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Aging Outside the Box

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Regular vigorous physical activity, including running and jogging, may postpone ... Bone mineral density is increased by exercise; osteoporosis is decreased. ... – PowerPoint PPT presentation

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Title: Aging Outside the Box


1
Aging Outside the Box
  • Stanford Continuing Studies
  • James F. Fries, MD
  • October 24, 2007
  • Slides Available at ARAMIS.Stanford.edu

2
A Personal Background
  • Information Science, Chronic Disease Databank
    Model, ARAMIS (Arthritis, Rheumatism, and Aging
    Medical Information System)
  • Outcomes of Chronic Illness (HAQ)
  • Compression of Morbidity
  • Medical Self-Care
  • Disease Criteria, NSAID Gastropathy, Inverting
    the Pyramid, Improving Outcomes in Arthritis

3
ON REDUCTIONIST SCIENCE
  • Science as Observation,
  • Science as Experiment
  • Truth as Correspondence (James),
  • Truth as Cohesion (Dewey)

4
Class Schedule
  • General Themes
  • October 17 Longevity
  • October 24 Compression of Morbidity
  • October 31 Declining Disability
  • November 7 Aging and Health Policy
  • December 5 Synthesis and Application

5
THE COMPRESSION OF MORBIDITY
  • A Classic 1980 Article for Discussion Concept,
    Logic, Data, Errors
  • Citations and Google
  • Readings Fries 1980, Vita 1998, Wang 2002

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7
The Compression of Morbidity Central Thesis
  • The age at first appearance of aging and chronic
    disease symptoms can increase more rapidly than
    life expectancy

8
Errors in the Classic Article
9
Errors in the Classic Article
  • Number of very old will not increase It will,
    but driven by birth cohorts and early life
    survival
  • Lifespan 85 years more like 90 but close
  • Standard Deviation of Age at Death 4 years
    its always been 8 years (Figure 5)
  • Centenarians 110,000 No, more than 1100

10
ORIGINS OF THE COMPRESSION OF MORBIDITY HYPOTHESIS
  • Center for Advanced Study in the Behavioral
    Sciences
  • The Plasticity of Aging Baltes, Riley, Loftus,
    Seligman, Valliant, Fries
  • An Interdisciplinary Light Bulb Clicks On
  • The Realities of Life Span Crapo

11
Elements of the Paradigm Shift
  • Natural and Premature death
  • Postponement Replaces Prevention
  • The Epidemiologic Transitions Acute (infection)
    to Chronic (heart) to Aging (frailty)
  • Or Early Death, Little Morbidity to Expansion of
    Morbidity to Compression of Morbidity

12
Critics of the Compression of Morbidity Hypothesis
  • Demographers vested in contrary predictions
  • Basic Scientists fearing lost grant funds
  • Humanists positing blaming the victim
  • Gerontologists wanting time to prepare
  • Pessimists believing it will never happen

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18
Evidence for Compression of Morbidity
  • Longitudinal studies document morbidity
    compression by social class, exercise, education
    level, combined risk factors
  • National surveys of disability since 1982 show
    current disability decreases of over 2 a year
  • Randomized studies in seniors show disability and
    cost reductions with health risk improvements

19
University of Pennsylvania Study 1986-2007
  • Three Lifestyle Risk Factors at Age 68
  • Overweight or obese
  • Cigarette smoking
  • No regular vigorous activity
  • Three Risk Groups
  • -LOWzero risk factors
  • -MODERATE1 risk factor
  • -HIGH2 or 3 risk factors

20
University of Pennsylvania Study, 2007 Death
Rates (per 10,000 Person-Years)
21
University of Pennsylvania Study, 2007
Hubert et al, AR, 2006
22
University of Pennsylvania Study, 2007
23
University of Pennsylvania Attendees
1939-40 Disability Index by Age and Risk Factor
Category
Disability Index
Age
Vita et al, NEJM, 1998
24
University of Pennsylvania Study, 2007
  • Conclusions
  • Mortality reduction from low risk to high risk
    groups is about 4 years
  • Disability postponement from high to low risk
    groups is about 8 years
  • Healthy lifestyle-related risk factors in
    seniors, including normal weight, regular
    physical activity and smoking abstinence offer
    protection against disability despite the
    associated survival advantages over time

25
Exercise and Disability A 21-Year Study Wang et
al, Archives Internal Medicine, 2002
Chakravarty et al, Archives Internal Medicine,
2008 (in press)
  • 538 Runners Club Members
    423 Community Controls
  • Average Age 58 in 1984
  • Average Age 79 in 2005

26
Disability by Age in Runners and Controls
Mean Disability Score
Community Control (n249) Runners Club (n369)
Age Category
Wang et al, Arch Int Med, 2002
27
Exercise and Disability
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Exercise and Disability Conclusions
  • Regular vigorous physical activity, including
    running and jogging, may postpone disability by
    12 to 16 years, far more than more casual
    exercise.
  • Bone mineral density is increased by exercise
    osteoporosis is decreased.
  • X-rays of knees are better in exercising
    subjects, even regular long-distance runners,
    than controls.

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