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PubMed2004

Life expectancy of patients with neovascular glaucoma drained by Molteno implants.

PURPOSE: To determine the survival of patients with sighted eyes who had Molteno implants inserted for neovascular glaucoma. METHODS: Patients who had Molteno implants inserted for neovascular glaucoma between October 1977 and March 2001 at Dunedin Hospital, New Zealand, were reviewed. Relative survival analysis was then used to compare survival in this group to survival of the New Zealand population of the same age. RESULTS: A total of 114 patients had 131 Molteno implants inserted for neovascular glaucoma. Neovascular glaucoma was secondary to central retinal vein occlusion in 66 eyes (50%) and diabetes in 42 eyes (32%), and patients lost 52% or 6.53 years of their expected remaining life span. Age, sex and postoperative intraocular pressure control did not predict survival. The only predictor of improved survival was a preoperative visual acuity of 6/48 or better. These patients lost 21% (or 2.43 years) of expected remaining life compared to 62% (or 10.78 years) in those patients who had a presenting visual acuity of 6/60 or worse. CONCLUSIONS: Patients with neovascular glaucoma had a markedly reduced life expectancy, which has improved in recent years when compared to that of the normal sex and age-matched New Zealand population. Patients presenting with better vision (6/48 or better) survived significantly longer than those presenting with poorer vision.

Adult↗
PubMed1988

Life expectancy in chronic liver disease.

Life-table analysis is a suitable method for evaluating the effectiveness of therapeutical approaches to and the progression of, chronic diseases. The authors performed 324 liver biopsies in patients with liver disease between 1976 and 1986. The cumulative life-table analysis of Cutler and Ederer was applied in this retrospective study. Survival rates of different groups of patients expressed as the 7-year life expectancy were as follows: toxic hepatitis 90%, steatosis hepatitis 87%, chronic persistent hepatitis 87%, nonspecific reactive hepatitis 76%, chronic active hepatitis 72%, acute alcoholic hepatitis 66%, liver cirrhosis 40%. There seems to be a correlation between the severity of histological alteration and live expectancy. A similar correlation between the inflammatory cell infiltration and life expectancy cannot be observed. The life expectancy of patients with chronic active hepatitis has significantly improved recently. Further improvement of survival of patients with liver cirrhosis can be expected only from a reduction of alcohol consumption. The results can be regarded as a reference data for life expectancy of patients with chronic liver disease in Hungary.

Biopsy↗
PubMed1997

Study of a calculation method for healthy life expectancy.

"To develop a calculation method for healthy life expectancy which would be suitable for China we analyzed the healthy life expectancy of urban residents in China, employing data on residents' deaths and data available from the 1993 national survey for health services and family health conditions.... Results of the study show that the ratio of healthy life expectancy to life expectancy decreases with the increase of the residents' age; healthy life expectancy for females is higher than that for males; [and] healthy life expectancy for residents of large cities is lower than that for residents of medium and small cities."

Age Factors↗
PubMed2001

[Increasing life expectancy: adding quality of life to those years].

Demographic changes are a challenge for the health care system. Based on three case reports, the potential for improving preventive, rehabilitative, and palliative care in older persons is presented. The article discusses the method of multidimensional geriatric assessment.

Aged↗
PubMed2003

[Disability-free life expectancy among 60-year-olds in Denmark].

INTRODUCTION: Life expectancy can be expressed as average expected lifetime in different health states. The purpose of the study was to estimate disability-free life expectancy, i.e. average lifetime without disabilities, in Denmark and in the counties of Denmark and evaluate the relation between life expectancy and the proportion of disability-free life expectancy. MATERIAL AND METHODS: Prevalence rates of disability (in terms of walking, walking on stairs, carrying 5 kg, reading, hearing and speaking) derived from the Danish Health Interview Survey 2000 were combined with life-table data and disability-free life expectancy was calculated by Sullivan's method. RESULTS: In 2000 expected lifetime of 60-year-old men and women was 18.8 years and 22.0 years respectively and disability-free life expectancy was 14.7 years for both sexes corresponding to 78.4% and 66.6% of the remaining lifetime for men and women respectively. Differences in disability-free life expectancy between counties ranged from zero to three years. In counties with the highest life expectancy among women they tended to have a higher proportion of life years with disabilities, but there was no correlation between life expectancy and the proportion of disability-free life expectancy for men. DISCUSSION: The results may illustrate theories about the relation between increased lifetime and quality of life in terms of health. Increased total lifetime for women prolongs the proportion of expected lifetime with disability ("expansion of morbidity"), whereas for men no correlation was found ("dynamic equilibrium").

