This article examines the evidence for two propositions: that health and ability to function can often be sustained into advanced old age through interventions that (1) control risk factors among people already old and (2) improve lifelong health behaviors and life-styles starting with people currently still young. Beginning with a general model of age-related changes in health, function, and survival, the article shows how the interrelationship between the three varies between two extreme types of diseases: the fast, lethal type, where death occurs early and rapidly, with few years spent in unhealthy or disabled conditions; and the slow, degenerative type, where prolonged survival allows for added years in unhealthy or disabled conditions. Since this latter type is predominant among older people in the United States today, interventions to prevent morbidity and functional loss are of critical importance. The need for an improved research base to guide such interventions is strongly urged.
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References
1.
1. For example, William B. Kannel and Tavia Gordon, “Cardiovascular Risk Factors in the Aged: The Framingham Study,” in Epidemiology of Aging, ed. S. G. Haynes and M. Feinleib, 1980, Department of Health and Human Services pub. no. 80-969, pp. 65-90.
2.
2. Kenneth G. Manton, “Changing Concepts of Morbidity and Mortality in the Elderly Population,”Milbank Memorial Fund Quarterly, 60:183-244 (1982).
3.
3. World Health Organization, The Uses of Epidemiology in the Study of the Elderly, Technical Report Series 706 (Geneva: World Health Organization, 1984).
4.
4. Russell Wilkins and Owen Adams, Healthfulness of Life (Montreal: Institute for Research on Public Policy, 1983).
5.
5. Nihon University, Population Aging in Japan: Problems and Policy Issues in the 21st Century (Tokyo: Nihon University, Population Research Institute, 1982).
6.
6. Jean M. Robineet al., “The Upper-Normandy Longitudinal Survey on Disability in the Aged, 1978-1985,”Revue d'épidémiologie et de santé publique, May 1988.
7.
7. For example, A. M. Haywood, “Patterns of Persistent Viral Infections,”New England Journal of Medicine, 315:939-948 (1986).
8.
8. Max A. Woodbury and Kenneth G. Manton, “A Random Walk Model of Human Mortality and Aging,”Theoretical Population Biology, 11(1):37-48 (1977).
9.
9. Kenneth G. Manton and Max A. Woodbury, “A Continuous-Time Multivariate Gaussian Stochastic Process Model of Change in Discrete and Continuous State Variables,” in Sociological Methodology 1985, ed. N. Tuma (San Francisco: Jossey-Bass, 1985), pp. 277-315.
10.
10. Kenneth G. Mantonet al., “Grade of Membership Techniques for Studying Complex Event History Processes with Unobserved Covariates,” in Sociological Methodology 1987, ed. C. Clogg (San Francisco: Jossey-Bass, 1987), pp. 309-346.
11.
11. Richard W. Besdine, “Functional Assessment in the Elderly: Relationship between Function and Diagnosis” (Paper delivered at the Fifth Annual Invitational Symposium on the Elderly and Their Health, Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, MD, 9 Oct. 1984).
12.
12. Edward G. Lakatta, “Health, Disease and Cardiovascular Aging,” in Health in an Older Society, Committee on an Aging Society, Institute of Medicine and National Research Council (Washington, DC: National Academy Press, 1985), pp. 73-104.
13.
13. Richard Peto, “Epidemiology, Multistage Models, and Short-Term Mutagenicity Tests,” in Origins of Human Cancer, ed. H. H. Hyatt, J. D. Watson, and J. A. Winsten (Cold Spring Harbor, NY: Cold Spring Harbor Laboratory, 1977), pp. 1403-1428.
14.
14. For example, J. Pekkanen, Coronary Heart Disease during a 15-Year Follow-Up: Risk Factors and Their Secular Trends in the Finnish Cohorts of the Seven Country Study (Helsinki: Government Printing Centre, 1987).
15.
15. Haywood, “Patterns of Persistent Viral Infections.”
16.
16. Kenneth G. Manton, “Procedures for Evaluating the Population-Level Impact of Primary Prevention: A Review of Models for Risk Assessment Forecasting on Impact Determination” (Report prepared for the Division of Noncommunicable Diseases, World Health Organization, Feb. 1985).
17.
17. Manton and Woodbury, “Continuous-Time Multivariate Gaussian Stochastic Process Model.”
18.
18. Based on the Framingham Study experience from 1950 to 1970.
19.
19. See also the analysis in Kenneth G. Manton, Max A. Woodbury, and Eric Stallard, “Forecasts of the Theoretical Limits to Human Life Expectancy” (Paper delivered at the Workshop on Estimating an Upper Limit to Human Life Expectancy, sponsored by the National Institute on Aging, University of California, Berkeley, CA, 28 Apr. 1988).
20.
20. See, for example, Lisa F. Berkman and Lester Breslow, Health and Ways of Living: The Alameda County Study (New York: Oxford University Press, 1983).
21.
21. Ralph S. Paffenbargeret al., “Physical Activity, All-Cause Mortality, and Longevity of College Alumni,”New England Journal of Medicine, 314:605-613 (1986).
22.
22. Kenneth G. Manton, “Planning Long-Term Care for Heterogeneous Older Populations,” in Annual Review of Gerontology and Geriatrics, vol. 8, ed. G. Maddox (New York, Springer, 1988).
23.
23. Wilkins and Adams, Healthfulness of Life.
24.
24. Kenneth G. Manton, “A Longitudinal Study of Functional Change and Mortality in the U.S.,”Journal of Gerontology, 43:153-161 (1988).
