Population of Individuals Aged 85 Years and Older Rapidly Increasing
By Laurie Barclay, MD
Medscape Medical News
December 23, 2009 — The prevalence of individuals 85 years of age or older — often described as the "oldest old" — may increase by 33% in the United Kingdom by 2010, according to the results from the Newcastle 85+ cohort study published online December 22 in the British Medical Journal.
"These 85-year-olds seemed optimistic," senior author Thomas B.L. Kirkwood, from Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, said in a news release. "[They] evaded the risks of mortality associated with specific adverse factors and are therefore particularly likely to be informative about the effects of intrinsic ageing."
Goals of the Newcastle 85+ Study are to evaluate the clinical, biological, and psychosocial characteristics of an unselected cohort of 85-year-olds and to assess subsequent health trajectories with aging.
The report describes a cross-sectional analysis of baseline health data from this cohort, consisting of 1042 people born in 1921 and registered with the participating general practices in Newcastle upon Tyne and North Tyneside primary care trusts, United Kingdom.
Primary study endpoints were detailed health evaluation and review of general practice records, including information concerning disease, medication, and use of general practice services. Study participants were permitted to decline various elements of the protocol.
Of 1453 eligible persons, 851 (58.6%) participated in health evaluation plus record review, 188 (12.9%) in record review only, and 3 (0.2%) in health evaluation only. Because of study withdrawal and missing values for some parameters, data from record review are reported on a maximum of 1030 participants and from health evaluation on a maximum of 853 participants.
The health evaluation sample included 530 women (62.1%) and 89 participants who were in institutional care (10.4%). The most prevalent diseases were hypertension (57.5%, 592/1030) and osteoarthritis (51.8%, 534/1030). Other conditions included hearing impairment in 59.6% (505/848), visual impairment in 37.2% (309/831), severe or profound urinary incontinence in 21.3% (173/813), and moderate or severe cognitive impairment in 11.7% (96/824).
Health evaluation identified participants with possible disease not previously documented in their medical record, including hypertension in 25.1%, (206/821), ischemic heart disease in 12.6% (99/788), depression in 6.9% (53/772), dementia in 6.7% (56/840), and atrial fibrillation in 3.8% (30/788). However, undiagnosed diabetes mellitus and thyroid disease were rare (1%, 7/717 and 6/762, respectively).
Although participants reported difficulty performing a median of 3 (interquartile range, 1 - 8) activities of daily living, 77.6% (646/832) of participants rated their own health as good, very good, or excellent compared with others of the same age. In the previous year, 93.8% (960/1024) of participants had contact with general practitioners.
Compared with men, women had significantly higher disease counts (median, 5 vs 4; P = .033) and disability scores (median, 4 vs 2; P = .0006). However, they were less likely to have visited outpatient clinics in the previous 3 months (29% [150/524] vs 37% [118/320]; odds ratio, 0.7; 95% confidence interval, 0.5 - 0.9).
"This large cohort of 85 year olds showed good levels of both self rated health and functional ability despite significant levels of disease and impairment," the study authors write. "Hypertension, ischemic heart disease, atrial fibrillation, depression, and dementia may be underdiagnosed. Notable differences were found between the sexes: women outnumbered men and had more disease and disability."
Limitations of this study include possible referral bias, reliance on self-report, and lack of generalizability to other populations.
"Our study shows the opportunities available to intervene to improve health further in this age group," the study authors conclude. "If the data are extrapolated to the future, much larger, populations of 85 year olds in developed countries, implications for health and social care and the resources needed to provide these are profound."
In an accompanying editorial, Thomas Perls, MD, MPH, an associate professor of medicine from Boston University Medical Center in Massachusetts, suggests that functional status must be considered when determining appropriate medical treatment in the very old.
"Disability, rather than disease, is the better predictor of mortality at these older ages," Dr. Perls writes. "Functional status, rather than age alone, must be an important consideration in establishing goals of medical treatment in the very old. Understanding the genetic and modifiable underpinnings of how some people deal with disease better than others should be a priority."
The Medical Research Council supported this study. The study authors have disclosed no relevant financial relationships.