Activities of Daily Living↗
PubMed2006

Screening colonoscopy in very elderly patients: prevalence of neoplasia and estimated impact on life expectancy.

CONTEXT: Current guidelines do not include an upper age cutoff for colorectal cancer screening with colonoscopy. Although the prevalence of colonic neoplasia increases with age, life expectancy decreases. Thus, the benefit of screening colonoscopy in very elderly patients may be limited. OBJECTIVE: To compare estimated life-years saved with screening colonoscopy in very elderly vs younger persons. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study conducted among 1244 asymptomatic individuals in 3 age groups (50-54 years [n = 1034], 75-79 years [n = 147], and > or =80 years [n = 63]) who underwent screening colonoscopy at a US teaching hospital and clinic. MAIN OUTCOME MEASURES: Prevalence of various types of colon neoplasia; estimated gain in life expectancy, calculated as life expectancy--(life expectancy during polyp lag time + life expectancy after colorectal cancer diagnosis); and comparison of mean gain in life expectancy across the 3 groups. Life expectancy and mortality data were derived from life tables, previous studies, and national databases. RESULTS: The prevalence of neoplasia was 13.8% in the 50- to 54-year-old group, 26.5% in the 75- to 79-year-old group, and 28.6% in the group aged 80 years or older. Despite higher prevalence of neoplasia in elderly patients, mean extension in life expectancy was much lower in the group aged 80 years or older than in the 50- to 54-year-old group (0.13 vs 0.85 years). In sensitivity analysis, with longer polyp lag times the mean extension in life expectancy decreased more in the elderly than in the younger patients; alternatively, if it was assumed that a smaller proportion of adenomas progress to colorectal cancer, the mean extension in life expectancy decreased less in the elderly than in the younger patients. CONCLUSIONS: Even though prevalence of neoplasia increases with age, screening colonoscopy in very elderly persons (aged > or =80 years) results in only 15% of the expected gain in life expectancy in younger patients. Screening colonoscopy in very elderly patients should be performed only after careful consideration of potential benefits, risks, and patient preferences.

Aged↗
PubMed1993

Educational status and active life expectancy among older blacks and whites.

BACKGROUND AND METHODS: Persons of low socioeconomic status are known to have reduced life expectancy. In a study of the relation of socioeconomic status to disability-free or active life expectancy among older persons, we analyzed prospectively gathered data on 2219 blacks and 1838 whites who were 65 years of age or older in the Piedmont region of North Carolina. We defined disability as the inability to perform independently one or more basic functional activities such as walking, bathing, dressing, eating, and using the toilet. For subgroups defined by sex, race, and education, statistical models were used to estimate, for persons at each year of age, the probability of transition from not being disabled or being disabled at base line to not being disabled, being disabled, or having died one year later. These transition probabilities were then entered into increment-decrement life tables to generate estimates of total, active, and disabled life expectancy (with total life expectancy equal to active life expectancy plus disabled life expectancy). RESULTS: Sixty-five-year-old black men had a lower total life expectancy (11.4 years) and active life expectancy (10 years) than white men (total life expectancy, 12.6 years; active life expectancy, 11.2 years), although the differences were reduced after we controlled for education. The estimates for 65-year-old black women (total life expectancy, 18.7 years; active life expectancy, 15.9 years) were similar to those for white women. Black men and women 75 years old and older had higher values for total life expectancy and active life expectancy than whites, and the differences were larger after stratification for education. Education had a substantially stronger relation to total life expectancy and active life expectancy than did race. At the age of 65, those with 12 or more years of education had an active life expectancy that was 2.4 to 3.9 years longer than the values for those with less education in all the four subgroups defined by sex and race. Overall, the subgroups with longer total life expectancy and active life expectancy also lived more years with a disability. CONCLUSIONS: Among older blacks and whites, the level of education, a measure of socioeconomic status, has a greater effect than race on total life expectancy and active life expectancy.

