The price of success: health care in an aging society.
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Aged↗
Biomedical subjects
S J Olshansky
Publications and source records attributed to S J Olshansky.
In search of Methuselah: estimating the upper limits to human longevity.
Estimates of the upper limits to human longevity have important policy implications that directly affect forecasts of life expectancy, active life expectancy, population aging, and social and medical programs tied to the size and health status of the elderly population. In the past, investigators have based speculations about the upper limits of human longevity on observations of past trends in mortality. Here the estimate of the upper bound is based on hypothesized reductions in current mortality rates necessary to achieve a life expectancy at birth from 80 to 120 years and an expectation of life at age 50 from 30 to 70 years. With the use of conditional probabilities of death from complete life tables for the United States, reductions in mortality required to achieve extreme longevity (that is, 80 to 120 years) were compared with those resulting from hypothetical cures for all cardiovascular diseases, ischemic heart disease, diabetes, and cancer. Results indicate that in order for life expectancy at birth to increase from present levels to what has been referred to as the average biological limit to life (age 85), mortality rates from all causes of death would need to decline at all ages by 55%, and at ages 50 and over by 60%. Given that hypothetical cures for major degenerative diseases would reduce overall mortality by 75%, it seems highly unlikely that life expectancy at birth will exceed the age of 85.
Female↗
On forecasting mortality.
Official forecasts of mortality made by the U.S. Office of the Actuary throughout this century have consistently underestimated observed mortality declines. This is due, in part, to their reliance on the static extrapolation of past trends, an atheoretical statistical method that pays scant attention to the behavioral, medical, and social factors contributing to mortality change. A "multiple cause-delay model" more realistically portrays the effects on mortality of the presence of more favorable risk factors at the population level. Such revised assumptions produce large increases in forecasts of the size of the elderly population, and have a dramatic impact on related estimates of population morbidity, disability, and health care costs.
Actuarial Analysis↗
Simultaneous/multiple cause-delay (SIMCAD): an epidemiological approach to projecting mortality.
Methods being used to project mortality are based on the hypothetical elimination of one or more diseases from the population or on extrapolation from observed mortality rates. This research presents an alternative projection method based on an epidemiological theory of aging and mortality change that is consistent with recent mortality transitions. The model is founded on the observation that recent mortality declines in the United States are attributable to improved life styles and advances in the prevention and treatment of degenerative diseases and that the risk of dying from such diseases is being redistributed (or delayed) from younger to older ages. A test using U.S. mortality and population data indicates that this alternative method is promising--particularly for projecting mortality rates from major chronic degenerative diseases among populations in middle and older ages.
Adult↗
The fourth stage of the epidemiologic transition: the age of delayed degenerative diseases.
Gains in longevity in the United States since the mid-nineteenth century occurred as a result of an epidemiologic transition: deaths from infectious diseases were replaced by deaths from degenerative diseases. Recent trends in cause-specific mortality suggest a distinct new stage, one of postponement of degenerative diseases. Projections based on these data must be applied cautiously; their implication for health and social policies are likely to be profound.
Actuarial Analysis↗
Pursuing longevity: delay vs elimination of degenerative diseases.
Using a new model which allows for projection of mortality change resulting from preventive health care measures, prospective changes in longevity for the resident United States population in 1978 were compared with projections of longevity gains occurring under a standard single cause-elimination model. Results indicate that equal or greater gains accrue from the prevention or delay of several major degenerative diseases, than from the complete elimination of some single major degenerative diseases. Observed declines in mortality from 1960 to 1978 have resulted in gains in longevity equivalent to the successful elimination of some major degenerative diseases.
Adolescent↗
Is smoker/nonsmoker segregation effective in reducing passive inhalation among nonsmokers?
Using expired carbon monoxide (CO) and a test of coordination as measures of tobacco smoke exposure in a natural environmental setting where smokers and nonsmokers were segregated, results indicate that by comparison to a control group, subjects seated in adjacent smoking/ nonsmoking environments were not only exposed to similar ambient levels of CO, but also show similar physical and physiological reactions to their exposure in the form of coordination test scores, expired CO, and blood carboxyhemoglobin. While the results may not be generalized to other tobacco smoke constituents or other environmental settings, they raise questions about the health benefits of smoker segregation which future research must address.
Adult↗