Background The mortality rates of older people changes with the seasons. However, it has not been properly investigated whether the seasons affect medical care expenditure (MCE) and... Show moreBackground The mortality rates of older people changes with the seasons. However, it has not been properly investigated whether the seasons affect medical care expenditure (MCE) and institutionalization. Seasonal variation in MCE is plausible, as MCE rises exponentially before death. It is therefore important to investigate the impact of the seasons on MCE both mediated and unmediated by mortality. Methods Data on mortality, MCE and institutionalization from people aged 65 and older in a region in the Netherlands from July 2007 through 2010 were retrieved from a regional health care insurer and were linked with data from the Netherlands Institute for Social Research, and Statistics Netherlands (n = 61,495). The Seasonal and Trend decomposition using Loess (STL) method was used to divide mortality rates, MCE, and institutionalization rates into a long-term trend, seasonal variation, and remaining variation. For every season we calculated the 95% confidence interval compared to the long-term trend using Welch’s t-test. Results The mortality rates of older people differ significantly between the seasons, and are 21% higher in the winter compared to the summer. MCE rises with 13% from the summer to the winter; this seasonal difference is higher for the non-deceased than for the deceased group (14% vs. 6%). Seasonal variation in mortality is more pronounced in men and people in residential care. Seasonal variation in MCE is more pronounced in women. Institutionalization rates are significantly higher in the winter, but the other seasons show no significant impact.Conclusions Seasonal changes affect mortality and the level of MCE of older people; institutionalization rates peak in the winter. Seasonal variation in MCE exists independently from patterns in mortality. Seasonal variation in mortality is similar for both institutionalized and communitydwelling elderly. Policy-makers, epidemiologists and health economists are urged to acknowledge and include the impact of the seasons in future policy and research. Show less
Schalkwijk Frank H.; Koopman Jacob J.E.; Ghariq Eidrees; Beer Joop A.A. de; Bodegom David van; Westendorp Rudi G.J. 2015
Purpose: The moving rectangle method is used to disentangle the contributions of rectangularization and life span extension to the increase in life expectancy. It requires the choice of an endpoint... Show morePurpose: The moving rectangle method is used to disentangle the contributions of rectangularization and life span extension to the increase in life expectancy. It requires the choice of an endpoint of the survival curve that approaches the maximum age at death. We examined the effect of choosing different end points on the outcomes of this method. Methods: For five developed countries, survival curves from age 50 years were constructed per calendar year from 1922 onward. Survival values of 0.1, 0.01, and 0.001 were chosen as end points of the survival curve, and the contributions of rectangularization and life span extension to the increase in life expectancy were calculated using the moving rectangle method. Results: The choice of different survival values as end points profoundly influenced the estimated contributions of rectangularization and life span extension to the increase in life expectancy. When choosing 0.001, rectangularization contributed most years, whereas when choosing 0.1, life span extension contributed most years. Conclusions: When the moving rectangle method is used to estimate the contributions of rectangularization and life span extension to the increase in life expectancy, its outcomes depend on the choice of the endpoint of the survival curve. Show less
Koopman, Jacob J.E.; Rozing, Maarten P.; Kramer, Anneke; Abad, José M.; Finne, Patrik; Heaf, James G.; ... ; Westendorp, Rudi G.J. 2015
The rate of senescence can be inferred from the acceleration by which mortality rates increase over age. Such a senescence rate is generally estimated from parameters of a mathematical model fitted... Show moreThe rate of senescence can be inferred from the acceleration by which mortality rates increase over age. Such a senescence rate is generally estimated from parameters of a mathematical model fitted to these mortality rates. However, such models have limitations and underlying assumptions. Notably, they do not fit mortality rates at young and old ages. Therefore, we developed a method to calculate senescence rates from the acceleration of mortality directly without modeling the mortality rates. We applied the different methods to age group–specific mortality data from the European Renal Association—European Dialysis and Transplant Association Registry, including patients with end-stage renal disease on dialysis, who are known to suffer from increased senescence rates (n = 302,455), and patients with a functioning kidney transplant (n = 74,490). From age 20 to 70, senescence rates were comparable when calculated with or without a model. However, when using non-modeled mortality rates, senescence rates were yielded at young and old ages that remained concealed when using modeled mortality rates. At young ages senescence rates were negative, while senescence rates declined at old ages. In conclusion, the rate of senescence can be calculated directly from non-modeled mortality rates, overcoming the disadvantages of an indirect estimation based on modeled mortality rates. Show less