Activities of Daily Living↗
PubMed2006

Older adults' beliefs about physician-estimated life expectancy: a cross-sectional survey.

BACKGROUND: Estimates of life expectancy assist physicians and patients in medical decision-making. The time-delayed benefits for many medical treatments make an older adult's life expectancy estimate particularly important for physicians. The purpose of this study is to assess older adults' beliefs about physician-estimated life expectancy. METHODS: We performed a mixed qualitative-quantitative cross-sectional study in which 116 healthy adults aged 70+ were recruited from two local retirement communities. We interviewed them regarding their beliefs about physician-estimated life expectancy in the context of a larger study on cancer screening beliefs. Semi-structured interviews of 80 minutes average duration were performed in private locations convenient to participants. Demographic characteristics as well as cancer screening beliefs and beliefs about life expectancy were measured. Two independent researchers reviewed the open-ended responses and recorded the most common themes. The research team resolved disagreements by consensus. RESULTS: This article reports the life-expectancy results portion of the larger study. The study group (n = 116) was comprised of healthy, well-educated older adults, with almost a third over 85 years old, and none meeting criteria for dementia. Sixty-four percent (n = 73) felt that their physicians could not correctly estimate their life expectancy. Sixty-six percent (n = 75) wanted their physicians to talk with them about their life expectancy. The themes that emerged from our study indicate that discussions of life expectancy could help older adults plan for the future, maintain open communication with their physicians, and provide them knowledge about their medical conditions. CONCLUSION: The majority of the healthy older adults in this study were open to discussions about life expectancy in the context of discussing cancer screening tests, despite awareness that their physicians' estimates could be inaccurate. Since about a third of participants perceived these discussions as not useful or even harmful, physicians should first ascertain patients' preferences before discussing their life expectancies.

Aged↗
PubMed1988

Hypertension, quality of life and functional status: the concept of active life expectancy.

Mortality rates and measures of life expectancy are widely used to compare and monitor health within populations. However, there is a need to add dimensions of population health other than survival. An alternative measure, 'active life expectancy', is a way of quantifying the functional health of older adult populations and, in part, measuring quality of life. Life-table techniques are used to define the expected duration of well-being. Instead of death, the end-point of active life expectancy is loss of independence in activities of daily living. Initial studies showed that active life expectancy decreased with age, from 10 years to 4.7 years and 2.9 years, respectively, for people entering the age intervals 65-69, 80-84 and 85 years and over. Since cardiovascular disease is the major cause of disability in the older adult population, measures of active life expectancy can provide improved information about functional independence and dependence. Life tables with estimates of active life expectancy can be used as a basis for determining the needs of age cohorts of people with hypertension and other conditions.

Activities of Daily Living↗
PubMed2002

[Study on the life expectancy of residents in Xinjiang Production and Construction Group, from 1997 to 1999].

OBJECTIVE: To understand the life expectancy of residents in Xinjiang production and Construction Group, from 1997 to 1999. METHODS: Stratified cluster sampling method was used to obtain mortality rate, sequence of death causes, life expectancy, life eliminated major cause of deaths, years of potential life lost (YPLL) and level of long life. These indeices were used to compare and analyze health status on residents in the area. RESULTS: The life expectancy on residents in the area was 75.61 years old for all residents, 72.73 years old for males, 80.02 years old for females from 1997 to 1999. The life expectancy for people living in agricultural and livestock farms was lower (73.97 years old). It was found that life expectancy was parallel to the level of economy. Life expectancy of northern residents was higher than those living in the southern and eastern parts of the area. The annual average mortality rate of the residents was 5.17 per thousand (standard mortality rate 4.02 per thousand ). The sequence of major causes of death was shown as below: malignant tumors, cerebrovascular diseases, respiratory system diseases, cardiac diseases, accidental deaths, infectious diseases, certain conditions originated in the perinatal period. In the life eliminated major cause of deaths, respiratory system diseases and certain conditions originated in the perinatal period were higher than others. In both sequences of YPLL and SYPLL for major causes of death, accidental death was always in the leading place. There was a higher longevity on residents from the better economic area. CONCLUSIONS: Higher life expectancy in the area was noticed, but the differences among the different area were bigger. In order to improve the level of health on all residents in the area, it is necessary to strengthen the administration on social and natural environment of the area. Furthermore, decreasing accidental deaths, controlling respiratory system diseases (especially for infant) and improving health care of infants in perinatal period are very important tasks in the area.

