Intrinsic and extrinsic mortality are often separated in order to understand and measure aging. Intrinsicmortality is assumed to be a result of aging and to increase over age,whereas extrinsic... Show moreIntrinsic and extrinsic mortality are often separated in order to understand and measure aging. Intrinsicmortality is assumed to be a result of aging and to increase over age,whereas extrinsic mortality is assumed to be a result of environmental hazards and be constant over age. However, allegedly intrinsic and extrinsic mortality have an exponentially increasing age pattern in common. Theories of aging assert that a combination of intrinsic and extrinsic stressors underlies the increasing risk of death. Epidemiological and biological data support that the control of intrinsic as well as extrinsic stressors can alleviate the aging process. We argue that aging and death can be better explained by the interaction of intrinsic and extrinsic stressors than by classifying mortality itself as being either intrinsic or extrinsic. Recognition of the tight interaction between intrinsic and extrinsic stressors in the causation of aging leads to the recognition that aging is not inevitable, but malleable through the environment Show less
Rolden Herbert J.A.; Bodegom David van; Westendorp Rudi G.J. 2014
The health care costs of population ageing are for an important part attributable to higher mortality rates in combination with high costs of dying. This paper answers three questions that remain... Show moreThe health care costs of population ageing are for an important part attributable to higher mortality rates in combination with high costs of dying. This paper answers three questions that remain unanswered regarding the costs of dying: (1) contributions of different health services to the costs of dying; (2) variation in the costs of dying; and (3) the influence of preceding health care expenses on the costs of dying.We retrieved data on 61,495 Dutch subjects aged 65 and older from July 2007 through 2010 from a regional health care insurer. We included all deceased subjects of whom health care expenses were known for 26 months prior to death (n ¼ 2833). Costs of dying were defined as health care expenses made in the last six months before death. Lorenz curves, generalized linear models and a two-part model were used for our analyses. (1) The average costs of dying are V25,919. Medical care contributes to 57% of this total, and long-term care 43%. The costs of dying mainly relate to hospital care (40%). (2) In the costs of dying, 75% is attributable to the costliest half of the population. For medical care, this distribution figure is 86%, and for long-term care 92%. Age and preceding expenses are significant determinants of this variation in the costs of dying. (3) Overall, higher preceding health care expenses are associated with higher costs of dying, indicating that the costs of dying are higher for those with a longer patient history. To summarize, there is not a large variation in the costs of dying, but there are large differences in the nature of these costs. Before death, the oldest old utilize more long-term care while their younger counterparts visit hospitals more often. To curb the health care costs of population ageing, a further understanding of the costs of dying is crucial. Show less
Rolden, Herbert J.A.; Bodegom, David van; Westendorp, Rudi G.J. 2014
Background: In ageing populations, informal care holds great potential to limit rising health care expenditure. The majority of informal care is delivered by spouses. The loss of informal care due... Show moreBackground: In ageing populations, informal care holds great potential to limit rising health care expenditure. The majority of informal care is delivered by spouses. The loss of informal care due to the death of the spouse could therefore increase expenditure levels for formal care. Objective: To investigate the impact of the death of the spouse on health care expenditure by older people through time. Additionally, to examine whether the impact differs between socio-demographic groups, and what health services are affectedmost. Design: Longitudinal data on health care expenditure (from July 2007 through 2010) from a regional Dutch health care insurer was matched with data on marital status (2004–2011) from the Central Bureau of Statistics. Linear mixed models with log transformed health care expenditure, generalized linear models and two-part models were used to retrieve standardized levels of monthly health care expenditure of 6,487 older widowed subjects in the 42 months before and after the loss of the spouse. Results: Mean monthly health care expenditure in married subjects was J502 in the 42 months before the death of the spouse, and expenditure levels rose by J239 (48%) in the 42 months after the death of the spouse. The increase in expenditure after the death of the spouse was highest for men (J319; 59%) and the oldest old (J553; 82%). Expenditure levels showed the highest increase for hospital and home care services (together J166). Conclusions: The loss of the spouse is associated with an increase in health care expenditure. The relatively high rise in long-term care expenses suggests that the loss of informal care is an important determinant of this rise. Show less
Rolden, Herbert J.A.; Bodegom, David van; Hout, Wilbert B. van den; Westendorp, Rudi G.J. 2014
