Carol Jagger

Newcastle University | NCL · Institute of Health and Society

Although retirement ages are rising in the United Kingdom and other countries, the average number of years people in England can expect to spend both healthy and work from age 50 (Healthy Working Life Expectancy; HWLE) is less than the number of years to the State Pension age. This study aimed to estimate HWLE with the presence and absence of selec...

Background In the general population an increase in low-density lipoprotein cholesterol (LDL-C) predicts higher cardiovascular disease risk, and lowering LDL-C can prevent cardiovascular disease and reduces mortality risk. Interestingly, in cohort studies that include very old populations, no or inverse associations between LDL-C and mortality have...

Objectives Dietary intake information is key to understanding nutrition-related outcomes. Intake changes with age and some older people are at increased risk of malnutrition. Application, difficulties, and advantages of the 24-hour multiple pass recall (24hr-MPR) dietary assessment method in three cohorts of advanced age in the United Kingdom (UK)...

Background Mobility disability is predictive of further functional decline and can itself compromise older people’s capacity (and preference) to live independently. The world’s population is also ageing, and multimorbidity is the norm in those aged ≥85. What is unclear in this age group, is the influence of multimorbidity on (a) transitions in mobi...

Background In the UK, the General Medical Council (GMC) and Royal College of General Practitioners (RCGP) require doctors to consider spiritual health in their consultations. There are documented barriers to discussion of spiritual health, and suggested tools to help overcome them. Aim To investigate how comfortable general practitioners (GPs) fee...

Objectives: Low education and unhealthy lifestyle factors such as obesity, smoking, and no exercise are modifiable risk factors for disability and premature mortality. We aimed to estimate the individual and joint impact of these factors on disability-free life expectancy (DFLE) and total life expectancy (TLE). Methods: Data ( n = 22,304) were from...

Although leading causes of death are regularly reported, there is disagreement on which long-term conditions (LTCs) reduce disability-free life expectancy (DFLE) the most. We aimed to estimate increases in DFLE associated with elimination of a range of LTCs. This is a comprehensive systematic review and meta-analysis of studies assessing the effect...

Objectives: While randomized controlled trials have proven the benefits of blood pressure (BP) lowering in participating octogenarians, population-based observational studies suggest an association between low systolic blood pressure (SBP) and faster overall decline. This study investigates the effects of BP-lowering treatment, a history of cardio...

Introduction: Higher dietary protein, alone or in combination with physical activity (PA), may slow the loss of age-related muscle strength in older adults. We investigated the longitudinal relationship between protein intake and grip strength, and the interaction between protein intake and PA, using four longitudinal ageing cohorts. Methods: In...

Objectives to assess the effect of recent stalling of life expectancy and various scenarios for disability progression on projections of social care expenditure between 2018 and 2038, and the likelihood of reaching the Ageing Society Grand Challenge mission of five extra healthy, independent years at birth. Design two linked projections models: th...

Research on religiosity and health has generally focussed on the United States, and outcomes of health or mortality but not both. Using the European Values Survey 2008, we examined cross-sectional associations between four dimensions of religiosity/spirituality: attendance, private prayer, importance of religion, belief in God; and healthy life exp...

Objective: While randomized controlled trials have proven the benefits of blood pressure (BP) lowering in participating octogenarians, population-based observational studies suggest an association between low systolic blood pressure (SBP) and faster overall decline. This study investigates the effects of BP-lowering treatment, a history of cardiov...

Background There is a need to know how changes in health expectancy differ for population subgroups globally. The aim of this study was to estimate 10-year trends in health expectancies by individual markers of socioeconomic position from three points over the lifecourse, evaluating how compression and expansion of morbidity have varied within a na...

Retirement ages are rising in many countries to offset the challenges of population ageing, but osteoarthritis is an age-associated disease that is becoming more prevalent and may limit capacity to work until older ages. We aimed to assess the impact of osteoarthritis on healthy working life expectancy (HWLE) by comparing HWLE for people with and w...

