Research Interests: Japan, Mortality, Longevity, Population, Humans, and 7 moreFemale, Male, Demographic change, Life Expectancy, Aged, Birth Cohort, and Mortality rate
Research Interests: Cognition, Aging, Medicine, England, Activities of Daily Living, and 14 moreHumans, Female, Male, Life Expectancy, Health Status, Aged, Prevalence, Geriatric Assessment, Cognition disorders, Disabled Persons, Disability Evaluation, health status indicators, The Lancet, and Medical and Health Sciences
Research Interests:
Although the biological rationale for the association between folate, vitamin B12, and homocysteine with cognitive function seems plausible, conflicting results have been reported. This study aimed to determine the associations between... more
Although the biological rationale for the association between folate, vitamin B12, and homocysteine with cognitive function seems plausible, conflicting results have been reported. This study aimed to determine the associations between 1-carbon (1-C) metabolism biomarkers (folate, vitamin B12, and homocysteine), and cognitive impairment at baseline and the rate of cognitive decline over 5 years in the very old. The Newcastle 85+ Study was a prospective longitudinal study of people 85 years old and followed over 5 years in Northeast England. Community-dwelling and institutionalized. The analytical sample included 765 very old participants with 1-C metabolism biomarkers and cognitive measures. Global cognition was measured by the Standardized Mini-Mental State Examination (SMMSE) at baseline, and at 3 and 5 years of follow-up and, attention-specific cognition with the Cognitive Drug Research (CDR) System at baseline, and at 1.5 and 3.0 years of follow-up. Baseline red blood cell folat...
Research Interests:
models projecting future disease burden have focussed on one or two diseases. Little is known on how risk factors of younger cohorts will play out in the future burden of multi-morbidity (two or more concurrent long-term conditions). a... more
models projecting future disease burden have focussed on one or two diseases. Little is known on how risk factors of younger cohorts will play out in the future burden of multi-morbidity (two or more concurrent long-term conditions). a dynamic microsimulation model, the Population Ageing and Care Simulation (PACSim) model, simulates the characteristics (sociodemographic factors, health behaviours, chronic diseases and geriatric conditions) of individuals over the period 2014-2040. about 303,589 individuals aged 35 years and over (a 1% random sample of the 2014 England population) created from Understanding Society, the English Longitudinal Study of Ageing, and the Cognitive Function and Ageing Study II. the prevalence of, numbers with, and years lived with, chronic diseases, geriatric conditions and multi-morbidity. between 2015 and 2035, multi-morbidity prevalence is estimated to increase, the proportion with 4+ diseases almost doubling (2015:9.8%; 2035:17.0%) and two-thirds of tho...
Research Interests:
Research Interests:
Research Interests: Primary Health Care, Public Health, Mortality, Activities of Daily Living, Humans, and 14 moreDiabetes mellitus, Female, Feasibility Studies, Male, Life Expectancy, Aged, Great Britain, Longitudinal Studies, Public health systems and services research, Diabetes complications, Physical examination, Geriatric Assessment, Public Health Medicine, and Disabled Persons
Research Interests:
The aim of this study was to estimate the expected years lived with hearing impairment, vision impairment, and dual sensory impairment among older adults. A total of 4,160 adults (45.1% men) from two Australian community based studies... more
The aim of this study was to estimate the expected years lived with hearing impairment, vision impairment, and dual sensory impairment among older adults. A total of 4,160 adults (45.1% men) from two Australian community based studies were followed for up to 16 years (average 8.9 years). Hearing impairment was defined by a pure-tone average (500-4000 Hz) greater than 25 dB in the better ear. Vision impairment was defined by presenting distance visual acuity worse than 6/12 (20/40). Postliminary analyses were also conducted for moderate levels of sensory impairment. Dual sensory impairment was defined by concurrent hearing and vision impairment. Multistate Markov models were used to calculate sensory life expectancies based on transition probabilities between health states (no sensory impairment, sensory impairment, and death). Based on thresholds for mild impairment, men aged 65 had a total life expectancy of 19.4 years, and were estimated to live for 10.4 years (95% confidence inte...
