Lifestyle habits and compression of morbidity.
ABSTRACT There has been much debate regarding the degree to which healthy lifestyles can increase longevity and whether added years will be offset by increased morbidity at older ages. This study was designed to test the compression of morbidity hypothesis, proposing that healthy lifestyles can reduce and compress disability into a shorter period toward the end of life.
Functional status in 418 deceased members of an aging cohort was observed between 1986 and 1998 in relationship to lifestyle-related risk factors, including cigarette smoking, physical inactivity, and under- or overweight. Three risk groups were created based on the number of these factors at study entry. Disability scores prior to death were modeled for each risk group to compare levels and rates of change, as well as to determine if and when acceleration in functional decline occurred.
The risk-factor-free group showed average disability scores near zero 10-12 years before death, rising slowly over time, without evidence of accelerated functional decline. In contrast, those with two or more factors maintained a greater level of disability throughout follow-up and experienced an increase in the rate of decline 1.5 years prior to death. For those at moderate risk, the rate of decline increased significantly only in the last 3 months of life. Other differences between groups provided no alternative explanations for the findings.
These results make a compelling argument for the reduction and postponement of disability with healthier lifestyles as proposed by the compression of morbidity hypothesis.
Full-textDOI: · Available from: John W Oehlert, Jun 06, 2015
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ABSTRACT: Cardiovascular risk reduction, while saving lives, may prolong the time with disability and impair the quality of life in survivors. We compared the consequences of middle age cardiovascular risk in old age.Study design and settingIn 1974, risk was low in 593 (low-risk group) and high in 610 men (high-risk group). At baseline, all were healthy with similar age and socioeconomic status. Lifestyle and clinical factors, including quality of life (RAND-36), were surveyed with a questionnaire in 2000, and mortality was determined up to 2002.ResultsDuring the follow-up, 303 men died, with mortality 54% higher in the high-risk group (P = .001). In the 2000 survey, high-risk men still had significantly greater BMI, higher blood glucose, higher prevalence of smoking, and more sedentary lifestyle, and they reported more both cardiovascular and noncardiovascular diseases. All the RAND-36 scales were worse in the high-risk group; of the two component summary scores, physical (PCS), but not mental (MCS) score, was significantly lower in the high-risk group.Conclusion Low cardiovascular risk in middle age was associated with lower mortality, morbidity, and better quality of life in old age 26 years later. The results may support the theory of compression of morbidity.Journal of Clinical Epidemiology 04/2004; 57(4):415-421. DOI:10.1016/S0895-4356(03)00378-0 · 5.48 Impact Factor
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ABSTRACT: Tobacco use remains the leading cause of morbidity and mortality in the US. Effective tobacco cessation aids are widely available, yet underutilized. Tobacco cessation brief interventions (BIs) increase quit rates. However, BI training has focused on conventional medical providers, overlooking other health practitioners with regular contact with tobacco users. The 2007 National Health Interview Survey found that approximately 20% of those who use provider-based complementary and alternative medicine (CAM) are tobacco users. Thus, CAM practitioners potentially represent a large, untapped community resource for promoting tobacco cessation and use of effective cessation aids. Existing BI training is not well suited for CAM practitioners' background and practice patterns, because it assumes a conventional biomedical foundation of knowledge and philosophical approaches to health, healing and the patient-practitioner relationship. There is a pressing need to develop and test the effectiveness of BI training that is both grounded in Public Health Service (PHS) Guidelines for tobacco dependence treatment and that is relevant and appropriate for CAM practitioners. The CAM Reach (CAMR) intervention is a tobacco cessation BI training and office system intervention tailored specifically for chiropractors, acupuncturists and massage therapists. The CAMR study utilizes a single group one-way crossover design to examine the CAMR intervention's impact on CAM practitioners' tobacco-related practice behaviors. Primary outcomes included CAM practitioners' self-reported conduct of tobacco use screening and BIs. Secondary outcomes include tobacco using patients' readiness to quit, quit attempts, use of guideline-based treatments, and quit rates and also non-tobacco-using patients' actions to help someone else quit. CAM practitioners provide care to significant numbers of tobacco users. Their practice patterns and philosophical approaches to health and healing are well suited for providing BIs. The CAMR study is examining the impact of the CAMR intervention on practitioners' tobacco-related practice behaviors, CAM patient behaviors, and documenting factors important to the conduct of practice-based research in real-world CAM practices.BMC Complementary and Alternative Medicine 12/2014; 14(1):510. DOI:10.1186/1472-6882-14-510 · 1.88 Impact Factor
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ABSTRACT: Ageing is a dynamic process, and trends in the health status of older adults aged at least 60 years vary over time because of several factors. We examined reported trends in morbidity and mortality in older adults during the past two decades to identify patterns of ageing across the world. We showed some evidence for compression of morbidity (ie, a reduced amount of time spent in worse health), in four types of studies: 1) of good quality based on assessment criteria scores; 2) those in which a disability-related or impairment-related measure of morbidity was used; 3) longitudinal studies; or 4) studies undertaken in the USA and other high-income countries. Many studies, however, reported contrasting evidence (ie, for an expansion of morbidity), but with different methods, these measures are not directly comparable. Expansion of morbidity was more common when trends in chronic disease prevalence were studied. Our secondary analysis of data from longitudinal ageing surveys presents similar results. However, patterns of limitations in functioning vary substantially between countries and within countries over time, with no discernible explanation. Data from low-income countries are very sparse, and efforts to obtain information about the health of older adults in less-developed regions of the world are urgently needed. We especially need studies that focus on refining measurements of health, functioning, and disability in older people, with a core set of domains of functioning, that investigate the effects of these evolving patterns on the health-care system and their economic implications. Copyright © 2014 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd. All rights reserved.The Lancet 11/2014; 385(9967). DOI:10.1016/S0140-6736(14)61462-8 · 39.21 Impact Factor