Jacob A. Brody

Trading Off Longer Life for Worsening Health: The Expansion of Morbidity Hypothesis

This article demonstrates and explains why future declines in mortality will have a diminishing effect on the metric of life expectancy but a large impact on the size of future elderly cohorts. Additionally, the article addresses a hypothesis in which it is argued that morbidity and disability will decline and become compressed into a shorter duration of time before death. Although studies have demonstrated that declining mortality can lead to worsening health, what is missing from the literature is a formal mechanistic hypothesis that describes why this phenomenon takes place. Two primary mechanisms are identified. One is based on arguments in which medical technology is identified to improve the survival of those with disabling conditions; the other is that declining mortality from fatal diseases leads to a shift in the distribution of causes of disability from fatal to nonfatal diseases of aging. Procedures for testing this hypothesis are discussed.

New model of health promotion and disease prevention for the 21st century

Our susceptibility to disease increases as we grow older. Robert Butler and colleagues argue that interventions to slow down ageing could therefore have much greater benefit than those targeted at individual disease

DEPRESSION OF THE TUBERCULIN REACTION BY VIRAL VACCINES.

TEMPORARY depression of the tuberculin reaction was reported first by Pirquet1 in 1908 in a child with measles. Since that time depressions of the tuberculin reaction have been noted to follow many infectious diseases, including pertussis,2 typhus,3 scarlet fever,4 influenza5 and rubella.6 This phenomenon also occurs during terminal tuberculosis,7 after radiation8 and with high doses of steroids.9 Recently, through direct suggestion under hypnosis, depression of tuberculin sensitivity was elicited.10 Because measles causes a depression of tuberculin reaction, and possibly a worsening of clinical tuberculosis,11 12 13 several investigators have studied the effects of measles vaccines on tuberculin sensitivity. Mellman and Wetton14 showed .xa0.xa0.

Hip fracture incidence among elderly Hispanics

OBJECTIVESnThis study estimated hip fracture incidence for elderly Hispanics in the United States.nnnMETHODSnA cohort of Spanish-surnamed 1992 Medicare enrollees was followed for 2 years. Hip fractures were identified by inpatient diagnostic code.nnnRESULTSnFor Hispanic women, the national age-adjusted hip fracture rate was 7.3 per 1000 person-years; for men, the rate was 3.3. Rates varied markedly, with higher rates for the predominantly Mexican-American southwestern states than for Puerto Ricans.nnnCONCLUSIONSnNationally, the Hispanic population is at intermediate risk of hip fracture between Blacks and Whites, but geographic variation suggests that Mexican Americans are at higher risk than Puerto Ricans.

Epidemiology and Aging

Since the beginning of the twentieth century, staggering changes have occurred in the size, age structure, health profile, and health care utilization patterns of the United States population. The size of the population has more than tripled.1,2 The population has aged; persons 65 years of age and over make up almost 13% of the total population, more than three times what it was in 1900. Today more than 70% of the population live to the traditional retirement age of 65. In 1900, only 25% of the population lived that long.3 Longevity has increased at an astounding rate.4 The predominant disease pattern is chronic illness, in contrast to infectious disease or disease due to poor living conditions, and medical care utilization is now greatest during the last years of life.3

The infectiousness of rubella and the possibility of reinfection.

A SERIES of rubella epidemics occurred in Alaska in 1963-1964 in isolated Eskimo and Aleut communities in which the disease had been absent for at least 20 years. Details of one of these epidemics appear elsewhere.12 In this communication, an attempt will be made to analyze the epidemiological implications of these outbreaks. Several controversial concepts will be expressed concerning the infectiousness of rubella as opposed to measles and the problem of subelinical and second infections with rubella.

Musical experience and dementia. Hypothesis

Background and aims: Cognitively stimulating activities appear to protect against the development of dementing illness — playing a musical instrument may be one of these activities. Consistent with this notion, the aim of this study was to explore the hypothesis that dementia might be less common among orchestral musicians. Methods: A cross-sectional survey of 23 older orchestral musicians who were former members of a single orchestra was carried out. Prior musical background, family history, and health history were obtained. A cognitive screen was administered in person or by telephone. Musicians were also queried regarding their awareness of living former orchestral colleagues with dementia. Results: The mean age of participants was 76.9±6.8 (SD). No participant was aware of a living former or current orchestral member with either reported or suspected dementia. Conclusions: The results are consistent with the hypothesis that dementing illness may be less among orchestral musicians — possibly from a lifetime engaged in a cognitively stimulating endeavor.

Age- associated diseases and conditions: Implications for decreasing late life morbidity

We discuss two types of age- associated diseases; aging- dependent such as Alzheimer’s disease and congestive heart failure which increase logarithmically with age, versus age- dependent such as multiple sclerosis and amyotrophic lateral sclerosis which occur at proscribed ages, and then occurrence of new cases ceases or diminishes with further aging. Prevention strategies with both types emphasize postponement or delay of onset. The nonfatal aging- dependent diseases and conditions are an accumulating burden as we age, and increase overall morbidity in late years. These include Alzheimer’s disease and other dementias, Parkinson’s disease, loss of vision and hearing, incontinence, osteoporosis and hip fracture, osteoarthritis and depression. With mortality postponed, we will be living for many years at old and vulnerable ages. Life’s quality will be reasonable for most. Still, increasing the chance that all will experience this desirable outcome requires pursuing the means to delay the onset of the physical and social events which we categorize as the non- fatal agingdependent diseases and conditions. We must recognize that each added year occurs at the tip of an exponential curve where risk is maximal.

Epidemiologic Aspects of Alzheimer's Disease: Facts and Fragments

To date, the classical approach of epidemiology has been neither exhaustive nor particularly helpful in developing insights into the nature of Alzheimers disease. The inability both to diagnose the disease and predict its clinical course hampers our ability to conduct adequate research on cause, prevention, clinical trials, and other treatment modalities as well as to select those key patients for whom greater efforts toward securing autopsies must be made. We are engaged in establishing an Alzheimers Disease Patient Registry, to determine the data needed to embark on major etiologic and epidemiologic studies. Our studies of Alzheimers disease in families and in forms of social and financial milieu are designed to develop humanitarian and potentially cost-effective approaches.

Demography, Epidemiology, and Aging

Demography is the study of populations—viewed rexadgionally, nationally, or globally—describing the numbers of people and the dynamics of population change. Demographic studies reveal the phenomenon of increasing numbers and increasing proportion of older people in the United States and in other developed countries. This phenomenon is so predictable that it has become a measure of improved economic and health status of nations in the 20th Century. Aging populations are the result of three major factors: fertility, mortality, and immigration. This discussion concerns the United States, where in the last half century immigration has not been a major influence on mortality patterns, and thus will not discuss immigration in any detail.