Research Interests:
Research Interests:
To assess the evaluative research literature on the costs, quality and effectiveness of different locations of care for older patients. A systematic review of evaluative research from 1988 using CRD4 guidelines. Twenty-five databases were... more
To assess the evaluative research literature on the costs, quality and effectiveness of different locations of care for older patients. A systematic review of evaluative research from 1988 using CRD4 guidelines. Twenty-five databases were searched, using processes developed specially for this review. Library OPACS, the Internet and research registers were also searched for relevant material. The final stage of the review was confined to randomised and pseudorandomised trials. Studies were selected for review by pairs of researchers working independently who then met to reach a decision. Analysis was predominantly descriptive; simple pooled odds ratios were used to explore some outcomes. Eighty-four papers from 45 trials were included. Firm conclusions were difficult to draw, except in relation to some outcomes for stroke units, early discharge schemes and geriatric assessment units. Few trials in this area have adequately addressed issues of patients' quality of life and costs t...
Research Interests:
Objectives. We aim to develop robust estimates of disability-free life expectancy (DFLE) and healthy life expectancy (HLE) for ethnic groups in England and Wales in 2001 and to examine observed variations across ethnic groups. Design.... more
Objectives. We aim to develop robust estimates of disability-free life expectancy (DFLE) and healthy life expectancy (HLE) for ethnic groups in England and Wales in 2001 and to examine observed variations across ethnic groups. Design. DFLE and HLE by age and gender for five-year age groups were computed for 16 ethnic groups by combining the 2001 Census data on ethnicity, self-reported limiting long-term illness and self-rated health using mortality by ethnic group estimated by two methods: the Standardised Illness Ratio (SIR) method and the Geographically Weighted Method (GWM). Results. The SIR and GWM methods differed somewhat in their estimates of life expectancy (LE) at birth but produced very similar estimates of DFLE and HLE by ethnic group. For the more conservative method (GWM), the range in DFLE at birth was 10.5 years for men and 11.9 years for women, double that in LE. DFLE at birth was highest for Chinese men (64.7 years, 95% CI 64.0-65.3) and women (67.0 years, 95% CI 66.4-67.6). Over half of the ethnic minority groups (men: 10; women: 9) had significantly lower DFLE at birth than White British men (61.7 years, 95% CI 61.7-61.7) or women (64.1 years, 95% CI 64.1-64.2), mostly the Black, Asian and mixed ethnic groups. The lowest DFLE observed was for Bangladeshi men (54.3 years, 95% CI 53.7-54.8) and Pakistani women (55.1 years, 95% CI 54.8-55.4). Notable were Indian women whose LE was similar to White British women but who had 4.3 years less disability-free (95% CI 4.0-4.6). Conclusions. Inequalities in DFLE between ethnic groups are large and exceed those in LE. Moreover, certain ethnic groups have a larger burden of disability that does not seem to be associated with shorter LE. With the increasing population of the non-White British community, it is essential to be able to identify the ethnic groups at higher risk of disability, in order to target appropriate interventions.
Research Interests:
Smoking is the single most important health threat yet there is no consistency as to whether non-smokers experience a compression of years lived with disability compared to (ex-)smokers. The objectives of the manuscript are (1) to assess... more
Smoking is the single most important health threat yet there is no consistency as to whether non-smokers experience a compression of years lived with disability compared to (ex-)smokers. The objectives of the manuscript are (1) to assess the effect of smoking on the average years lived without disability (Disability Free Life Expectancy (DFLE)) and with disability (Disability Life Expectancy (DLE)) and (2) to estimate the extent to which these effects are due to better survival or reduced disability in never smokers. Data on disability and mortality were provided by the Belgian Health Interview Survey 1997 and 2001 and a 10 years mortality follow-up of the survey participants. Disability was defined as difficulties in activities of daily living (ADL), in mobility, in continence or in sensory (vision, hearing) functions. Poisson and multinomial logistic regression models were fitted to estimate the probabilities of death and the prevalence of disability by age, gender and smoking sta...