Background As mortality is more and more concentrated at old age, it becomes critical to identify the determinants of old age mortality. It has counterintuitively been found that mortality rates at... Show moreBackground As mortality is more and more concentrated at old age, it becomes critical to identify the determinants of old age mortality. It has counterintuitively been found that mortality rates at all ages are higher during short-term increases in economic growth. Work-stress is found to be a contributing factor to this association, but cannot explain the association for the older, retired population. Methods Historical figures of gross domestic product (Angus Maddison) were compared with mortality rates (Human Mortality Database) of middle aged (40– 44 years) and older people (70–74 years) in 19 developed countries for the period 1950–2008. Regressions were performed on the de-trended data, accounting for autocorrelation and aggregated using random effects models. Results Most countries show pro-cyclical associations between the economy and mortality, especially with regard to male mortality rates. On average, for every 1% increase in gross domestic product, mortality increases with 0.36% for 70-year-old to 74-year-old men (p<0.001) and 0.38% for 40-year-old to 44-year-old men ( p<0.001). The effect for women is 0.18% for 70-year-olds to 74-year-olds ( p=0.012) and 0.15% for 40-year-olds to 44-year-olds ( p=0.118). Conclusions In developed countries, mortality rates increase during upward cycles in the economy, and decrease during downward cycles. This effect is similar for the older and middle-aged population. Traditional explanations as work-stress and traffic accidents cannot explain our findings. Lower levels of social support and informal care by the working population during good economic times can play an important role, but this remains to be formally investigated. Show less
Engelaer, Frouke M.; Koopman Jacob J.E.; Bodegom, David van; Eriksson, Ulrika K.; Westendorp, Rudi G.J. 2014
Background Many African countries experience a protracted epidemiologic transition, different from the classical transition in western societies. The factors driving this protracted transition are... Show moreBackground Many African countries experience a protracted epidemiologic transition, different from the classical transition in western societies. The factors driving this protracted transition are largely unknown. In northeast Ghana, we studied an ongoing epidemiologic transition and investigated the effects of socioeconomic status and drinking water source on the transition. Methods During a 9-year period, we followed a cohort of almost 30 000 individuals and collected information on mortality and fertility rates. In addition, using the standards set out by the WHO, we obtained the causes of death by verbal autopsy. Individuals were stratified according to their socioeconomic status and the households' use of an improved or unimproved drinking water source. Results Mortality rates decreased by −5.0% annually (p<0.001) and the main cause of death shifted from infectious to non-infectious diseases (p=0.014). General fertility rates and child-women ratios decreased annually by −12.7% (p<0.001) and −11.9% (p<0.001), respectively. There was no difference in the decline of mortality and fertility depending on socioeconomic status or drinking water source. Show less
Koopman, Jacob J.E.; Bodegom, David van; Westendorp, Rudi G.J.; Jukema, Johan Wouter 2014
Background: In western societies, atrial fibrillation is an increasingly common finding among the elderly. Established risk factors of atrial fibrillation include obesity, diabetes, hypertension,... Show moreBackground: In western societies, atrial fibrillation is an increasingly common finding among the elderly. Established risk factors of atrial fibrillation include obesity, diabetes, hypertension, and cardiovascular disease. Atrial fibrillation has almost exclusively been studied in western populations where these risk factors are widely present. Therefore, we studied the epidemiology of atrial fibrillation in a traditional African community. Methods: In rural Ghana, among 924 individuals aged 50 years and older, we recorded electrocardiograms to detect atrial fibrillation. As established risk factors, we documented waist circumference, body mass index (BMI), capillary glucose level, blood pressure, and electrocardiographic myocardial infarction. In addition, we determined circulating levels of interleukin-6 (IL6), a proinflammatory cytokine, and C-reactive protein (CRP), a marker of systemic inflammation. We compared the risk factors with reference data from the USA. Results: Atrial fibrillation was detected in only three cases, equalling 0.3% (95% CI 0.1–1.0%). Waist circumference, BMI, and capillary glucose levels were very low. Hypertension and myocardial infarction were uncommon. Circulating levels of IL6 were similar, but those of CRP were lower compared with the USA. Conclusion: Atrial fibrillation is very scarce in this traditional African community. Its low prevalence compared with western societies can be explained by the rareness of its established risk factors, which are closely related to lifestyle, and by possible unmeasured differences in other risk factors or genetic factors. Show less
Engelaer, Frouke M.; Bodegom, David van; Mangione, Julia N.A.; Eriksson, Ulrika K.; Westendorp, Rudi G.J. 2014
Mirzada, Fereshta; Schimberg, Anouk S.; Engelaer, Frouke M.; Bijwaard, Govert E.; Bodegom, David van; Westendorp, Rudi G. J.; Poppel, Frans W. A. van 2014
