Kenneth G. Manton

The impact of heterogeneity in individual frailty on the dynamics of mortality

Life table methods are developed for populations whose members differ in their endowment for longevity. Unlike standard methods, which ignore such heterogeneity, these methods use different calculations to construct cohort, period, and individual life tables. The results imply that standard methods overestimate current life expectancy and potential gains in life expectancy from health and safety interventions, while underestimating rates of individual aging, past progress in reducing mortality, and mortality differentials between pairs of populations. Calculations based on Swedish mortality data suggest that these errors may be important, especially in old age.

Changes in the prevalence of chronic disability in the United States black and nonblack population above age 65 from 1982 to 1999

Survey evidence through the early 1990s generally suggests a reduction in disability in the elderly population of the United States. Because the evidence is not fully consistent, several authors have speculated about whether disability declines will continue. This paper reports results from the 1999 National Long-Term Care Survey on disability trends from 1982 through 1999. It is found that disability continued to decline in the 1994 to 1999 period, and that the decline was greater in the 1990s than in the 1980s. The disability decline from 1982 to 1989 was 0.26% per year, from 1989 to 1994 it was 0.38% per year, and from 1994 to 1999 it was 0.56% per year. In addition, disability declined by a greater percentage for blacks than for nonblacks over the 1989 to 1999 period.

Changing Concepts of Morbidity and Mortality in the Elderly Population

A review of current theories concerning human mortality is first presented and their consistency with current evidence on mortality is considered. The author then presents some alternative perspectives on human mortality and longevity and discusses short- and long-term implications of various models of mortality. The need for systematic mortality research with a multidisciplinary perspective in order to understand current mortality conditions and to anticipate future mortality trends is stressed. The main geographic focus of the study is on the United States and the need to obtain information to plan for a rapidly aging population is emphasized.

The oldest old

INTRODUCTION: R.M. Suzman, K.G. Manton, and D.P. Willis: Introducing the oldest old C.M. Taeuber and I. Rosenwaike: A demographic portrait S.H. Preston: Cohort succession G.C. Myers, B.B. Torrey, and K. Kinsella: An international comparison PART II: PROBLEMS IN STUDYING THE OLDEST OLD: K.G. Manton and R.M. Suzman: Conceptual issues in the design and analysis of national longitudinal surveys W.L. Rodgers and A.R. Herzog: Collecting data: problems and procedures R.B. Wallace, F.J. Kohout, and P.L. Coulsher: Interview surveys K.G. Manton: Mortality and life expectancy changes E.C. Hadley: Causes of death among the oldest old PART III: THE DYNAMICS OF BECOMING THE OLDEST OLD: K.G. Manton and B.J. Soldo: Disability and mortality: implications for current and future health and long term service needs P. Doty: Institutional long-term care from an international perspective J.C. Cornoni-Huntley et al: Epidemiology of physical and cogitive disability D.A. Evans et al: The impact of Alzheimers disease in the United States population PART IV: A SOCIAL PORTRAIT OF THE OLDEST OLD: M.G. Kovar and R.S. Stone: Living arrangements R.C. Gibson and J.S. Jackson: The black oldest old: health, functioning and informal support R.M. Suzman et al: The robust oldest old: optimistic perspectives for increasing healthy life expectancy G.L. Atkins: Making it last: Economic resources PART V: SOCIAL AND MEDICAL POLICY TOWARD THE OLDEST OLD: B.B. Torrey: Sharing increasing costs on declining income: the visible dilemma of the invisible aged R.H. Binstock: Intergenerational equity.

Change in chronic disability from 1982 to 2004/2005 as measured by long-term changes in function and health in the U.S. elderly population

Changes in the health and functioning of the Medicare-enrolled population aged 65+ are tracked by using the 1982–2004/2005 National Long-Term Care Surveys. We found a significant rate of decline in the prevalence of chronic disability that accelerated from 1982 to 2004. These declines are significant for both persons with less severe chronic disability, which might be compensated by modifying the built environment and providing assistive devices, and for persons with more serious disability, which may be affected by reductions in the incidence and severity of disease through biomedical interventions. Declines in chronic disability continued over the 22-year period at a rate fast enough (i.e., 1.52% per annum) to contribute significantly to the long-term fiscal stability of the Medicare (and Medicaid) programs. Changes in the rate and substance of disability declines seem consistent with the intentions of policy interventions in Medicare and Medicaid.