Research Interests:
The Global Activity Limitation Indicator (GALI), the measure underlying the European indicator Healthy Life Years (HLY), is widely used to compare population health across countries. However, the comparability of the item has been... more
The Global Activity Limitation Indicator (GALI), the measure underlying the European indicator Healthy Life Years (HLY), is widely used to compare population health across countries. However, the comparability of the item has been questioned. This study aims to further validate the GALI in the adult European population. Data from the European Health Interview Survey (EHIS), covering 14 European countries and 152,787 individuals, were used to explore how the GALI was associated with other measures of disability and whether the GALI was consistent or reflected different disability situations in different countries. When considering each country separately or all combined, we found that the GALI was significantly associated with measures of activities of daily living, instrumental activity of daily living, and functional limitations (P < 0.001 in all cases). Associations were largest for activity of daily living and lowest though still high for functional limitations. For each measu...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Using data from the 1994 European Community Household Panel, we compare active life expectancy differentials at age 65 years between women and men in 12 European countries. We seek to explain the extent to which differences are a... more
Using data from the 1994 European Community Household Panel, we compare active life expectancy differentials at age 65 years between women and men in 12 European countries. We seek to explain the extent to which differences are a reflection of gender differentials in life expectancy at 65 years or reflect differences in active life expectancy earlier in life. Considerable variation in the gender differentials in both total and active life expectancies at age 65 years exist within Europe, with some countries experiencing 20% lower life expectancy at age 65 years for men compared to women. Some evidence was found to suggest that gender differentials in active life expectancy may continue from younger ages through to later life.
Research Interests:
To investigate the order in which activities of daily living (ADLs) are lost and whether the order is invariant between the sexes and age groups. Longitudinal data from the first five rounds of a routine health assessment by a nurse in... more
To investigate the order in which activities of daily living (ADLs) are lost and whether the order is invariant between the sexes and age groups. Longitudinal data from the first five rounds of a routine health assessment by a nurse in participant&amp;amp;#39;s own home. One large UK general practice with a list size of 32,500. Patients registered with the practice and age 75 and older. Disability was measured by self-report of performance in seven ADLs: mobility around the home, getting to and from the toilet, transfer from chair, transfer from bed, feeding, dressing, and bathing. Disability in each ADL was classified as being independent but having difficulty, using aids or help, or being unable to perform. Age at onset of disability in each ADL was calculated and analyzed using Kaplan-Meier plots and Cox regression models. Subjects who had died or remained independent by their last assessment were not included. The mean times between health assessments was approximately 20 months but with substantial variability both within and between individuals. A total of 1,344 people reported no difficulty in any ADL initially and 47.6% (640) subsequently reported disability. The order of activity restriction was bathing, mobility, toileting, dressing, transfers from bed and chair, and feeding. Women had a higher risk of disability in bathing (relative risk (RR) = 1.6, 95% confidence interval (CI) 1.3-1.9, P &amp;amp;lt; .001) and toileting (RR = 1.7, 95% CI 1.2-2.5, P = .003), while for all ADLs there was a significant increase in the risk of disability with increasing age. The order of onset of disability for ADLs was invariant across sex and age groups. Lower-extremity strength (bathing, mobility, toileting) appears to be lost in older people before upper-extremity strength (dressing, feeding). Further work is now needed to develop prevention strategies to delay the onset of these disabilities.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Journal of Aging and Health http://jah.sagepub.com/ Planning for the Future : The Effect of Changing Mortality, Incidence, and Recovery Rates on Life Expectancy with Visual Disability Carol Jagger, Neil Raymond and Kevin Morgan J Aging... more
Journal of Aging and Health http://jah.sagepub.com/ Planning for the Future : The Effect of Changing Mortality, Incidence, and Recovery Rates on Life Expectancy with Visual Disability Carol Jagger, Neil Raymond and Kevin Morgan J Aging Health 1998 10: 154 DOI: 10.1177 ...