Akintola, Abimbola A.; Jansen, Steffy W.; Bodegom, David van; Grond, Jeroen van der; Westendorp, Rudi G.; Craen, Anton J.M. de; Heemst, Diana van 2015
Het is zo’n twintig jaar geleden dat in Nederland onderzoek plaatsvond naar het aantal slachtoffers van ouderenmishandeling. Er is sinds die tijd veel veranderd: er zijn meer ouderen, de zorg is... Show moreHet is zo’n twintig jaar geleden dat in Nederland onderzoek plaatsvond naar het aantal slachtoffers van ouderenmishandeling. Er is sinds die tijd veel veranderd: er zijn meer ouderen, de zorg is sterk veranderd en de aandacht voor ouderenmishandeling is toegenomen.Er zijn allerlei initiatieven genomen om ouderenmishandeling te bestrijden en eerder te signaleren, zie bijvoorbeeld het actieplan ‘Ouderen in veilige handen’. Wat echter ontbreekt, is een actueel beeld van het aantal slachtoffers van ouderenmishandeling. De staatssecretaris van Volksgezondheid, Welzijn en Sport (vws) wil graag de aard, omvang en oorzaken van ouderenmishandeling laten onderzoeken. Hij heeft het Sociaal en Cultureel Planbureau (scp) gevraagd eerst de bestaande kennis bijeen te brengen alvorens nieuw onderzoek te starten. Het scp heeft daarom diverse partijen benaderd die actuele gegevens hebben over ouderenmishandeling en hen gevraagd om deze gegevens samen te brengen in deze bundel. De Leyden Academy on Vitality and Ageing, Movisie, het Verwey-Jonker Instituut, Bureau Beke, de Inspectie voor de Gezondheidszorg (igz) en de Gemeentelijke of Gemeenschappelijke Gezondheidsdiensten (ggd’en) hebben een bijdrage geleverd. Het is inspirerend om te zien dat zoveel verschillende organisaties, met elk hun eigen perspectief, zoveel inzet tonen en samenwerken om het zicht op een moeilijk bespreekbaaren te onderzoeken fenomeen te verbeteren. Show less
This article focuses on the development of a conceptual framework for explaining the etiology of violence in later life by various groups involved in the field of elder abuse. In this study, we... Show moreThis article focuses on the development of a conceptual framework for explaining the etiology of violence in later life by various groups involved in the field of elder abuse. In this study, we explore this through eight focusgroups with different professionals involved in the field of elder abuse and older persons themselves and in interviews with 35 experts in the field. Our findings show that dependency, vulnerability, power and control, social isolation, stress, and care burden play a central role in their explanations for the occurrence of violence in later life. The role of a history of violence in violence in later life is equivocal. The complexity and ambiguity of dependency and vulnerability, the notion of mutual dependency, and diverse attitudes and expectations toward them that arise with the aging process are distinct features of violence in later life that were found. Show less
Elder abuse is often the result of the organisation of health systems rather than the fault of individuals, argue Yuliya Mysyuk and colleagues. They call for system abuse to be acknowledged and... Show moreElder abuse is often the result of the organisation of health systems rather than the fault of individuals, argue Yuliya Mysyuk and colleagues. They call for system abuse to be acknowledged and addressed by incorporating older people’s views when designing health services Show less
This thesis explores perceptions and views of different groups involved in elder abuse. First chapter provides a general introduction to the topic and current study. In the second chapter of this... Show moreThis thesis explores perceptions and views of different groups involved in elder abuse. First chapter provides a general introduction to the topic and current study. In the second chapter of this thesis, definitions of elder abuse and their developments are reviewed. Chapter three explores different perspectives on the etiology of violence in later life. Chapter four discusses older persons’ definitions of and explanations for elder abuse. Chapter five explores older victims’ ideas about the causes and effects of abuse, the ways of coping with abuse and how they currently feel about it. In the sixth chapter, the framing of elder abuse as a social and a health problem is addressed, with attention to the factors that influence societal context and the health care system. Chapter seven raises the debate about the distinction of system abuse as a separate form of elder abuse. Finally, key findings of this thesis on perspectives on elder abuse are summarized in chapter eight of this thesis. Show less
Kaptijn, Ralf; Thomese, Fleur; Liefbroer, Aart C.; Poppel, Frans van; Bodegom, David van; Westendorp, Rudi G.J. 2015