Adolescent↗
PubMed1994

Estimating increment-decrement life tables with multiple covariates from panel data: the case of active life expectancy.

A fundamental limitation of current multistate life table methodology-evident in recent estimates of active life expectancy for the elderly-is the inability to estimate tables from data on small longitudinal panels in the presence of multiple covariates (such as sex, race, and socioeconomic status). This paper presents an approach to such an estimation based on an isomorphism between the structure of the stochastic model underlying a conventional specification of the increment-decrement life table and that of Markov panel regression models for simple state spaces. We argue that Markov panel regression procedures can be used to provide smoothed or graduated group-specific estimates of transition probabilities that are more stable across short age intervals than those computed directly from sample data. We then join these estimates with increment-decrement life table methods to compute group-specific total, active, and dependent life expectancy estimates. To illustrate the methods, we describe an empirical application to the estimation of such life expectancies specific to sex, race, and education (years of school completed) for a longitudinal panel of elderly persons. We find that education extends both total life expectancy and active life expectancy. Education thus may serve as a powerful social protective mechanism delaying the onset of health problems at older ages.

Activities of Daily Living↗
PubMed2003

Cause-deleted health-adjusted life expectancy of Canadians with selected chronic conditions.

Health-adjusted life expectancy (HALE) is life expectancy weighted or adjusted for the level of health-related quality of life (HRQOL). Cause-deleted probabilities of dying were derived using the cause-eliminated life table technique and death data from vital statistics for Canada in 1998/99. Life expectancy for men and women in Canada was 76.0 and 81.5 years respectively; HALE was 67.9 years for men and 71.1 years for women. Cancer represented the greatest burden of disease in the population, and eliminating it would increase men's life expectancy to 79.6 years and women's to 85.1 years. HALE would rise to 70.7 years for men and 73.6 for women. The gain in life expectancy would be very small if osteoarthritis were eliminated, but there would be an overall gain in HALE of approximately 1.0 years for men and 2.5 years for women. HALE estimated for chronic conditions using a utility-based measure of HRQOL from population health surveys should be regarded as a valuable component of population health surveillance.

Aged↗
PubMed1999

What has contributed to the change in life expectancy in Italy between 1980 and 1992?

Life expectancy at birth in southern Europe is known to be greater than expected in comparison with levels of economic development. This has been attributed to the 'Mediterranean diet'. There are, however, concerns that this comparative advantage is being lost. This paper examines the factors underlying changing life expectancy in Italy since 1980. The subjects of this analysis are obtained from data on all deaths in Italy between 1980 and 1992. Change in age specific death rates is calculated from selected causes and, using the method developed by Pollard, the contribution of deaths from different causes and at different ages to changing life expectancy at birth is estimated. Between 1980 and 1992, life expectancy at birth increased by 2.70 years for men and 2.75 years for women. Death rates have fallen among children and those over 40. In contrast, death rates have increased among men aged between 20 and 39 and have increased very slightly among women aged 25-29. Falling death rates from ischaemic heart disease are continuing to contribute to increasing life expectancy. Death rates from lung and breast cancer are rising among women but are compensated for by falling death rates from other cancers. Among men, falling death rates from cancer at younger ages are being offset by increases at older ages. The rising death rate among younger men is almost entirely due to AIDS, with accidents also making a small contribution. Life expectancy in Italy has improved throughout the 1980s, largely driven by falling death rates from cardiovascular diseases. Here are, however, some worrying trends, most notably the rising death rate among young men, due almost entirely to AIDS. The changing pattern of mortality has some similarities with Spain, another Mediterranean country, but there are also important differences.

Acquired Immunodeficiency Syndrome↗