UK state pension age is rising in response to life expectancy gains but population health and job opportunities may not be sufficient to achieve extended working lives1, 2–3. This study aimed to estimate future trends in healthy working life expectancy (HWLE) from age 50 to 75 for men and women in England. Using the ‘intercensal’ health expectancy...

Background: We aimed to estimate healthy working life expectancy (HWLE) at age 50 years by gender, cohort, and level of education in Australia. Methods: We analysed data from two nationally representative cohorts in the Household Income and Labour Dynamics in Australia survey. Each cohort was followed up annually from 2001 to 2010 and from 2011 to...

Objective To estimate the probability of onset and progression of disease and disability, length of life with or without disease and/or disability, and incidence of mortality, and to identify factors associated with transitioning to disease and/or disability over time. Study design A prospective cohort study. Data were provided by 12,432 participa...

Objectives: Cognitive stimulation therapy (CST) is one of the few non-pharmacological interventions for people living with dementia shown to be effective and cost-effective. What are the current and future cost and health-related quality of life implications of scaling-up CST to eligible new cases of dementia in England? Methods/design: Data fro...

Background : Disability-free life expectancy (DFLE) inequalities by socioeconomic deprivation are widening, alongside rising prevalence of multiple long-term conditions (MLTCs). We use longitudinal data to assess whether MLTCs contribute to the widening DFLE inequalities by socioeconomic deprivation. Methods : The Cognitive Function and Ageing Stu...

Background and objectives Nutritional deficiencies, renal impairment and chronic inflammation are commonly mentioned determinants of anaemia. The aim of this study was to investigate the effects of these determinants, singly and in combination, on anaemia in the very old. Method The TULIPS Consortium consists of four population-based studies in ol...

Background In the UK, doctors’ regulatory and professional bodies require general practitioners (GPs) to consider discussing spiritual health as part of the consultation. However, spiritual health is not defined in guidance, and it is unknown what individual doctors understand by the term. Research question What do GPs understand by the term ‘spir...

Physical activity and protein intake are associated with ageing-related outcomes, including loss of muscle strength and functional decline, so may contribute to strategies to improve healthy ageing. We investigated the cross-sectional associations between physical activity or sedentary behaviour and protein intake patterns in community-dwelling old...

Background: Low serum TSH has been associated with an increased risk of cognitive impairment in observational studies of older individuals but the mechanism underlying this is unclear. We investigated the association between changes in thyroid status and cognitive impairment in very old adults, using prospective data from the Newcastle 85+ study....

Background Retirement ages are rising in many countries due to population ageing and increasing life expectancy. However, poor health, comorbidity and workplace factors are major reasons for work absence and it is unclear if people in later working-age life (age ≥50) are able to work for longer. Osteoarthritis (OA), the most common joint condition...

Background The aims of this study were (1) to estimate 10-year trends in disability-free life expectancy (DFLE) by area-level social disadvantage and (2) to examine how incidence, recovery and mortality transitions contributed to these trends. Methods Data were drawn from the nationally representative Household Income and Labour Dynamics in Austra...

A Correction to this paper has been published: https://doi.org/10.1038/s41467-021-22613-2

Background Dietary protein may slow the decline in muscle mass and function with aging, making it a sensible candidate to prevent or modulate disability progression. At present, studies providing reliable estimates of the association between protein intake and physical function, and its interaction with physical activity (PA), in community-dwelling...

Background Despite increasing life expectancy (LE), cross-sectional data show widening inequalities in disability-free LE (DFLE) by socioeconomic status (SES) in many countries. We use longitudinal data to better understand trends in DFLE and years independent (IndLE) by SES, and how underlying transitions contribute. Methods The Cognitive Functio...

Modifiable factors delaying frailty progression are important in demographic ageing; health disparities for indigenous people require specific strategies. Does dietary protein intake impact transitions in frailty in Maori (indigenous) and non-Maori aged 80+ in New Zealand? LiLACS NZ is population based longitudinal cohorts of Maori aged 80-90 years...

