age zero for both men and women in India except for Kerala (the only state to experience this crossover in 2000 for men and 1999 for women).

Conclusions

For India, using life expectancy at age zero and under-five mortality rate together may be more meaningful to measure overall health of its people until the crossover. Delayed crossover for women, despite higher life expectancy at birth than for men reiterates that Indian women are still disadvantaged and hence use of life expectancies at ages zero, one and five become important for India. Greater programmatic efforts to control leading causes of death during the first month and 1–59 months in high child mortality areas can help India to attain this crossover early.     

Mortality and socio-economic differences in Denmark: a competing risks proportional hazard model

This paper explores how mortality is related to such socio-economic factors as education, occupation, skill level and income for the years 1992-1997 using an extensive sample of the Danish population. We employ a competing risks proportional hazard model to allow for different causes of death. This method is important as some factors have unequal (and sometimes opposite) influence on the cause-specific mortality rates. We find that the often-found inverse correlation between socio-economic status and mortality is to a large degree absent among Danish women who die of cancer. In addition, for men the negative correlation between socio-economic status and mortality prevails for some diseases, but for women we find that factors such as being married, income, wealth and education are not significantly associated with higher life expectancy. Marriage increases the likelihood of dying from cancer for women, early retirement prolongs survival for men, and homeownership increases life expectancy in general.     

Molecular mechanisms involved in muscle wasting in cancer and ageing: cachexia versus sarcopenia

The aim of the present review is to summarize and evaluate the different mechanisms and catabolic mediators involved in cancer cachexia and ageing sarcopenia since they may represent targets for future promising clinical investigations. Cancer cachexia is a syndrome characterized by a marked weight loss, anorexia, asthenia and anemia. In fact, many patients who die with advanced cancer suffer from cachexia. The degree of cachexia is inversely correlated with the survival time of the patient and it always implies a poor prognosis. Unfortunately, at the clinical level, cachexia is not treated until the patient suffers from a considerable weight loss and wasting. At this point, the cachectic syndrome is almost irreversible. The cachectic state is often associated with the presence and growth of the tumour and leads to a malnutrition status due to the induction of anorexia. In recent years, age-related diseases and disabilities have become of major health interest and importance. This holds particularly for muscle wasting, also known as sarcopenia, that decreases the quality of life of the geriatric population, increasing morbidity and decreasing life expectancy. The cachectic factors (associated with both depletion of fat stores and muscular tissue) can be divided into two categories: of tumour origin and humoural factors. In conclusion, more research should be devoted to the understanding of muscle wasting mediators, both in cancer and ageing, in particular the identification of common mediators may prove as a good therapeutic strategies for both prevention and treatment of wasting both in disease and during healthy ageing.     

Calculation of longevity and life expectancy in captive elephants

The concepts of longevity (longest lived) and life expectancy (typical age at death) are common demographic parameters that provide insight into a population. Defined as the longest lived individual, longevity is easily calculated but is not representative, as only one individual will live to this extreme. Longevity records for North American Asian elephants (Elephas maximus) and African elephants (Loxodonta africana) have not yet been set, as the oldest individuals (77 and 53 years, respectively) are still alive. One Asian elephant lived to 86 years in the Taipei Zoo. This is comparable to the maximum (though not typical) longevity estimated in wild populations. Calculation of life expectancy, however, must use statistics that are appropriate for the data available, the distribution of the data, and the species' biology. Using a simple arithmetic mean to describe the non‐normally distributed age at death for elephant populations underestimates life expectancy. Use of life‐table analysis to estimate median survivorship or survival analysis to estimate average survivorship are more appropriate for the species' biology and the data available, and provide more accurate estimates. Using a life‐table, the median life expectancy for female Asian elephants (Lx=0.50) is 35.9 years in North America and 41.9 years in Europe. Survival analysis estimates of average life expectancy for Asian elephants are 47.6 years in Europe and 44.8 years in North America. Survival analysis estimates for African elephants are less robust due to less data. Currently the African elephant average life expectancy estimate in North America is 33.0 years, but this is likely to increase with more data, as it has over the past 10 years. Zoo Biol 23:365–373, 2004. © 2004 Wiley‐Liss, Inc.     

HOW TO CONNECT BIOETHICS AND ENVIRONMENTAL ETHICS: HEALTH, SUSTAINABILITY, AND JUSTICE

In this paper, I explore one way to bring bioethics and environmental ethics closer together. I focus on a question at the interface of health, sustainability, and justice: How well does a society promote health with the use of no more than a just share of environmental capacity? To address this question, I propose and discuss a mode of assessment that combines a measurement of population health, an estimate of environmental sustainability, and an assumption about what constitutes a fair or just share. This mode of assessment provides an estimate of the just and sustainable life expectancy of a population. It could be used to monitor how well a particular society promotes health within just environmental limits. It could also serve as a source of information that stakeholders use when they deliberate about programs, policies, and technologies. The purpose of this work is to focus attention on an ethical task: the need to fashion institutions and forms of life that promote health in ways that recognize the claims of sustainability and justice.     

Vitamin E affects cell death in adult rat dentate gyrus

We have previously reported the presence of dying cells in the granule cell layer (GCL) of adult rat dentate gyrus (DG), where neurogenesis occurs. In particular, we found that cell death in the GCL increased in vitamin E deficiency and decreased in vitamin E supplementation. These findings were regarded as related to changes in neurogenesis rate, which in turn was influenced by vitamin E availability; a neuroprotective effect of vitamin E on cell death was also proposed. In order to verify this latter hypothesis, we have studied cell death in all layers of DG in vitamin E-deficient and vitamin E-supplemented rats and in control rats at different ages, using TUNEL and nick translation techniques. The phenotype of TUNEL-positive cells was characterized and the existence of dying BrdU-positive cells was investigated. Dying cells with neuronal phenotype were observed throughout the DG in all experimental groups. The number of TUNEL-positive cells decreased from juvenile to adult age. A higher number of TUNEL-positive cells in vitamin E-deficient rats and a lower number in vitamin E-supplemented rats, with respect to age-matched controls, were found; moreover, in these groups, TUNEL-positive cells had a different percentage distribution in the different layers of the DG. Our results confirm the occurrence of cell death in DG, demonstrate that cell death affects neuronal cells and support the hypothesis that the effect of vitamin E on cell death is not related to neurogenesis.