Exceptional longevity does not result in excessive levels of disability
Exceptional longevity does not result in excessive levels of disability
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DOI：
10.1073/pnas.0804931105
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发表时间：
2008-09-09
影响因子：
11.1
通讯作者：
Vaupel, James W.
中科院分区：
文献类型：
--
作者：
Christensen, Kaare;McGue, Matt;Vaupel, James W.
晚年失去日常生活的独立性是老年人和社会的一个核心问题。增加高龄存活率的影响在群体水平上可能不同于在个人水平上。在这里，我们使用了一个纵向多评估调查的整个丹麦1905年队列从1998年至2005年，以评估损失的身体和认知独立的年龄范围为92至100岁。研究了多项功能结果，包括独立性，独立性定义为能够在没有其他人帮助的情况下进行基本的日常生活活动，并且具有23或更高的简易精神状态检查（MMSE）评分。总体而言，1905年队列在92岁至100岁之间的4次评估中独立个体的比例仅适度下降：39%、36%、32%和33%，第一次和最后一次评估之间的差异为6% [95%置信区间（CI），-1-14%]。然而，对于存活到2005年的参与者，独立性的患病率下降了2倍以上，从1998年的70%下降到2005年的33%（差异，37%; 95%CI，28-46%）。其他功能结局也获得了类似的结果。对无应答和死亡造成的缺失数据的分析表明，人口轨迹和个人轨迹之间的差异是由依赖个体的死亡率增加造成的。对个人来说，长寿带来了越来越大的丧失独立性的风险。对社会而言，死亡率的降低预计不会导致老年人群体的残疾程度异常严重。
Late-life loss of independence in daily living is a central concern for the aging individual and for society. The implications of increased survival to advanced age may be different at the population level than at the individual level. Here we used a longitudinal multi-assessment survey of the entire Danish 1905 cohort from 1998 to 2005 to assess the loss of physical and cognitive independence in the age range of 92 to 100 years. Multiple functional outcomes were studied, including independence, which was defined as being able to perform basic activities of daily living without assistance from other persons and having a MiniMental State Examination (MMSE) score of 23 or higher. In the aggregate, the 1905 cohort had only a modest decline in the proportion of independent individuals at the 4 assessments between age 92 and 100 years: 39%, 36%, 32%, and 33%, with a difference between first and last assessment of 6% [95% confidence interval (CI), -1-14%]. For participants who survived until 2005, however, the prevalence of independence was reduced by more than a factor of 2, from 70% in 1998 to 33% in 2005 (difference, 37%; 95% CI, 28-46%). Similar results were obtained for the other functional outcomes. Analyses of missing data resulting from nonresponse and death suggest that the discrepancy between the population trajectory and the individual trajectory is caused by increased mortality among dependent individuals. For the individual, long life brings an increasing risk of loss of independence. For society, mortality reductions are not expected to result in exceptional levels of disability in cohorts of the very old.