Research Interests:
To validate the short Geriatric Depression Scale (GDS15) as a screening instrument and determine the optimal cutpoint for detecting depression among older people living in the community. Two stage study with the first stage consisting of... more
To validate the short Geriatric Depression Scale (GDS15) as a screening instrument and determine the optimal cutpoint for detecting depression among older people living in the community. Two stage study with the first stage consisting of a health check of people aged 75 years and over by a practice nurse which included the GDS15. A second-stage diagnostic interview including the criterion standard was carried out blind to GDS15 score. A large general practice in Melton Mowbray, Leicestershire, UK. A random sample (stratified according to first-stage GDS15 score) of 257 older people living in the community, without significant cognitive impairment, were selected for the second-stage diagnostic interview. The first-stage GDS15 score was compared with diagnostic status for depression and anxiety disorders (according to ICD-10 criteria) and presence of depressive symptoms at the second-stage clinical interview. Ninety-three per cent of those eligible for the study were successfully screened with the GDS15. A cutpoint of &amp;amp;amp;amp;lt;3/3+ had a sensitivity of 100% and specificity of 72% in detecting cases of depression but fewer than one in five of those testing positive reached a diagnostic threshold. Only 25% of those with a diagnosis of depression had any mention of mental health problems in their medical notes in the year prior to the clinical interview. For detecting depressive symptoms the same cutpoint was 79% sensitive and 78% specific with a positive predictive value of 46%. Used as part of an annual over-75 health check in primary care, the GDS15 would detect a significant amount of hidden morbidity which would serve the original purpose of the annual elderly health checks in the UK.
Research Interests:
The health and social status was assessed by interview for all people aged 75 years and over, living in and around Melton Mowbray. This initial survey took place in 1981 and five years later, data are now available on the mortality status... more
The health and social status was assessed by interview for all people aged 75 years and over, living in and around Melton Mowbray. This initial survey took place in 1981 and five years later, data are now available on the mortality status of the original survey population. Significantly lower survival rates were found for various subgroups including those respondents who perceived their health poor, those with high disability scores and severe cognitive impairment and those taking hypoglycaemic agents and diuretics.
Research Interests:
In 1981 a survey was undertaken of the physical and mental health and social status of all those aged 75 years and over belonging to a large general practice which alone served the town of Melton Mowbray and its surrounding area. Seven... more
In 1981 a survey was undertaken of the physical and mental health and social status of all those aged 75 years and over belonging to a large general practice which alone served the town of Melton Mowbray and its surrounding area. Seven years later the survey was repeated. This elderly population had increased by almost 30% in number between the two surveys despite a relatively stable practice population over this time period. After adjustment for the different age and sex distributions of the two survey populations, significant increases in independence levels were found over the time period for: getting in and out of a chair and bed, dressing, bathing and getting to and from the toilet. No differences were found for mobility around the home, feeding or continence of urine or faeces. A higher prevalence of cognitive impairment was found in 1988 than in 1981, 7.0% compared with 4.5%, but this appeared to be due to the larger number of unclassifiable respondents in 1981. A re-analysis of the data, excluding those living in the area less than five years confirmed that the differences found in health over time were not due to a group of elderly migrating into the area. This study provides evidence that the elderly of today appear fitter than previous cohorts of elderly. Service planners will need to take this into account if sensible provision of resources for this age group are to be made.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Extending healthy active life expectancy is a priority if we are to achieve gains in both the quality and quantity of life lived at older ages. We investigated the role of sensory (vision and hearing) and cognitive function on the onset... more
Extending healthy active life expectancy is a priority if we are to achieve gains in both the quality and quantity of life lived at older ages. We investigated the role of sensory (vision and hearing) and cognitive function on the onset of activity restriction in older people. A survey of a total population (N = 1579) of people aged 75 years and older, registered with a large general population in Melton Mowbray, Leicestershire, England, was undertaken in 1988 and linked with subsequent routine health assessments (up to a maximum of five) over 10 years. Activity restriction was defined as having difficulty performing on their own, requiring help or aids or not doing any one of seven Activities of Daily Living (ADLs). The study population comprised the 643 persons who were not restricted at baseline. Cox proportional hazard regression models were fitted to time of onset of activity restriction with those dying before activity restriction was reported being censored at time of death. After adjustment for confounding factors (socio-demographic and psychosocial factors, physical health and physical functional limitations), difficulty with both vision and hearing conferred a doubling of risk of activity restriction (RR = 2.36, 95% CI 1.31 to 4.28). A unit decrease in the Information/Orientation subtest was associated with a 10% increase in risk (RR = 1.10, 95% CI 1.02 to 1.19), even after adjustment for vision and hearing as well as other confounding factors, though baseline Mini-Mental State Examination score was not indicative of increased risk (RR= 1.02, 95% CI 0.98 to 1.06). Differentiating whether disability is a result of physical, sensory or cognitive functional limitations, is necessary to identify need and the direction in which efforts should be targeted to improve active life expectancy in older people.