Practising arts has been linked to lowering stress, anxiety and blood pressure. These mechanisms are all known to affect the ageing process. Therefore, we examine the relation between long-term... Show morePractising arts has been linked to lowering stress, anxiety and blood pressure. These mechanisms are all known to affect the ageing process. Therefore, we examine the relation between long-term involvement in arts and life expectancy at age 50 (LE50), in a cohort of 12,159 male acoustic, literary and visual artists, who were born between 1700 and 1899 in the Low Countries. We compared the life expectancy at age 50 of the various artists with the elite and middle class of that time. In the birth cohorts before 1850, acoustic (LE50:14.5–19.5) and literary artists (LE50:17.8–20.8) had a similar life expectancy at age 50 compared to the elite (LE50:18.0–19.0). Only visual artists (LE50:15.5–17.1) had a lower life expectancy at age 50 compared to the elite at that time. For the most recent birth cohorts from 1850 through 1899, the comparison between artists and the elite reversed and acoustic and literary artist had a lower life expectancy at age 50, while visual artists enjoyed a similar life expectancy at age 50. Although artists belonged to the middle socioeconomic class and lived predominantly in urban areas with poor living conditions, they had a life expectancy similar to the elite population. This is in line with observed favourable effects of practicing arts on health in the short-term. From our historical analysis, we hypothesize several mechanisms through which artistic creativity could influence the ageing process and life expectancy. These hypotheses, however, should be formally tested before any definite conclusions on effects of arts on ageing can be drawn. Show less
Beenakker, Karel G.M.; Koopman, Jacob J.E.; Bodegom, David van; Kuningas, Maris; Slagboom, Pieternella E.; Meij, Johannes J.; ... ; Westendorp, Rudi G.J. 2014
Recently, it has been shown that the capacity of the innate immune system to produce cytokines relates to skeletal muscle mass and strength in older persons. The interleukin-10 (IL-10)gene... Show moreRecently, it has been shown that the capacity of the innate immune system to produce cytokines relates to skeletal muscle mass and strength in older persons. The interleukin-10 (IL-10)gene regulates the production capacities of IL-10 and tumour necrosis factor-a (TNF-a). In rural Ghana, IL-10 gene variants associated with different production capacities of IL-10 and TNF-a are enriched compared with Caucasian populations. In this setting, we explored the association between these gene variants and muscle strength. Among 554 Ghanaians aged 50 years and older, we determined 20 single nucleotide polymorphisms in the IL-10 gene, production capacities of IL-10 and TNF-a in whole blood upon stimulation with lipopolysaccharide (LPS) and handgrip strength as a proxy for skeletal muscle strength. We distinguished pro-inflammatory haplotypes associated with low IL-10 production capacity and anti-inflammatory haplotypes with high IL-10 production capacity. We found that distinct haplotypes of the IL-10 gene associated with handgrip strength. A proinflammatory haplotype with a population frequency of 43.2% was associated with higher handgrip strength (P = 0.015). An anti-inflammatory haplotype with a population frequency of 7.9% was associated with lower handgrip strength (P = 0.006). In conclusion, variants of the IL-10 gene contributing to a proinflammatory cytokine response associate with higher muscle strength, whereas those with anti-inflammatory response associate with lower muscle strength. Future research needs to elucidate whether these effects of variation in the IL-10 gene are exerted directly through its role in the repair of muscle tissue or indirectly through its role in the defence against infectious diseases Show less
Loevezijn, Ariane A. van; Cameron, Ian D; Kurrle, Susan E; Bodegom, David van 2014
Steady growth in human life expectancy has been a key feature of the last century, with projected further increases likely to have enormous impacts on societies worldwide. Despite the significance... Show moreSteady growth in human life expectancy has been a key feature of the last century, with projected further increases likely to have enormous impacts on societies worldwide. Despite the significance of these changes, our understanding of the factors shaping this trend is incomplete. During most of the historical increase, by far, the major influence was progressive decline in early and midlife death rates because of the reduction in premature deaths, caused chiefly by infection. Recent decades have seen the emergence of a new driver of increasing longevity—declining mortality among those who are old already, pointing to greater malleability in human aging than had been foreseen. There is still debate, however, as to how much of this decrease in old age mortality is caused by a better early-life environment and how much is caused by improved conditions in late life. A unique resource exists in the case of Japan, where material circumstances for the general population were consistently adverse through the early decades of the 20th century but improved rapidly after 1950. Here, we compare the Japanese birth cohorts of 1900, 1910, and 1920 and follow their period and cohort mortality trends. The results show that cohorts with similar environments early in life have very different mortality trajectories in old age. This strengthens the expectation that preventive measures in later life can deliver great benefit, while not contradicting the importance of life course approaches, to improving health and well-being. Show less
