Chi-Tsun Chiu

The Significance of Education for Mortality Compression in the United States

Recent studies of old-age mortality trends assess whether longevity improvements over time are linked to increasing compression of mortality at advanced ages. The historical backdrop of these studies is the long-term improvement in a population’s socioeconomic resources that fueled longevity gains. We extend this line of inquiry by examining whether socioeconomic differences in longevity within a population are accompanied by old-age mortality compression. Specifically, we document educational differences in longevity and mortality compression for older men and women in the United States. Drawing on the fundamental cause of disease framework, we hypothesize that both longevity and compression increase with higher levels of education and that women with the highest levels of education will exhibit the greatest degree of longevity and compression. Results based on the Health and Retirement Study and the National Health Interview Survey Linked Mortality File confirm a strong educational gradient in both longevity and mortality compression. We also find that mortality is more compressed within educational groups among women than men. The results suggest that educational attainment in the United States maximizes life chances by delaying the biological aging process.

New Estimates of Racial/Ethnic Differences in Life Expectancy with Chronic Morbidity and Functional Loss: Evidence from the National Health Interview Survey

This study documents the mortality, chronic morbidity and physical functioning experiences of U.S. Hispanics, non-Hispanic whites, and non-Hispanic blacks 50xa0years of age and older in the United States. Hispanics are classified by nativity to better assess an important source of heterogeneity in population health within that population. Drawing on mortality and morbidity data from the National Health Interview Survey, demographic models of healthy life expectancy are used to derive estimates of life expectancy, life expectancy with and without chronic morbidity conditions, and life expectancy with and without functional limitations. The results not only highlight the mortality advantages of foreign-born Hispanics, but also document their health advantages in terms of morbidity and physical functioning beyond age 50. Nativity is a highly important factor differentiating the health and mortality experiences of Hispanics: U.S.-born Hispanics have a health profile more indicative of their minority status while foreign-born Hispanics have much more favorable mortality and health profiles. Differences in smoking across racial/ethnic/nativity groups is suggested as an important reason behind the apparent health advantages of foreign-born Hispanics relative to whites as well as relative to their U.S.-born counterparts.

Spirituality, religiosity, aging and health in global perspective: A review

Persistent population aging worldwide is focusing attention on modifiable factors that can improve later life health. There is evidence that religiosity and spirituality are among such factors. Older people tend to have high rates of involvement in religious and/or spiritual endeavors and it is possible that population aging will be associated with increasing prevalence of religious and spiritual activity worldwide. Despite increasing research on religiosity, spirituality and health among older persons, population aging worldwide suggests the need for a globally integrated approach. As a step toward this, we review a subset of the literature on the impact of religiosity and spirituality on health in later life. We find that much of this has looked at the relationship between religiosity/spirituality and longevity as well as physical and mental health. Mechanisms include social support, health behaviors, stress and psychosocial factors. We identify a number of gaps in current knowledge. Many previous studies have taken place in the U.S. and Europe. Much data is cross-sectional, limiting ability to make causal inference. Religiosity and spirituality can be difficult to define and distinguish and the two concepts are often considered together, though on balance religiosity has received more attention than spirituality. The latter may however be equally important. Although there is evidence that religiosity is associated with longer life and better physical and mental health, these outcomes have been investigated separately rather than together such as in measures of health expectancy. In conclusion, there is a need for a unified and nuanced approach to understanding how religiosity and spirituality impact on health and longevity within a context of global aging, in particular whether they result in longer healthy life rather than just longer life.

Acculturation, Gender, and Active Life Expectancy in the Mexican-Origin Population

Objective: This study examines the potential effects of nativity and acculturation on active life expectancy (ALE) among Mexican-origin elders. Method: We employ 17 years of data from the Hispanic Established Population for the Epidemiologic Study of the Elderly to calculate ALE at age 65 with and without disabilities. Results: Native-born males and foreign-born females spend a larger fraction of their elderly years with activities of daily living (ADL) disability. Conversely, both foreign-born males and females spend a larger fraction of their remaining years with instrumental activities of daily life (IADL) disability than the native-born. In descriptive analysis, women with low acculturation report higher ADL and IADL disability. Men manifest similar patterns for IADLs. Discussion: Although foreign-born elders live slightly longer lives, they do so with more years spent in a disabled state. Given the rapid aging of the Mexican-origin population, the prevention and treatment of disabilities, particularly among the foreign born, should be a major public health priority.

