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 (those aged ≥80 years) are the most rapidly growing age
group globally, and are most in need of health care and assistance. We aimed to assess
changes in mortality, disability in activities of daily living, and physical and cognitive
functioning among oldest-old individuals between 1998 and 2008. METHODS: We used data
from the Chinese Longitudinal Healthy Longevity Study. Three pairs of cohorts aged
80-89 years, 90-99 years, and 100-105 years (in total, 19 528 oldest-old participants)
were examined; the two cohorts in each pair were born 10 years apart, with the same
age at the time of the assessment in the 1998 and 2008 surveys. Four health outcomes
were investigated: annual death rate, Activities of Daily Living (ADL), physical performance
in three tests and cognitive function measured by Mini-Mental State Examination (MMSE).
We used different tests and multivariate regression analyses to examine the cohort
differences. FINDINGS: Controlling for various confounding factors, we noted that
annual mortality among oldest-old individuals was substantially reduced between 0·2%
and 1·3% in 1998-2008 compared with individuals of the same age born 10 years previously,
and that disability according to activities of daily living had significantly reduced
annually between 0·8% and 2·8%. However, cognitive impairment in the later cohorts
increased annually between 0·7% and 2·2% and objective physical performance capacity
(standing up from a chair, picking up a book from the floor, and turning around 360°)
decreased anually between 0·4% and 3·8%. We also noted that female mortality was substantially
lower than male mortality among the oldest-old, but that women's functional capacities
in activities of daily living, cognition, and physical performance were worse than
their male counterparts. INTERPRETATION: Advances in medications, lifestyle, and socioeconomics
might compress activities of daily living disability, that is, benefits of success,
but lifespan extension might expand disability of physical and cognitive functioning
as more frail, elderly individuals survive with health problems, that is, costs of
success. FUNDING: National Natural Science Foundation of China, National Institute
on Aging/National Institutes of Health, United Nations Funds for Population Activities.
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https://hdl.handle.net/10161/14637Published Version (Please cite this version)
10.1016/S0140-6736(17)30548-2Publication Info
Zeng, Yi; Feng, Qiushi; Hesketh, Therese; Christensen, Kaare; & Vaupel, James W (2017). Survival, disabilities in activities of daily living, and physical and cognitive functioning
among the oldest-old in China: a cohort study. Lancet, 389(10079). pp. 1619-1629. 10.1016/S0140-6736(17)30548-2. Retrieved from https://hdl.handle.net/10161/14637.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
James Walton Vaupel
Research Professor Emeritus in the Sanford School of Public Policy
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Yi Zeng
Professor in Medicine
(1) Socioeconomic, behavior, environmental and genetic determinants of healthy aging
and healthy longevity; (2) Factors related to elderly disability and mental health;
(3) Methods of family households and elderly living arrangements forecasting/analysis
and their applications in health services and socioeconomic planning, and market studies;
(4) Policy analysis in population aging, social welfare, retirement, and fertility
transitions.
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