The role of individual characteristics in incidences of elder abuse has long been highest on research and policy agendas. Now, it is timely to discuss factors that go beyond victim and perpetrator.... Show moreThe role of individual characteristics in incidences of elder abuse has long been highest on research and policy agendas. Now, it is timely to discuss factors that go beyond victim and perpetrator. Environmental factors also play an important role in elder abuse. In this paper, we address the framing of elder abuse as a social and health problem. Attention is paid to the factors that influence societal context and the Healthcare system, its organization, structure, and principles Show less
Engelaer, Frouke M.; Bodegom, David van; Westendorp, Rudi G.J. 2013
For a long time, life expectancy at birth was used as the sole indicator of population health. More recently, population health is also being expressed as healthy life expectancy and it is debated... Show moreFor a long time, life expectancy at birth was used as the sole indicator of population health. More recently, population health is also being expressed as healthy life expectancy and it is debated how healthy life expectancy will develop in the future. Since it is known that men and women have very different health and disease trajectories, we compared healthy life expectancy between the sexes, at birth and at age 80. From 1985 to 2010 life expectancy at birth in the Netherlands increased from 73.1 to 78.8 for men and from 79.7 to 82.7 for women. During the same period, the expected number of years without disabilities and in good self-reported health increased parallel, pointing to a shift of disability towards older age. Paradoxically, however, there has been an expansion of morbidity per se, as indicated by a continuing decrease in life expectancy without chronic diseases from 51.4 to 47.2 for men and from 48.8 to 40.6 for women. After these diverging trends of the last thirty years, Dutch women nowadays have a life expectancy that is 3.9 years longer than men but a life expectancy without chronic diseases that is 6.6 years lower. When examining these figures in the oldest old, the number of years expected to live in good health is similar for the sexes, but women of 80 years can expect to live another 9.7 years, still almost two years longer than the 7.9 years for men. All in all, the increase of life expectancy in the Netherlands is accompanied by a shift of disability but an expansion of morbidity, which is much more pronounced in women. It remains to be examined what biological or social mechanisms are behind these large sex differences in healthy life expectancy in the Netherlands. Show less
Engelaer F.M.; Bodegom D. van; Westendorp, R.G.J. 2013
Life expectancy has steadily increased with around 2.5 years per decade over the past 150 years and continuous to do so at a similar rate [1]. Before 1950, the increase in life expectancy was... Show moreLife expectancy has steadily increased with around 2.5 years per decade over the past 150 years and continuous to do so at a similar rate [1]. Before 1950, the increase in life expectancy was primarily driven by reductions in child mortality. During the last decades, however, the increase in life expectancy is mainly the result of mortality reductions at old age [2]. Better living conditions and hygiëne have saved us from an early death, while incremental health care innovations have brought us an old age Show less
Engelaer, Frouke M.; Bodegom, David van; Westendorp, Rudi G.J. 2012
Elder abuse has devastating consequences for older persons such as a poor quality of life, psychological distress, and loss of property and security. It is also associated with increased mortality... Show moreElder abuse has devastating consequences for older persons such as a poor quality of life, psychological distress, and loss of property and security. It is also associated with increased mortality and morbidity. Elder abuse is a problem that manifests itself in both rich and poor countries and at all levels of society. It is timely to discuss one of the basic problems that has hampered the study, detection and intervention of elder abuse as the variety of definitions that exist now produce a definitional chaos for researchers, practitioners, and policy makers. In this article we trace the elements of “how to define elder abuse” and situate them in their socio-historical context. We also analyze the purposes of these different definitions to assess their appropriateness in different settings concerned with elder abuse. Our analysis shows that elder abuse mirrors the societal arrangements which gave rise to them. It also highlights that it is a complex problem that is difficult to define. The central question is whether we need a common definition of elder abuse or different definitions that can be used in different settings. By evidence of our analysis we can see that there is a need for a sufficiently broad and flexible definition in order to cover different behaviors that can constitute abuse and the various settings in which it may occur. On the other hand, the definition needs to be specific and concrete to be useful in professional contexts. To take a further step forward for both research and practice of elder abuse, we propose to consistently adhere to the WHO definition that leads the enquirer towards a better understanding of the problem and helps to distinguish it from other phenomena; and to a simplified definition for professional practice that sets boundaries to the phenomena and is appropriate for effective prevention and intervention measures Show less
Zwiers, R.; Zantvoord, F.W.A.; Engelaer, F.M.; Bodegom, D. van; Ouderaa, F.J.G. van der; Westendorp, R.G.J. 2012
Objective To assess the mortality risk in subsequent years (adjusted for year of birth, nationality, and sex) of former Olympic athletes from disciplines with different levels of exercise intensity.
