Frouke M. Engelaer

Malleability of Human Aging The Curious Case of Old-Age Mortality in Japan

Steady growth in human life expectancy has been a key feature of the last century, with projected further increases likely to have enormous impacts on societies worldwide. Despite the significance of these changes, our understanding of the factors shaping this trend is incomplete. During most of the historical increase, by far, the major influence was progressive decline in early and midlife death rates because of the reduction in premature deaths, caused chiefly by infection. Recent decades have seen the emergence of a new driver of increasing longevity—declining mortality among those who are old already, pointing to greater malleability in human aging than had been foreseen. There is still debate, however, as to how much of this decrease in old age mortality is caused by a better early-life environment and how much is caused by improved conditions in late life. A unique resource exists in the case of Japan, where material circumstances for the general population were consistently adverse through the early decades of the 20th century but improved rapidly after 1950. Here, we compare the Japanese birth cohorts of 1900, 1910, and 1920 and follow their period and cohort mortality trends. The results show that cohorts with similar environments early in life have very different mortality trajectories in old age. This strengthens the expectation that preventive measures in later life can deliver great benefit, while not contradicting the importance of life course approaches, to improving health and well-being.

Sex Differences in Healthy Life Expectancy in the Netherlands

For a long time, life expectancy at birth was used as the sole indicator of population health. More recently, population health is also being expressed as healthy life expectancy and it is debated how healthy life expectancy will develop in the future. Since it is known that men and women have very different health and disease trajectories, we compared healthy life expectancy between the sexes, at birth and at age 80. From 1985 to 2010 life expectancy at birth in the Netherlands increased from 73.1 to 78.8 for men and from 79.7 to 82.7 for women. During the same period, the expected number of years without disabilities and in good self-reported health increased parallel, pointing to a shift of disability towards older age. Paradoxically, however, there has been an expansion of morbidity per se, as indicated by a continuing decrease in life expectancy without chronic diseases from 51.4 to 47.2 for men and from 48.8 to 40.6 for women. After these diverging trends of the last thirty years, Dutch women nowadays have a life expectancy that is 3.9 years longer than men but a life expectancy without chronic diseases that is 6.6 years lower. When examining these figures in the oldest old, the number of years expected to live in good health is similar for the sexes, but women of 80 years can expect to live another 9.7 years, still almost two years longer than the 7.9 years for men. All in all, the increase of life expectancy in the Netherlands is accompanied by a shift of disability but an expansion of morbidity, which is much more pronounced in women. It remains to be examined what biological or social mechanisms are behind these large sex differences in healthy life expectancy in the Netherlands.

Seasonal variation in child and old-age mortality in rural Ghana

BACKGROUND Mortality in tropical countries varies considerably from season to season. As many of these countries have seen mortality moving from child to old-age mortality, we have studied seasonal variation in child and old-age mortality in a rural area in Ghana that currently undergoes an epidemiologic transition. METHODS In an annual survey from 2002 through to 2011, we followed 29 642 individuals and obtained the cause and month of death from 1406 deceased individuals by making use of verbal autopsies. RESULTS When comparing the seasons, we observed a trend for higher mortality during the wet season. When comparing separate months, we observed 34% more deaths than expected in September (95% CI 1.04-1.69; p = 0.024) at the end of the wet season and 43% more deaths in April (95% CI 1.13-1.80; p = 0.004) at the end of the dry season, while there were 42% less deaths than expected in December (95% CI 0.52-0.70; p = 0.003), shortly after the wet season. Cause-specific analysis indicated that the peak at the end of the wet season was due to excess mortality from infectious diseases in children and older people alike, whereas the peak in old-age mortality at the end of the dry season was due to non-infectious causes in older people only. CONCLUSIONS Taken together, our data suggest that during the epidemiologic transition, mortality not only shifts from child to old-age and from infectious to non-infectious, but also from the wet to the dry season.

Hypotension is more risky than hypertension in very old people.

The open label treatment extension of the original HYVET study received enthusiastic applause as further evidence for direct and long term benefits of treating hypertension in very old people (≥80 years).1 However, we should be cautious in extrapolating these findings to clinical practice. It …

Arts and ageing; life expectancy of historical artists in the Low Countries.

Practising arts has been linked to lowering stress, anxiety and blood pressure. These mechanisms are all known to affect the ageing process. Therefore, we examine the relation between long-term involvement in arts and life expectancy at age 50 (LE50), in a cohort of 12,159 male acoustic, literary and visual artists, who were born between 1700 and 1899 in the Low Countries. We compared the life expectancy at age 50 of the various artists with the elite and middle class of that time. In the birth cohorts before 1850, acoustic (LE50:14.5–19.5) and literary artists (LE50:17.8–20.8) had a similar life expectancy at age 50 compared to the elite (LE50:18.0–19.0). Only visual artists (LE50:15.5–17.1) had a lower life expectancy at age 50 compared to the elite at that time. For the most recent birth cohorts from 1850 through 1899, the comparison between artists and the elite reversed and acoustic and literary artist had a lower life expectancy at age 50, while visual artists enjoyed a similar life expectancy at age 50. Although artists belonged to the middle socioeconomic class and lived predominantly in urban areas with poor living conditions, they had a life expectancy similar to the elite population. This is in line with observed favourable effects of practicing arts on health in the short-term. From our historical analysis, we hypothesize several mechanisms through which artistic creativity could influence the ageing process and life expectancy. These hypotheses, however, should be formally tested before any definite conclusions on effects of arts on ageing can be drawn.

Better health, longer lives.

Life expectancy has steadily increased with around 2.5 years per ecade over the past 150 years and continuous to do so at a similar ate [1]. Before 1950, the increase in life expectancy was primarly driven by reductions in child mortality. During the last decades, owever, the increase in life expectancy is mainly the result of morality reductions at old age [2]. Better living conditions and hygiene ave saved us from an early death, while incremental health care nnovations have brought us an old age. When confronted with the increasing life expectancy, individals are uncertain whether they would like to live longer than the owadays average of 80 years. In sharp contrast almost everyody prefers to maintain a good health when growing old. This otion is even more pertinent as not only life expectancy has greatly ncreased, but the prevalence of life-style related diseases such as ardiovascular disease, obesity and diabetes as also increased [3]. t seems, that the increase in longevity comes at a cost of ill health. ere however, we reason that this conclusion is unjust and that e live longer in better health. To unravel this paradox, we should ot only consider life expectancy with and without chronic disases, but also life expectancy with and without disabilities, and ife expectancy in self-perceived health. For several decades in the Netherlands, life expectancy withut disability and life expectancy in good self-perceived health ave increased parallel to the increase in life expectancy [4]. Durng the same period life expectancy without chronic diseases has ecreased, in line with the international trends. There is a sound ogic that the reduction of years without chronic diseases can coinide with living in better health for longer. First, changes in life-style ave increased the prevalence of hypertension, obesity, diabetes nd other life-style related diseases. Second, ailments associated ith ageing are diagnosed earlier due to increased health awareess and screening. But third, treatment outcomes of disease states re ever improving and permanent damage is increasingly being revented. The net result is that life-style changes and earlier diagosing have contributed to an increased number of years ‘suffering’ rom chronic diseases, but at the same time appropriate treatent of these ailments provided us with an extra number of years ithout disabilities. We now live healthier for longer than ever efore.