Research Interests:
Research Interests: Cognition, Aging, Brazil, Multidisciplinary, Probability, and 20 moreLatin America, Longevity, Humans, Female, Male, Life Expectancy, Caribbean region, PLoS one, Clinical Sciences, Aged, Prevalence, Middle Aged, Sex Factors, Age Factors, Educational Status, Geriatric Assessment, Personal Satisfaction, Logistic Models, Cognition disorders, and Socioeconomic Factors
Research Interests:
ABSTRACT Northern England faces important demographic challenges over the next 25 years: population ageing, a more ethnically diverse society, moderate demographic growth but with large differences between most and least successful... more
ABSTRACT Northern England faces important demographic challenges over the next 25 years: population ageing, a more ethnically diverse society, moderate demographic growth but with large differences between most and least successful localities. We examine past and future demographic changes in Northern England and their effect on population health, labour force size and household numbers, drawing out implications for public policy. We use new projections for England’s local authority (LA) populations by ethnicity from 2001 to 2036. The population of Northern England will grow between 8 % and 12 %, depending on projection scenario. So, aggregate demand for goods and services in Northern England will continue to increase. The population will experience, however, rising old age dependency ratios. To maintain current ratios, pension entitlement age will need to increase to 70 by 2036 rather than the 68 planned in the 2011 Pension Act. Population ageing will impact numbers with limiting long term illness, which will increase more than the population as a whole because the age structure will become older. A decrease in the labour force will occur as the baby boomers retire, if labour force participation rates remain constant. Action needs to be taken to encourage employers to introduce flexible transitions to retirement that reward older workers who wish to continue in work. We also project the numbers of households, which increase a little faster than the population because ageing shifts the population towards older ages where households are smaller.
Research Interests:
Research Interests:
Research Interests: Psychology, Activities of Daily Living, Humans, Female, Male, and 12 moreLife Expectancy, Incidence, Clinical Sciences, Physical Fitness, Aged, Prevalence, Great Britain, Longitudinal Studies, Cognitive impairment, Public health systems and services research, Geriatric Assessment, and Cognition disorders
Research Interests:
Research Interests: Psychology, Dementia, Hospitals, Residential care, Humans, and 21 moreOlder people, Old Age, Elderly People, Nursing Homes, Female, Male, Social Services, Mental Disorders, National Health Service, Clinical Sciences, Rating Scale, Aged, Local Authority, Cognitive impairment, Institutionalization, Public health systems and services research, Confusion, Confidence Interval, Behavioural Problems, Homes for the Aged, and Health services for the aged
Movements between dependency states, institutionalization and death are investigated in a general practice cohort of people aged 75 years and over with follow-up at 5 and 7 years from initial interview. Initially, 1203 people were... more
Movements between dependency states, institutionalization and death are investigated in a general practice cohort of people aged 75 years and over with follow-up at 5 and 7 years from initial interview. Initially, 1203 people were interviewed, 1124 living in the community and 79 in institutions. By 5 years, 42% (510) had died and by 7 years 58% (700) had died. Dependency was defined as requiring help or aids with at least one activity of daily living (ADL). Of those initially independent, 34% were still independent 7 years later. Women at each age were more likely to become dependent whilst men had higher mortality. Those rating their health as fair or poor were more likely to lose independence at both 5 and 7 years than those rating their health as good. These differences remained, even after adjustment for age, sex and baseline ADL status. With the assumption that once institutionalized a person did not return to live in the community (an assumption upheld by the present data), 7% (79/1124) of those initially resident in the community were institutionalized during the 7 years; the rates for men (6%) being slightly lower than for women (7.5%).