Several hypotheses have been put forward to explain the relationship between women’s fertility and their post-reproductive longevity. In this study, we focus on the disposable soma theory, which... Show moreSeveral hypotheses have been put forward to explain the relationship between women’s fertility and their post-reproductive longevity. In this study, we focus on the disposable soma theory, which posits that a negative relationship between women’s fertility and longevity can be understood as an evolutionary trade-off between reproduction and survival. We examine the relationship between fertility and longevity during the epidemiological transition in the Netherlands. This period of rapid decline in mortality from infectious diseases offers a good opportunity to study the relationship between fertility and longevity, using registry data from 6,359 women born in The Netherlands between 1850 and 1910. We hypothesize that an initially negative relationship between women’s fertility and their longevity gradually turns less negative during the epidemiological transition, because of decreasing costs of higher parities. An initially inversed U-shaped association between fertility and longevity changes to zero during the epidemiological transition. This does suggest a diminishing environmental pressure on fertility. However, we find no evidence of an initial linear trade-off between fertility and post-reproductive survival. Show less
Koopman Jacob J.E.; Bodegom David van; Maan Arie C.; Li Zhao; Ziem Juventus B.; Westendorp Rudi G.J.; Jukema J.Wouter 2015
A high heart rate and a low heart rate variability at rest are established predictors of various forms of functional impairment, morbidity, and mortality [1–6]. Two explanations can be given for... Show moreA high heart rate and a low heart rate variability at rest are established predictors of various forms of functional impairment, morbidity, and mortality [1–6]. Two explanations can be given for these associations. On one hand, a high heart rate and a low heart rate variability are thought to reflect dysfunction of the flexible autonomic regulation of the heart rate in particular and of the body's functioning in general that arises during ageing [3–5]. On the other hand, a high heart rate and a low heart rate variability are brought about by cardiovascular risk factors, such as obesity, hyperlipidaemia, diabetes, hypertension, and physical inactivity [2,3,7–9]. Since research on heart rate and heart rate variability has almost exclusively been conducted in western populations with an affluent sedentary lifestyle and high prevalences of these risk factors, it has been difficult to determine whether or not heart rate and heart rate variability are associated with functional impairment, morbidity, and mortality independently of cardiovascular risk factors. Show less
Koopman, Jacob J.E.; Bodegom, David van; Heemst, Diana van; Westendorp, Rudi G.J. 2015
Background: muscle strength measured as handgrip strength declines with increasing age and predicts mortality. While handgrip strength is determined by lifestyle through nutrition and physical... Show moreBackground: muscle strength measured as handgrip strength declines with increasing age and predicts mortality. While handgrip strength is determined by lifestyle through nutrition and physical activity, it has almost exclusively been studied in western populations with a sedentary lifestyle. This study aims to investigate the relation between handgrip strength, ageing and mortality in a population characterised by a predominance of malnutrition and manual labour. Design: a population-based longitudinal study. Setting: a traditional African rural population in Ghana. Subjects: nine hundred and twenty-three community-dwelling individuals aged 50 and older. Methods: demographic characteristics were registered. At baseline, height, body mass index (BMI) and handgrip strength were measured and compared with those in a western reference population. Survival of the participants was documented during a period of up to 2 years. Results: handgrip strength was dependent on age, sex, height and BMI. Compared with the western reference population, handgrip strength was lower due to a lower height and BMI but declined over age similarly. Risk of mortality was lower in participants having higher handgrip strength, with a hazard ratio of 0.94 per kg increase (P = 0.002). After adjustment for age, sex, tribe, socio-economic status, drinking water source, height and BMI, only handgrip strength remained predictive of mortality. Conclusion: in a traditional rural African population characterised by malnutrition and manual labour, handgrip strength declines over age and independently predicts mortality similar to western populations. Handgrip strength can be used as a universal marker of ageing. Show less
Simons, Luuk P.A.; Bodegom, David van; Dumaij, Adrie; Jonker, Catholijn M. 2015
Work site healthy lifestyle interventions hold promise for improving health and employability. As part of a larger employer vitality program and a work site RCT (Randomized Controlled Trial, n=59... Show moreWork site healthy lifestyle interventions hold promise for improving health and employability. As part of a larger employer vitality program and a work site RCT (Randomized Controlled Trial, n=59 intervention arm) to assess cardiac risk impacts, we conducted a design analysis on a hybrid eHealth solution. The control condition was a six weeks waiting list and then start of the hybrid eHealth support (n=57). Based on preliminary 6 week- and 3 month-results, the hybrid eHealth support generated statistically significant risk factors improvement (like LDL cholesterol). The waiting list condition yielded no significant improvements. The late start after the waiting list did yield significant improvements, but not as large as a direct start. The direct start also appears to yield higher satisfaction and intention to recommend. Show less
Koopman Jacob J.E.; Wensink Maarten J.; Rozing Maarten P.; Bodegom David van; Westendorp Rudi G.J. 2014
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