The combined contribution of multi-morbidity and socio-economic position (SEP) to trends in disability free life expectancy (DFLE) is unknown. We use longitudinal data from the Cognitive Function and Ageing Studies (CFAS I: 1991; CFAS II: 2011), with two year follow up. Disability was defined as difficulty in activities of daily living, and SEP as...

Life expectancy has increased over previous decades, but several countries are seeing widening inequalities in disability-free life expectancy (DFLE) by socioeconomic position (SEP). In this symposium we address three unanswered questions.1. Do DFLE trends differ for SEP groups, and which of the underlying transitions (incidence, recovery, death wh...

To understand how and why disability-free life expectancy (DFLE) trends differ by socioeconomic position (SEP) we use longitudinal data from the Cognitive Function and Ageing Studies (CFAS I: 1991; CFAS II: 2011), with two year follow up. Disability was defined as difficulty in activities of daily living, and SEP as area-level deprivation. Between...

There has been little investigation of how life-course social mobility is linked to Disability-Free Life Expectancy (DFLE). We report novel analysis of the HILDA survey examining how DFLE trends differs by three markers of socio-economic position (SEP): early-life (educational attainment), midlife (occupational level), and late-life (area-disadvant...

To update previous reviews, we searched Medline, Embase, Scopus and the Office for National Statistics (ONS) website for studies and reports published after 2016 that describe trends in healthy life expectancy, active life expectancy or disability-free life expectancy (DFLE) in the UK and other OECD high-income countries. We focus here on studies r...

We report the first analysis of inequalities in Disability-Free Life Expectancy (DFLE) trends for Australia, based on two cohorts of the nationally representative Household Income and Labour Dynamics in Australia survey. Each cohort was aged 45+ at baseline with 7-years of annual follow-up (Older cohort: 2001-2007, n=6363; Younger cohort: 2011-2017...

Background Smoking and obesity are two modifiable risk factors for disability. We examine the impact of smoking and obesity on disability-free life expectancy (DFLE) at older ages, using two levels of disability. Methods We used the DYNOPTA dataset, derived by harmonizing and pooling risk factors and disability outcomes from five Australian longit...

Background: Subclinical and overt thyroid dysfunction is easily detectable, often modifiable, and, in younger age groups, has been associated with clinically relevant outcomes. Robust associations in very old persons, however, are currently lacking. This study aimed to investigate the associations between (sub-)clinical thyroid dysfunction and disa...

Background: Low vitamin D status is common in very old adults which may have adverse consequences for muscle function, a major predictor of disability. Aims: To explore the association between 25-hydroxyvitamin D [25(OH)D] concentrations and disability trajectories in very old adults and to determine whether there is an 'adequate' 25(OH)D concentra...

Introduction Growth in the number of very old (≥ 85 years) adults will likely lead to increased prevalence of disability. Our aim was to determine the contribution of protein intake, and the interaction between protein intake and physical activity (PA), to the transition between disability states and to death in the very old using the Newcastle 85+...

Background: Selenium is a trace element essential for health. Severe selenium deficiencies are associated with poor musculoskeletal (MSK) function. However, the effects of moderate deficiency on MSK function, especially in older adults, is unclear. Objectives: To determine the associations between selenium intake and MSK function in very old adults...

Background Diabetes is a major chronic condition with ever-increasing health and economic burden. This study aimed to measure the impact of diabetes on total life expectancy (TLE) and healthy life expectancy (HLE) at ages 70 and 80 and to assess how educational level, obesity, and comorbidity affected the expectancies. Methods The study involved 9...

Retirement ages for receipt of state/social pensions are rising in many countries in response to population ageing and increasing life expectancy. However, sickness absence and early retirement for health reasons (especially among adults aged ≥ 50) present challenges to this. Estimates of the average number of years people are both healthy and in w...

