Toni P. Miles

An overview of body weight of older persons, including the impact on mortality The national health and nutrition examination survey i-epidemiologic follow-up study

The authors studied distributions of body weight for height, change in body weight with age, and the relationship between body mass index and mortality among participants in the Epidemiologic Follow-up Study of the first National Health and Nutrition Examination Survey (NHEFS) (n = 14,407), a cohort study based on an representative sample of the U.S. population. Percentiles of body weight for height according to age and sex are presented. Cross-sectional analyses of body weight suggest that mean body weight increases with age until late middle age, then plateaus and decreases for older aged persons. However, longitudinal analysis of change in weight with age shows that younger persons in the lower quintile at baseline tend to gain more than those in the higher quintile. Older persons in the higher quintile at baseline have the greatest average loss in weight. The relationship of body mass index to mortality is a U-shaped curve, with increased risks in the lowest and highest 15% of the distribution. Increased risk of mortality associated with the highest 15th percentile of the body mass index distribution, as well as the highest 15% of the joint distribution of body mass index and skinfold thickness, is statistically significant for white women. However, the risk diminishes when adjusted for the presence of disease and factors related to disease. More noteworthy is the fact that there is a statistically significant excess risk of mortality for both race and sex groups in the lowest 15% of the body mass index distribution after adjusting for smoking history, and presence of disease. Those in the lowest 15% of the joint body mass index and skinfold thickness distribution, were also at increased risk. Risk of mortality for both men and women who have lost 10% or more of their maximum lifetime weight within the last 10 years is statistically significant, even when controlling for current weight. This study has replicated previously reported relationships, while correcting for several methodological issues.

Effective Aging Meeting the Challenge of Growing Older

n this century we have seen the dream of sigxuficant increases in life expectancy move closer to reality, with remarkable declines in mortality occurring for I all age groups. However, as human life expectancy increases, it has become evident that remaining vigorous and free of disability, and, perhaps most critically, maintaining an acceptable quality of life is as important, perhaps more important, than the absolute number of years achieved. Aging “well,” which has in the past been termed ”productive,” 1 “healthy,” 2 or, most recently, ”successful”3 aging, has been receiving increasing attention from the public, policymakers, and scientists. However, in the great majority of cases, the challenge of growing older involves more than the avoidance of disease or physiologic change. It frequently requires effectively compensating for physiologic changes and diseases.

Morbidity, disability, and health status of black American elderly: a new look at the oldest-old.

There are over 2.5 million black Americans aged 65 and over living in the United States today, including some 258,000 persons aged 85 years and over. The post‐World War II baby boom within the US black population should ensure that the numbers of persons aged 65 and over will increase into the 21st Century. If present trends continue, it is projected that the current population of black elders will also age. This means that the numbers of black persons aged 85 and over will also increase. Data from both national surveys and population‐based community studies concerning the health and well‐being of black elders are now becoming available. This report presents information concerning self‐reported health status, chronic disease prevalence, disease‐risk‐factor prevalence, measures of physical functioning, and nursing home utilization rates for age groups within the black population aged 65 years and over. The availability of such data should lead to the development of targeted interventions designed to lessen impairment and prolong independent living. J Am Geriatr Soc 40:1047–1054, 1992

Mortality postponed and the unmasking of age-dependent non-fatal conditions.

Mortality occurs at older ages in our growing and salubrious population. At present, fewer than 20% of all deaths, in Sweden, occur before age 65 with 18% of the Swedish population 65 and over. In the United States, 24% of deaths occur before age 65 with only 12% of the population age 65 and over. All countries in the developed world will have approximately 20% of their populations age 65 and over by about 2020. At that time, the percentage of deaths occurring prior to age 65 should range from 14%–16%. Thus future gains in morbidity and mortality will be influenced, to a lesser extent, by events prior to age 65 and prevention and health promotion strategies post age 65 become increasingly important. Active life expectancy, a developing concept, refers to the years lived in good health with no functional limitations. The period after active life expectancy consists of years of compromised health and well being. At present, each year gained of active life expectancy incurs almost four years of compromised health. A group of age-dependent non-fatal conditions are largely responsible for increased prevalence of social and physical deficits with age. These include dementia, osteoarthritis, diminished hearing and visual acuity, incontinence, depression, widowhood, isolation and institutionalization. Age-specific incidence of most of these conditions is unknown. There is little evidence, however, that adding years to life has postponed their age at onset. For these conditions, postponement is the major mechanism of prevention. We are attempting to construct time trends concerning the age-specific incidence and the ability to postpone age-dependent conditions. Unless we succeed in delaying onset, morbidity will inevitably expand as longevity increases. (Aging 2:283-289,1990)