Projection of Young-Old and Old-Old with Functional Disability: Does Accounting for the Changing Educational Composition of the Elderly Population Make a Difference?

This study compares projections, up to year 2040, of young-old (aged 60-79) and old-old (aged 80+) with functional disability in Singapore with and without accounting for the changing educational composition of the Singaporean elderly. Two multi-state population models, with and without accounting for educational composition respectively, were developed, parameterized with age-gender-(education)-specific transition probabilities (between active, functional disability and death states) estimated from two waves (2009 and 2011) of a nationally representative survey of community-dwelling Singaporeans aged ≥60 years (N=4,990). Probabilistic sensitivity analysis with the bootstrap method was used to obtain the 95% confidence interval of the transition probabilities. Not accounting for educational composition overestimated the young-old with functional disability by 65 percent and underestimated the old-old by 20 percent in 2040. Accounting for educational composition, the proportion of old-old with functional disability increased from 40.8 percent in 2000 to 64.4 percent by 2040; not accounting for educational composition, the proportion in 2040 was 49.4 percent. Since the health profiles, and hence care needs, of the old-old differ from those of the young-old, health care service utilization and expenditure and the demand for formal and informal caregiving will be affected, impacting health and long-term care policy.

Age at migration and disability-free life expectancy among the elder Mexican-origin population

BACKGROUND Migration selectivity is thought to shape the health profiles of Mexican immigrants. OBJECTIVE This study examines how the experience of Mexican migration to the United States affects the health process and the quality of life in old age by age at migration, specific to sex. METHODS We use 20 years of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to estimate the proportion of life spent disability-free prior to death across eight subgroups by sex, nativity, and age at migration among Mexican-origin elderly in the United States. RESULTS Female migrants are at a significant disadvantage in terms of IADL disability-free life expectancy relative to US-born women, particularly late-life migrants. Conversely, mid- and late-life male migrants exhibit an advantage in ADL disability-free life expectancy compared to their US-born counterparts. CONCLUSIONS Foreign-born Mexican elders are not a homogeneous group. This issue merits special attention in the development of community-based long-term care programs in order to appropriately target the specific needs of different subgroups of older Mexican individuals entering their last decades of life. CONTRIBUTION This study contributes to immigrant health literature by providing a more comprehensive documentation of nativity differentials, by distinguishing subgroups of Mexican elderly by sex, nativity, and age at migration.

Age of Migration Life Expectancy with Functional Limitations and Morbidity in Mexican Americans.

The U.S. Mexican American population enjoys longer life expectancies relative to other racial/ethnic groups but is disproportionately affected by chronic conditions and functional limitations. Studying the impact of heterogeneity in age, time and other characteristics of migration among older Mexican Americans can inform our understanding of health disparities and healthcare needs in later‐life. This research used 20 years of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to assess the proportion of life spent with functional limitations and one or more morbidity (according to age of migration and sex) in the U.S. Mexican‐American population. The results indicate that early‐life and late‐life migrant women spend more years with Performance‐Oriented Mobility Assessment limitations than U.S.‐born women. Conversely, midlife migrant women were not statistically different from U.S.‐born women in years spent disabled. In men, midlife migrants had longer life expectancies and had more disability‐free years than U.S.‐born men. For morbidity, late‐life migrant women spent a significantly smaller proportion of their elderly years with morbidity than U.S.‐born women, but late‐life migrant men spent more years with morbidity than U.S.‐born men. These findings illustrate that older Mexican Americans in the United States are heterogeneous in nativity and health outcomes. More years spent disabled or unhealthy may result in greater burden on family members and greater dependence on public resources. These findings have implications for the development of social and health policies to appropriately target the medical conditions and disabilities of older Mexican Americans entering late life.