Research Interests:
Research Interests: Psychology, Depression, Aging, Prospective studies, Humans, and 16 moreAge, Female, Male, Hearing Loss, Risk factors, Health Status, Clinical Sciences, Aged, Questionnaires, Public health systems and services research, Time Factors, Vision Disorders, Geriatric Assessment, Risk Factors, Logistic Models, and Cognition disorders
Objectives. To examine the extent and complexity of the morbidity burden in 85-year-olds; identify patterns within multimorbidity; and explore associations with medication and healthcare use. Participants. 710 men and women; mean (SD) age... more
Objectives. To examine the extent and complexity of the morbidity burden in 85-year-olds; identify patterns within multimorbidity; and explore associations with medication and healthcare use. Participants. 710 men and women; mean (SD) age 85.5 (0.4) years. Methods. Data on 20 chronic conditions (diseases and geriatric conditions) ascertained from general practice records and participant assessment. Cluster analysis within the multimorbid sample identified subgroups sharing morbidity profiles. Clusters were compared on medication and healthcare use. Results. 92.7% (658/710) of participants had multimorbidity; median number of conditions: 4 (IQR 3-6). Cluster analysis (multimorbid sample) identified five subgroups sharing similar morbidity profiles; 60.0% (395/658) of participants belonged to one of two high morbidity clusters, with only 4.9% (32/658) in the healthiest cluster. Healthcare use was high, with polypharmacy (≥5 medications) in 69.8% (459/658). Between-cluster differences ...
Research Interests:
Healthy diet has been associated with better muscle strength and physical performance in cross-sectional studies of older adults but the effect of dietary patterns (DP) on subsequent decline, particularly in the very old (aged 85+), has... more
Healthy diet has been associated with better muscle strength and physical performance in cross-sectional studies of older adults but the effect of dietary patterns (DP) on subsequent decline, particularly in the very old (aged 85+), has not been determined. We investigated the association between previously established DP and decline in muscle strength and physical performance in the very old. 791 participants (61.8% women) from the Newcastle 85+ Study were followed-up for change in hand grip strength (HGS) and Timed Up-and Go (TUG) test over 5 years (four waves 1.5 years apart). Mixed models were used to determine the effects of DP on muscle strength and physical performance in the entire cohort and separately by sex. Previously we have established three DP that varied in intake of red meats, potato, gravy and butter and differed with key health and social factors. HGS declined linearly by 1.59 kgF in men and 1.08 kgF in women (both p<0.001), and TUG slowed by 0.13 log10-transfo...
Research Interests:
People aged 85 years and older are the fastest growing age group worldwide. This study assessed respiratory health, prevalence of respiratory disease and use of spirometry in respiratory diagnosis in a population-based cohort of 85 year... more
People aged 85 years and older are the fastest growing age group worldwide. This study assessed respiratory health, prevalence of respiratory disease and use of spirometry in respiratory diagnosis in a population-based cohort of 85 year olds to better understand respiratory health and disease in this sector of society. A single year birth-cohort of 85 year olds participated in a respiratory assessment at their home or residential institution including self-reporting of symptoms and measurement of spirometry. General practice medical records were reviewed for respiratory diagnoses and treatments. In the 845 participants, a substantial burden of respiratory disease was seen with a prevalence of COPD in medical records of 16.6% (n=140). A large proportion of the cohort had environmental exposures through past or current smoking (64.2%, n=539) and occupational risk factors (33.6%, n=269). Spirometry meeting reliability criteria was performed in 87% (n=737) of participants. In the subgro...