The growing evidence on compression of morbidity

Health, functioning, and disability in older adults—present status and future implications

There is currently a wide debate about chronic care and multimorbidity. Some messages appear that this is strictly connected with ageing, and forget the details. Though disease process have to be tackled, we have to ask ourselves about wellbeing in later life. A key issue is to understand its impact on functioning and disability. This is precisely what a recent article in The Lancet offers. The research question:

Will the years gained be productive and healthy, or will elderly people live longer lives in conditions of ill health? Three main hypotheses have been proposed to address this question.² The compression of morbidity hypothesis posits a situation for which the age of onset of morbidity is delayed to a greater extent than life expectancy rises, thereby compressing morbidity into a short period at a late age.³ The expansion of morbidity hypothesis maintains the opposite, that increases in life expectancy are matched or exceeded by added periods of morbidity.⁴ Both compression and expansion of morbidity could happen in absolute or relative terms—ie, changes in the absolute number of years lived with disability—or in terms of healthy life expectancy as a proportion of total life expectancy.

And a conclusion:

 Our systematic examination of the scientific literature shows that support for morbidity pattern hypotheses varies mainly according to the type of health indicator. Disability-related or impairment-related measures of morbidity tend to support the theory of compression of morbidity, whereas chronic disease morbidity tends to support the expansion of morbidity hypothesis.

This is an article to read and file for the future. The basic approach is defined, the difficulty is about the data. My impression is that we need to use morbidity adjusted life expectancy measures, as those I presented in this blog some months ago. The advantages are clear compared to healthy life expectancy that needs a lot of hypothesis and are based on surveys and self perceptions. Morbidity adjusted measures use  disease codes directly. Why not apply them widely?

PS. The whole series on ageing in The Lancet.

Compression of morbidity

Revisiting Compression of Morbidity and Health Disparities in the 21st Century

Age, Socioeconomic Status, and Health

Compression of morbidity:

an ideal population health dynamic in which people live long, healthy lives with declines in physical and cognitive health associated with senescence “compressed” into a short time period at the end of life.

 There are many ongoing debates in the compression of morbidity literature, including which measures of morbidity should be prioritized and the best methodological approaches for life course analyses that adequately address the thorny challenge of isolating age, period, and cohort effects. Even so, the extant research literature regarding compression of morbidity in the United States suggests that it is not happening at the population level.[3] However, much of the published research does not stratify analyses by socioeconomic position, as House and colleagues had recommended in 1990. House, Lantz, and Herd’s 2005 longitudinal analysis of ACL data affirmed that those in the highest income and education groups were significantly more likely to postpone physical functional impairments until much later in life

 

Disentangling ageing and health

World report on Ageing and Health

Although it may surprise, there is no clear pattern to indicate that elderly people  always utilise more health services. When one looks at the aggregated indicators, one may reach this conclusion, however taking into account the realities and individual characteristics, there are many remaining factors to explain the situation. This fact is evidenced by the last WHO report on aging and health. (P.90).
Even considering the increased morbidity at older ages, the burden of chronic diseases is diverse in terms of cost. Thus, few users and its distribution in the phase prior to death, it is the main cause of the high cost of chronic disease. Proximity to death and corresponding therapeutic effort confound the ageing factor in increasing health costs.
Furthermore, it has been shown that the compression of morbidity continues to advance. That is, the occurrence of chronic diseases is delayed gradually, the phenomenon of "survival of the fittest" is confirmed. The impact or impairment of chronic disease in human physiology for the very old is attenuated .
It is for these reasons that the report is worth, a new look to a reality that is already upon us and we need to give appropriate response.