Self-Care for Older People (SCOPE): A cluster randomized controlled trial of self-care training and health outcomes in low-income elderly in Singapore

UNLABELLEDnPopulation aging is associated with a higher prevalence of chronic health conditions. Previous studies have shown that older persons, specifically those with chronic conditions, often lack sufficient knowledge about their condition and thus frequently have poor self-care skills. Efforts to increase general health screenings and improve access to chronic condition management resources are hampered by a lack of disease and health awareness. Self-Care for Older People (SCOPE) study, a cluster randomized controlled trial in Singapore, was designed to evaluate the impact of a self-care program for chronic disease awareness and management of specific health measures and quality of life of older people over eighteen months. SCOPE provided self-care education targeted at older people with low income and low education in order to improve health-related knowledge. A total of 378 low-income older people with no or minimal disability, defined as having difficulty in one or more activities of daily living (ADL), were recruited from senior activity centers. The measurements taken included self-reported health conditions, health and disease knowledge questions, and biomarkers (HbA1c, blood pressure, peak expiratory flow, lipid panel, albumin, and creatinine). SCOPE was also designed to provide information for policy makers on chronic disease burden and healthcare facility utilization among community-dwelling older adults.nnnTRIAL REGISTRATION NUMBERnNCT01672177.

Age of Migration Differentials in Life Expectancy With Cognitive Impairment: 20-Year Findings From the Hispanic-EPESE

Background and ObjectivesnTo examine differences in life expectancy with cognitive impairment among older Mexican adults according to nativity (U.S.-born/foreign-born) and among immigrants, age of migration to the United States.nnnResearch Design and MethodsnThis study employs 20 years of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to estimate the proportion of life spent cognitively healthy and cognitively impaired prior to death among older Mexican adults residing in the southwestern United States. We combine age-specific mortality rates with age-specific prevalence of cognitive impairment, defined as a Mini-Mental Status Exam score of less than 21 points to calculate Sullivan-based life table models with and without cognitive impairment in later life.nnnResultsnForeign-born Mexican immigrants have longer total life expectancy and comparable cognitive healthy life expectancy regardless of gender compared to U.S.-born Mexican-Americans. However, the foreign-born spend a greater number of years after age 65 with cognitive impairment relative to their U.S.-born counterparts. Furthermore, we document an advantage in life expectancy with cognitive impairment and proportion of years after age 65 cognitively healthy among mid-life immigrant men and women relative to early- and late-life migrants.nnnDiscussion and ImplicationsnThe relationship between nativity, age of migration, and life expectancy with cognitive impairment means that the foreign-born are in more need of support and time-intensive care in late life. This issue merits special attention to develop appropriate and targeted screening efforts that reduce cognitive decline for diverse subgroups of older Mexican-origin adults as they age.

Dental health status of community-dwelling older Singaporeans: findings from a nationally representative survey.

OBJECTIVESnTo assess the dental health status of older Singaporeans by age, gender and ethnicity.nnnBACKGROUNDnPoor dental health in elders has been linked to a number of adverse health conditions and is often associated with an increased risk of mortality in older people.nnnMATERIALS AND METHODSnData came from a nationally representative cross-sectional 2009 survey of community-dwelling Singaporeans aged 60 and over. The distribution of the number of natural teeth, chewing ability and the presence of dentures were assessed by age, gender and ethnicity (Chinese/Malay/Indian) using sampling weights.nnnRESULTSnWith increasing age, there was a decrease in the average number of natural teeth, a decrease in the proportion of people with 20 or more natural teeth and with the strongest chewing ability, and an increase in the proportion that was edentulous or had dentures. Women, vs. men, had a lower average number of natural teeth (10.3 vs. 12.8), and they were more likely to be edentulous (37 vs. 24%) and to have dentures (73 vs. 63%). Across ethnic groups, Indians had the highest average number of natural teeth (17.0). However, among those who had dentures, Indians were the least likely to have the strongest chewing ability.nnnCONCLUSIONSnThe findings demonstrated differences in dental health status by age, gender and ethnicity. They highlight the need for improvements in the dental health status of all older Singaporeans, especially older women. The data presented herein may serve as a baseline for policymakers to evaluate the impact of recent schemes launched by the Ministry of Health (Singapore) to subsidise dental treatment.