Hong Kong, June 2nd 2003

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Hong Kong, June 2nd 2003
Longer life and better health a challenge for all
the low mortality countries
Jean-Marie Robine
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Longer life
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During the 18th centuryThe first limits for the
human life span

• Abraham de Moivre (1724) 86 ans
• Isaac de Graaf (1729) 92 ans
•  

As for what is alleged, that by some observations
of late years, it appears, that life is carried
to 90, 95, and even to 100 years  I am not more
moved by it, than by the example of Parr, or
Jenkins, the first of which lived 152 years, and
the other 167. de Moivre, 1724
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The first enumeration in France during the 17th
century
Source Bois, 1989
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Female record life expectancy in the world since
1840
Oeppen Vaupel, 2002
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Increase in life expectancy at birth in Japan
Robine Saito, 2002
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Increase in life expectancy at birth in France
Source Vallin et Meslé, 2001
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Four centuries of changes In France
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Rectangularization of the survival curve during
the 20th century in France

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Rectangularization of the survival curve during
the 20th century in France
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More than 10.000 centenariansin France, in 2002
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Mortality rates at age 100-104 and 105 and over
in Japan since 1975, females
Robine Saito, 2001
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Rates of increases in centenarians in France
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Centenarian Doubling Time (CDT) in France (in
year)
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Emergence of super-centenarians incidence of new
cases since 1950
International Database on Longevity, Robine
Vaupel, 2002
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Maximum reported age at death since 1960
International Database on Longevity, Robine
Vaupel, 2002
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Low mortality countries
Mortality trajectories
Robine Vaupel, 2002
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Concentration of deaths during the 20th century
in France
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Concentration of deaths during the 20th century
in France

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Source Vallin et Meslé, 2001
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Robine, 2001
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In this context
To give a priority to the quality of life even if
this probably will lengthen it more.
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Better health
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Total life expectancy, life expectancy without
disability and life expectancy without chronic
disease (WHO, 1984)
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Total survival, survival without disability and
survival without chronic disease, France
1981-1991, females
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In summary (1)

• Contradictory results even if almost all studies
  suggest in a way or another that the functional
  status of the elderly population has improved
  over the last thirty years

 

• Difficulty to to see the overall picture (kind
  of disability, level of severity, extend of the
  decline, pace and acceleration of the decline)

• Statistical series, still sparse, short, few
  points in time, poorly comparable

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In summary (2)

• The comparison of men and women shows that the
  latter live longer, live longer without
  disability, but also live longer with disability.
  The proportion of years lived without disability
  within life expectancy differs very little from
  one sex to the other, even if it is generally
  larger for men
• Almost all studies from low mortality countries

 
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First assumption
Trends toward more educated elderly cohorts could
partially explain the disability decline
(Preston, 1992 Crimmins et al, 1999 Freedman
and Martin, 1999 Waidmann and Liu, 2000) and
especially decline in cognitive functional
limitations and IADL-disabilities having strong
cognitive components (Feedman et al, 2001) Better
educated and better trained, most recent cohorts
had better cognitive performance and therefore
developp better strategies to limit activity
restrictions in daily life
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Second assumption
Change in disability level at old ages is linked
to the fall of mortality. The fall of mortality
is accompagnied by a redistribution of the levels
of disability with a decrease in the prevalence
of the most severe levels of disability
(ADL-type) and an increase in the prevalence of
the least severe levels. In the recent periods
long standing illnesses (reported morbidity),
better known and better treated, are less severe
and lead significantly less often to death or
severe disability (Robine et al, 1998 Crimmins
and Saito, 2000 Freedman and Martin, 2000)
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Third assumption
Recent studies show that people with lower risks
(defined on the basis of smoking, body mass
index, and exercise patterns) not only live
longer, but experience fewer years of disability
before death (Vita et al, 1998, Ferruci et al,
1999, Nusselder et al, 2000) Thus, if future
increases in life expectancy are due to better
behaviors, they could also be accompanied with
larger increases in disability-free life
expectancy leading to a compression of disability.
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A possible synergy
A positive synergy between the improving levels
of education, improving nutritional status,
better working conditions, and better health
behaviors (including a better management of early
impairments) should improve the functional
abilities and performance of essential activities
for daily live of future cohorts and lead to a
redistribution of the years lived in disability,
from the most severe to the less severe levels.
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Chistensen M,115 ans

• In the community until 96
• Mentally alert until death

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Sarah K, 119 ans,
Thank you

• In the community until 110
• Independently until 100
• Mentally alert until her death

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Main issues

• Type of disability

Longstanding illness and health
problem Functional limitations (physical,
sensory, cognitive) Activity restrictions (ADL,
IADL)

• Level of severity
• Difficulty to do versus need for help

Improvment over time in ADL or IADL performance
is not necessarily linked with improvment in
physical, sensory or cognitive ablities
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About the rectangularization of the survival
curve There are several possibilities. It
might prove possible, first of all, to lengthen
the period of adult vigour without increasing the
final life-span. This would produce a nearly
square curve... This seems biologically the least
likely pattern for us to achieve. More probably
we might find means of prolonging the period of
adult vigour, either alone, or with proportional
prolongation of the pre-adult and the senile
stages- a scalar expansion of our present
survival pattern. (Comfort, The biology of
ageing, 1964). Can we extend this proposal to
active life expectancy and to life life
expectancy with ADL-disabilities?