Vanessa Yong

Are There Education Differentials in Disability and Mortality Transitions and Active Life Expectancy Among Japanese Older Adults? Findings From a 10-Year Prospective Cohort Study

OBJECTIVES To investigate the robust education-health association found in Western developed nations in the Japanese context. We examined disability and mortality transitions and computed active life expectancy (ALE) by educational attainment for a cohort of Japanese adults aged 65+ years. METHOD Nationally representative data from the Nihon University Japanese Longitudinal Study of Aging over a 10-year period in Japan (1999, 2001, 2003, 2006, and 2009) were used (N = 4,968). Disability was measured by difficulties in performing daily activities. A multistate life table method was employed using an interpolated Markov chain approach. RESULTS There is little effect of education on disability and mortality transitions. Except for transiting from an active to inactive state (disability incidence), the other health transitions, including to mortality, are not statistically significant. ALE computations show that Japanese men and women with more education can expect more years of remaining life and active life. DISCUSSION The robust education-health relationship found in Western societies does not seem applicable in Japan. We discuss the casual mechanisms addressed in the literature in relation to Japans relatively egalitarian society and specific characteristics.

Gender differences in health and health expectancies of older adults in Singapore: an examination of diseases, impairments, and functional disabilities.

Using a nationally representative sample of 4,511 Singaporeans aged 55+ from the 2005 National Survey of Senior Citizens (NSSC), this paper examines gender differences in specific diseases, impairments, and disabilities, and computes health expectancies for these health dimensions. Results show that women have higher prevalence for hypertension, bone/joint, eye/vision, and walking problems, while heart diseases and stroke are more common among men, particularly at younger ages. At ages 75+, women have more disabilities related to basic activities of daily living (bathing, dressing, toileting, transferring, and feeding) than men. Health expectancies computations by the Sullivan method reveal that while women live longer than men, they can also expect more years of life both without and with diseases, impairments, and disabilities. At age 65, a larger proportion of women’s remaining life is with hypertension, bone/joint problems, vision impairments, walking difficulties, and functional disabilities compared to same-aged men. The findings largely support the gender health-survival paradox found in Western countries—that women have higher morbidity rates despite longer life expectancy. The morbidity differences between men and women, however, vary depending on the particular health dimension and measure examined. Older women in Singapore tend to be advantaged in prevalence of diseases and disease-free life expectancy, but have more impairments and functional disabilities, and a larger proportion of remaining life with these difficulties compared to older men. Health policies and programs in Singapore will need to cater to these gender differences in specific health dimensions and measures.

Changes in the prevalence of mobility limitations and mobile life expectancy of older adults in Singapore, 1995-2005.

Objective: To examine changes in the prevalence of mobility limitations and mobile life expectancy of Singaporeans aged 55+. Method: Data came from the cross-sectional 1995 and 2005 National Survey of Senior Citizens (NSSC; n = 4,750 and n = 4,591, respectively). The prevalence-based Sullivan method was used to disaggregate total life expectancy into expected life time without and with mobility limitations. Results: Increases in life expectancy in the city-state were accompanied by increases in the prevalence of mobility limitations—from 3.0% to 5.7% for men and 5.1% to 9.7% for women. The impairments mostly began after age 65 and increased with age particularly at ages 85+. The proportion of life expectancy without mobility limitations declined over time, at all ages, and for both genders, with women still experiencing a higher proportion with mobility problems compared to men. Discussion: The overall results provided support for the expansion of morbidity hypothesis, and we discussed some possible reasons. From a policy perspective, the findings could suggest a need to develop infrastructures that would enable older Singaporeans to remain mobile in a highly urban setting.

How accurate are self-reported height, weight, and BMI among community-dwelling elderly Japanese?: Evidence from a national population-based study.

Aim:  The aims of this study are to investigate the accuracy of self‐reported height, weight, and derived BMI of community‐dwelling Japanese aged 70 and older, and to assess the concordance between report‐based and measurement‐based BMI categories.

Age Differential Effects of Severity of Visual Impairment on Mortality Among Older Adults in China

We use a population-based longitudinal survey in China from 2002 to 2005 to examine age differentials in the association between severity of visual impairment and mortality risk in older adults. Controlling for numerous factors and baseline health, a substantial age difference is found. Young-old women and men aged 65 to 79 with severe visual impairments have 161% (hazard ratio = 2.61) and 52% (hazard ratio = 1.52) higher risk of death respectively as compared to their unimpaired counterparts. Mild impairment does not increase mortality risk among young-old adults, while both mild and severe impairment increase mortality risk by 33% and 32% for women and 24% and 34% for men among the oldest-old as a whole when all factors are controlled for. We conclude that visual impairment is an independent predictor of mortality and severe visual impairment likely plays a stronger role in determining mortality risk among young-old adults than among the oldest-old.

Revisiting Mobility Limitations of Seniors in Singapore, 1995 to 2011

Singapore’s life expectancy at birth and at age 65 continues to improve. Although this is a positive development, it is necessary to understand how much of this increased life expectancy is spent with and without mobility limitations. This research uses the latest round of the National Survey of Senior Citizens to examine the situation in 2011 and the possible changes that may have occurred since the last survey in 2005. It seeks to add to earlier research in this area in Singapore and uses the prevalence-based Sullivan method to calculate lifetime free of mobility limitations for this population. Pertinent conclusions drawn from this research include evidence pointing to changing prevalence rates among the older adult population and observations that suggest the possibility of a compression of morbidity for this population in 2011 compared with an expansion of morbidity observed in the previous survey conducted in 2005. The research also shows that women continue to be disadvantaged as they age compared with men.

Policy and Program Measures for Successful Aging in Japan

Studies on successful aging have typically focused on individual-level, particularly health-related, determinants. In this chapter, we shift the attention to social structural factors which are at the same time as important. Framed within the Japanese social context, we examined the macro policy and program measures that were implemented in Japan to promote the successful aging of its rapidly graying population. We discussed policies in four pertinent areas of concern: healthcare, employment, active aging, and aging-in-place. Japan’s universal healthcare system and the introduction of a national long-term care insurance coverage in 2000 for all Japanese aged 65 and over play a critical role in the provision of affordable health and long-term care as well as lessening the burden of family caregivers. Health promotion and illness prevention measures were also undertaken in the national health program, Healthy Japan 21. Employment measures include extending the retirement age, promoting continual employment, securing the re-employment of older workers, and providing short-term and temporary job opportunities for retirees who may prefer more flexible work arrangements. Older Japanese people are also encouraged to remain active by participating in volunteer activities both locally and overseas. Finally, housing and transportation policies were implemented to enable older Japanese to age-in-place.