Background Retirement ages are rising in many countries to offset the challenges of population ageing, but people's capacity to work for more years in their later working life (>50 years) is unclear. We aimed to estimate healthy working life expectancy in England. Methods This analysis included adults aged 50 years and older from six waves (2002–1...

Background Lower protein intake in older adults is associated with loss of muscle mass and strength. The present study aimed to provide a pooled estimate of the overall prevalence of protein intake below recommended (according to different cut‐off values) among community‐dwelling older adults, both within the general older population and within spe...

Background: Using Newcastle 85+ Study data, we investigated transitions between frailty states from age 85 to 90 years and whether multi-morbidities and socioeconomic status (SES) modify transitions. Methods: The Newcastle 85+ Study is a prospective, longitudinal cohort study of all people born in 1921 in Newcastle and North Tyneside. Data inclu...

This paper extends investigation of religiosity and longevity to Taiwan using a 1989 survey: N = 3849, aged 60+, with 18 years of follow-up. Religious activity is measured as worship and performance of rituals. A Gompertz regression, adjusted and non-adjusted for covariates and mediating factors, shows the hazard of dying is lower for the religious...

This handbook presents global research on health expectancies, a measure of population health that examines the interaction between quantity and quality of life. With data from Europe, North America, Asia, and beyond, it explains how to define and measure health and morbidity and how to integrate these measurements with mortality. Coverage first hi...

Objective: High blood pressure is one of the main modifiable risk factors for dementia. However, there is conflicting evidence regarding the best antihypertensive class for optimizing cognition. Our objective was to determine whether any particular antihypertensive class was associated with a reduced risk of cognitive decline or dementia using com...

Background: The number of older people with dementia and the cost of caring for them, already substantial, are expected to rise due to population ageing. Objective: This study makes projections of the number of older people with dementia receiving unpaid care or using care services and associated costs in England. Methods: The study drew on up...

Objectives: To examine the association of protein intake with frailty progression in very old adults. Design: The Newcastle 85+ study, a prospective longitudinal study of people aged 85 years old in Northeast England and followed over 5 years. Setting and participants: 668 community-dwelling older adults (59% women) at baseline, with complete...

Understanding the extent to which reducing obesity will help maintain independence in later life is of key importance in the goal to achieve healthy ageing. To investigate this we use a unique dynamic microsimulation model, the Population Ageing and Care Simulation (PACSim) model, formed from three Longitudinal studies: Understanding Society, the E...

Background: Previous research using cross-sectional data shows widening inequalities in disability-free life expectancy (DFLE) by socioeconomic status (SES) in the UK. We aimed to understand the underlying transitions of DFLE and years dependency free (DepFLE) using longitudinal data from the Cognitive Function and Ageing Studies (CFAS I and CFAS I...

Populations worldwide are seeing rising levels of obesity and its health consequences, particularly diabetes. Levels of childhood obesity are particularly high with concerns of how this will affect individuals’ health and functioning in mid and later life. Such research questions are difficult to answer as ideally they require longitudinal studies...

Socioeconomic inequalities are important drivers of negative health outcomes. This study investigates the effect of social determinants on health using frailty from two studies 20-year apart and examines whether socio-economic differences are widening. A 30-item deficit accumulation score from the baseline data from the two Cognitive Function and A...

Early-life socio-economic position (SEP), defined by education, remains a significant factor in disability progression in Innovation in Aging, 2019, Vol. 3, No. S1 225 GSA 2019 Annual Scientific Meeting very old age, but there is less evidence for its effect on frailty progression. We used the Newcastle 85+ Study, a longitudinal cohort of people bo...

A number of studies have found that higher socio-economic position (SEP) appears protective of becoming frail. However, not only can SEP be defined in early, mid or late life, by education, occupational status or income/material disadvantage respectively, but frailty may occur in the young old as well as the very old. Do the same measures of SEP re...