Engelaer, Frouke M.; Bodegom, David van; Westendorp, Rudi G.J. 2012
Goed opgeleide artsen in de zorgvragen van de komende decennia zijn in ons aller belang. Leyden Academy heeft, mede financieel gesteund door ZonMw in het kader van het Nationaal Programma... Show moreGoed opgeleide artsen in de zorgvragen van de komende decennia zijn in ons aller belang. Leyden Academy heeft, mede financieel gesteund door ZonMw in het kader van het Nationaal Programma Ouderenzorg, het initiatief genomen tot een inventarisatie van ouderengeneeskunde in de medische curricula. Het Raamplan 2009 met de eindtermen van de basisopleiding geneeskunde geeft een te summiere beschrijving van ouderengeneeskunde om gedegen onderwijs hierin te waarborgen. Dit is terug te zien in de voortgangstoetsen van studenten geneeskunde. Er is verspreid over de faculteiten goed onderwijs in ouderengeneeskunde, maar een compleet aanbod van theoretisch en praktisch onderwijs ontbreekt op de meeste faculteiten. Slechts op drie van de acht faculteiten is een hoogleraar ouderengeneeskunde in de tweede lijn. De werkgroep doet de volgende aanbevelingen: •Het raamplan dient te worden aangepast zodat alle studenten op gedegen wijze in de ouderengeneeskunde worden onderwezen, waarbij de begrippen in het hier opgestelde toetsingskader aan de orde moeten komen. •Alle studenten dienen in de bachelorfase theoretisch onderwijs over veroudering te krijgen en kennis te maken met de ouderengeneeskundige praktijk in een zorgstage. In de masterfase dienen zij bovendien te worden voorbereid op hun toekomstige praktijk door een verplicht coschap ouderengeneeskunde. •Om gedegen onderwijs in de ouderengeneeskunde op iedere faculteit te waarborgen dient op iedere faculteit een hoogleraar ouderengeneeskunde te worden aangesteld. Show less
De levensverwachting in Nederland is vanaf de 19e eeuw sterk toegenomen. Tot 1870 lag de gemiddelde levensverwachting beneden de 50 jaar,daarna begon de epidemiologische transitie, een overgang van... Show moreDe levensverwachting in Nederland is vanaf de 19e eeuw sterk toegenomen. Tot 1870 lag de gemiddelde levensverwachting beneden de 50 jaar,daarna begon de epidemiologische transitie, een overgang van sterfte door infectieziekten op jonge leeftijd naar sterfte door kanker en harten vaatziekten op hogere leeftijd. Deze transitie kan verklaard worden door verbeterde hygiëne, sociaal-economische ontwikkelingen en toegenomen medische kennis. Door deze ontwikkelingen is de kindersterfte vrijwel verdwenen en de gemiddelde levensverwachting fors gestegen. Op dit moment heeft een Nederlandse man een kans van 86 procent om de leeftijd van 65 jaar te bereiken en voor vrouwen is dit zelfs 90 procent. Daarbij is de levensverwachting voor mannen 77 jaar en voor vrouwen 81 jaar. Het resultaat van dit succes is dat er nu meer oude mensen zijn dan ooit te voren. Dat wil echter niet zeggen dat veroudering een nieuw fenomeen is. Ook in vroeger tijden waren er mensen die een hoge leeftijd bereikten, alleen waren er veel minder mensen die dit geluk mochten smaken. In dit hoofdstuk gaan we in op de factoren die de levensverwachting beïnvloeden, waarbij we ons concentreren op de rol die het immuunsysteem speelt gedurende de levensloop. Show less
