Ageing 3 Health, Functioning, and Disability in Older Adults—present Status and Future Implications
Ageing 3 Health, Functioning, and Disability in Older Adults—present Status and Future Implications
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5.3
通讯作者：
S. Chatterji;J. Byles;D. Cutler;T. Seeman;E. Verdes
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作者：
S. Chatterji;J. Byles;D. Cutler;T. Seeman;E. Verdes
衰老是一个动态过程，60 岁以上老年人的健康状况趋势因多种因素而随时间变化。我们研究了过去二十年报告的老年人发病率和死亡率的趋势，以确定世界各地的老龄化模式。我们在四种类型的研究中展示了一些压缩发病率的证据（即减少健康状况较差的时间）：1）基于评估标准分数的良好质量； 2) 采用与残疾相关或与损伤相关的发病率衡量标准的情况； 3）纵向研究；或 4) 在美国和其他高收入国家进行的研究。然而，许多研究报告了相反的证据（即发病率的扩大），但采用不同的方法，这些措施不能直接比较。当研究慢性病患病率的趋势时，发病率的扩大更为常见。我们对纵向老龄化调查数据的二次分析得出了类似的结果。然而，随着时间的推移，国家之间和国家内部的功能限制模式差异很大，而且没有明显的解释。来自低收入国家的数据非常稀少，迫切需要努力获取有关世界欠发达地区老年人健康的信息。我们特别需要专注于对老年人的健康、功能和残疾进行细化测量的研究，以及一组核心的功能领域，调查这些不断变化的模式对医疗保健系统的影响及其经济影响。
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 diff erent 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 eff orts 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 refi ning measurements of health, functioning, and disability in older people, with a core set of domains of functioning, that investigate the eff ects of these evolving patterns on the health-care system and their economic implications.