Meinow Bettina, Li Peng, Jasilionis Domantas, Oksuzyan Anna, Sundberg Louise, Kelfve Susanne, Wastesson Jonas W
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden.
Stockholm Gerontology Research Center, Stockholm, Sweden.
BMC Public Health. 2022 Apr 14;22(1):759. doi: 10.1186/s12889-022-13099-8.
Due to population aging, it is essential to examine to what extent rises in life expectancy (LE) consist of healthy or unhealthy years. Most health expectancy studies have been based on single health measures and have shown divergent trends. We used a multi-domain indicator, complex health problems (CHP), indicative of the need for integrated medical and social care, to investigate how LE with and without CHP developed in Sweden between 1992 and 2011. We also addressed whether individuals with CHP more commonly lived in the community in 2011 compared to earlier years.
CHP were defined as having severe problems in at least two of three health domains related to the need for medical and/or social care: symptoms/diseases, cognition/communication, and mobility. The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), a nationally representative survey of the Swedish population aged ≥ 77 years with waves in 1992, 2002 and 2011 (n≈2000), was used to estimate the prevalence of CHP. Age- and gender-specific death rates were obtained from the Human Mortality Database. The Sullivan method was deployed to calculate the remaining life expectancy with and without CHP. The estimates were decomposed to calculate the contribution of changes from morbidity and mortality to the overall trends in LE without CHP.
Between 1992 and 2011, both total LE (+ 1.69 years [95% CI 1.56;1.83] and LE without CHP (+ 0.84 years [-0,87;2.55]) at age 77 increased for men, whereas LE at age 77 increased for women (+ 1.33 [1.21;1.47]) but not LE without CHP (-0.06 years [-1.39;1.26]). When decomposing the trend, we found that the increase in LE with CHP was mainly driven by an increase in the prevalence of CHP. Among individuals with CHP the proportion residing in care homes was lower in 2011 (37%) compared to 2002 (58%) and 1992 (53%).
The findings, that an increasing number of older people are expected to live more years with CHP, and increasingly live in the community, point towards a challenge for individuals and families, as well as for society in financing and organizing coordinated and coherent medical and social services.
由于人口老龄化，有必要研究预期寿命（LE）的增长在多大程度上包括健康或不健康的年份。大多数健康预期寿命研究都基于单一的健康指标，且呈现出不同的趋势。我们使用了一个多领域指标——复杂健康问题（CHP），它表明了对综合医疗和社会护理的需求，以调查1992年至2011年期间瑞典有和没有CHP的LE是如何发展的。我们还探讨了与早年相比，2011年患有CHP的个体是否更普遍地居住在社区中。
CHP被定义为在与医疗和/或社会护理需求相关的三个健康领域中的至少两个领域存在严重问题：症状/疾病、认知/沟通和行动能力。瑞典老年人口生活状况小组研究（SWEOLD）是一项对瑞典年龄≥77岁人群的全国代表性调查，分别在1992年、2002年和2011年进行了多轮调查（n≈2000），用于估计CHP的患病率。年龄和性别特异性死亡率来自人类死亡率数据库。采用沙利文方法计算有和没有CHP的剩余预期寿命。对估计值进行分解，以计算发病率和死亡率变化对无CHP的LE总体趋势的贡献。
1992年至2011年期间，77岁男性的总LE（增加1.69岁[95%CI 1.56；1.83]）和无CHP的LE（增加0.84岁[-0.87；2.55]）均有所增加，而77岁女性的LE有所增加（增加1.33岁[1.21；1.47]），但无CHP的LE没有增加（减少0.06岁[-1.39；1.26]）。在分解趋势时，我们发现有CHP的LE增加主要是由CHP患病率的增加驱动的。在患有CHP的个体中，2011年居住在养老院的比例（37%）低于2002年（58%）和1992年（53%）。
研究结果表明，预计越来越多的老年人将在患有CHP的情况下多活几年，并且越来越多地居住在社区中，这对个人和家庭以及社会在为协调一致的医疗和社会服务提供资金和组织方面构成了挑战。