In order for governments to plan health and social care strategies to help people maintain independence, evidence is required to show how risk factors are associated with progression in dependency. We use a transparent measure of dependency, based on help needed with activities of daily living, incontinence and cognitive impairment, categorised as:...

Background Depression is a leading cause of disability, with older people particularly susceptible to poor outcomes. Aims To investigate whether the prevalence of depression and antidepressant use have changed across two decades in older people. Method The Cognitive Function and Ageing Studies (CFAS I and CFAS II) are two English population-based...

Objectives: Existing literature shows religion is associated with health and survival separately. We extend this literature by considering health and survival together using a multistate life table approach to estimate total, disability-free, and disabled life expectancy (LE), separately for women and men, for 2 disability measures, and by 2 indic...

Background: Frailty is a significant determinant of health care utilisation and associated costs, both of which also increase with proximity to death. What is not known is how the relationships between frailty, proximity to death, hospital use and costs develop in a population aged 85 years and over. Methods: This study used data from a prospect...

Objectives: We examined the development of disease and disability in a large cohort of older women, the extent to which these conditions exempt them from being classified as successful agers and different trajectories of disease, disability and longevity across women's later life. Methods: We used survey data from 12,432 participants of the 1921...

Human longevity is heritable, but genome-wide association (GWA) studies have had limited success. Here, we perform two meta-analyses of GWA studies of a rigorous longevity phenotype definition including 11,262/3484 cases surviving at or beyond the age corresponding to the 90th/99th survival percentile, respectively, and 25,483 controls whose age at...

Background: The translation of evidence on dementia risk factors into clinical advice requires careful evaluation of the methodology and scope of data from which risk estimates are obtained. Objective: To evaluate the quantity and quality and of evidence, we conducted a review of reviews of risk factors for Alzheimer's disease (AD), Vascular dem...

Objectives: Eight years of panel data are used to investigate the association between three dimensions of religiosity and total and disability-free life expectancy (TLE/DFLE) in Taiwan. Method: Data come from the 1999 “Taiwan Longitudinal Study on Aging” (TLSA; N = 4,440; Age 55+). Dimensions of religiosity are public, private, belief, and coping....

Objectives This study measures the average per person and annual total costs of dementia in England in 2015. Methods/Design Up‐to‐date data for England were drawn from multiple sources to identify prevalence of dementia by severity, patterns of health and social care service utilisation and their unit costs, levels of unpaid care and its economic...

BACKGROUND: Age of onset of multimorbidity and its prevalence are well documented. However, its contribution to inequalities in life expectancy has yet to be quantified. METHODS: A cohort of 1.1 million English people aged 45 and older were followed up from 2001 to 2010. Multimorbidity was defined as having 2 or more of 30 major chronic diseases....

BACKGROUND: Age of onset of multimorbidity and its prevalence are well documented. However, its contribution to inequalities in life expectancy has yet to be quantified. METHODS: A cohort of 1.1 million English people aged 45 and older were followed up from 2001 to 2010. Multimorbidity was defined as having 2 or more of 30 major chronic diseases....

Background: Sarcopenia, a progressive age-related loss of skeletal muscle mass and strength, leads to disability, falls, and hospitalisation. Individual variation in sarcopenia onset may be partly explained by lifestyle factors such as physical activity and diet. Healthy dietary patterns (DPs) have been linked to better physical functioning in old...

Supplementary Figure S1. Flowchart of recruitment and cohort retention profile of the Newcastle 85+ Study according to the sample used. Supplementary Figure S2. The 17 basic (BADL) and instrumental activities of daily living (IADL) and mobility items used to derive the disability score. Supplementary Figure S3. Disability trajectories with 95% co...

Purpose: The very old (aged ≥ 85 years), fastest growing age group in most western societies, are at especially high risk of muscle mass and strength loss. The amount, sources and timing of protein intake may play important roles in the aetiology and management of sarcopenia. This study investigated the prevalence and determinants of low protein i...