Resolving inconsistencies in trends in old-age disability: Report from a technical working group

In September 2002, a technical working group met to resolve previously published inconsistencies across national surveys in trends in activity limitations among the older population. The 12-person panel prepared estimates from five national data sets and investigated methodological sources of the inconsistencies among the population aged 70 and older from the early 1980s to 2001. Although the evidence was mixed for the 1980s and it is difficult to pinpoint when in the 1990s the decline began, during the mid- and late 1990s, the panel found consistent declines on the order of 1%–2.5% per year for two commonly used measures in the disability literature: difficulty with daily activities and help with daily activities. Mixed evidence was found for a third measure: the use of help or equipment with daily activities. The panel also found agreement across surveys that the proportion of older persons who receive help with bathing has declined at the same time as the proportion who use only equipment (but not personal care) to bathe has increased. In comparing findings across surveys, the panel found that the period, definition of disability, treatment of the institutionalized population, and age standardizing of results were important to consider. The implications of the findings for policy, national survey efforts, and further research are discussed.

Survival after the Age of 80 in the United States, Sweden, France, England, and Japan

BACKGROUND In many developed countries, life expectancy at birth is higher than in the United States. Newly available data permit, for the first time, reliable cross-national comparisons of mortality among persons 80 years of age or older. Such comparisons are important, because in many developed countries more than half of women and a third of men now die after the age of 80. METHODS We used extinct-cohort methods to assess mortality in Japan, Sweden, France, and England (including Wales) and among U.S. whites for cohorts born from 1880 to 1894, and used cross-sectional data for the year 1987. Extinct-cohort methods rely on continuously collected data from death certificates and do not use the less reliable data from censuses. RESULTS In the United States, life expectancy at the age of 80 and survival from the ages of 80 to 100 significantly exceeded life expectancy in Sweden, France, England, and Japan (P < 0.01). This finding was confirmed with accurate cross-sectional data for 1987. The average life expectancy in the United States is 9.1 years for 80-year-old white women and 7.0 years for 80-year-old white men. CONCLUSIONS For people 80 years old or older, life expectancy is greater in the United States than it is in Sweden, France, England, and Japan. This finding suggests that elderly Americans are receiving better health care than the elderly citizens of other developed countries.

Statistical Applications Using Fuzzy Sets.

Likelihood Formulation of the Fuzzy Set Partition Estimation of the Parameters of the GoM Model A GoM Model for Aggregate Data Longitudinal and Event History Forms of the GoM Model Empirical Bayes Generalization of the GoM Model Forecasting and Simulation and Fuzzy Set Models Fuzzy Set Analyses of Combined Data Sets: A Model for Evaluation Studies Areas of Further Statistical Research on Fuzzy Sets.

Limits to human life expectancy: evidence prospects and implications.

Identifying limits to human life expectancy and life span is difficult because survival is determined by the individuals physiology exogenous influences and their interaction over time. To explore theoretical limits the authors examine the life expectancy of selected populations with good health behavior and apply a multivariate risk-factor model to longitudinal data. The risk-factor model and the population data produce consistent estimates of a lower bound of the theoretical limit to human life expectancy. The results suggest that such limits may be higher than estimates obtained by extrapolating human mortality trends which necessarily are dependent on historical conditions. The investigation emphasizes the need to use information on individual physiological processes and health changes prior to death in addition to mortality or endpoint data in making estimates. The low-risk populations studied are from the United States and Japan. (SUMMARY IN FRE AND SPA) (EXCERPT)

Health differentials between blacks and whites: recent trends in mortality and morbidity.

Black Americans continue to have large numbers of premature and excess deaths, measured against white experience, from seven major causes. Major differences in chronic disease, disability and case fatality rates persist despite similarities in the amount of health care received; the nature and quality of care is likely to be dissimilar. Epidemiological and clinical evidence suggests various strategies to reduce these differentials through well-designed public health efforts at prevention. These will have to deal with harsh realities of sociocultural, economic, and political contexts.