Determinants and trajectories of healthy life expectancy and deficit accumulation in older adults in Germany - follow-up of the KORA-Age cohort study
Final Report Abstract
Demographic change, the epidemiologic transition and increasing live expectancy will lead to a higher share of older people in industrialized societies who are at risk for multiple chronic health deficits. However, health trajectories exhibit considerable heterogeneity throughout adult life. The objectives of this project were therefore to study determinants of healthy life expectancy in a representative sample of the aged German population, taking early life experience as a consequence of birth cohort and the gradual development of deficit accumulation into account. We used data from the KORA-Age cohort. The KORA-Age study population is based on the participants of four former population representative MONICA/KORA surveys. For the KORA-Age baseline wave in 2008/09, all former MONICA/KORA participants born in 1943 or earlier were invited. Out of these, 4,127 participants aged 65 or older underwent a detailed interview. A subgroup was re-examined in a telephone interview and medical examination in the first KORA-Age follow-up in 2012 (KORA-Age 2). In 2016, all former MONICA/KORA participants aged 65 years or older on December 31, 2015 were additionally invited to participate in a structured computer-assisted telephone interview, the second KORA-Age follow-up (KORA-Age 3). This project contributed to disentangling cohort, age and period effects of deficit accumulation. In our studies, morbidity prevalence increased with age, and was higher for women than for men in all age groups. Despite higher life expectancy in women, the higher prevalence of disability resulted in lower health expectancy for women as compared to men. Older adults whose critical developmental age coincided with the early reconstruction and food crisis period after World War II in Germany had significantly higher levels of disability at ages 65-71 years as compared to participants from the earlier-born cohort whose critical developmental age had ended before the food crisis period and also compared to the later post-war cohort participants who were conceived and born after the food crisis period. We also showed that mortality risk in older adults was predicted by transitions of frailty. We found that frail persons in stable state survived longer. Future research will need to look deeper into the reasons why and how individuals succeed in stabilizing their health state, and how vulnerable individuals can be protected from further accumulation of health deficits. Early life experiences and modifiable life style factors still play a relevant role in this.
Publications
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(2017). The effect of income and wealth on the onset of health deficit accumulation in older adults in Europe–results from the SHARE study. Das Gesundheitswesen, 79(08/09), V-48
Stephan, A. J., Strobl, R., & Grill, E.
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(2018). Do birth cohorts make a difference for deficit accumulation trajectories in older age? First results from the KORA-Age study. Revue d'Épidémiologie et de Santé Publique, 66, S236
Stephan, A. J., Strobl, R., Holle, R., Meisinger, C., Ladwig, K. H., Linkohr, B., ... & Grill, E.
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(2019). Being born in the aftermath of World War II increases the risk for health deficit accumulation in older age: results from the KORA-Age study. European journal of epidemiology, 34(7), 675-687
Stephan, A. J., Strobl, R., Schwettmann, L., Meisinger, C., Ladwig, K. H., Linkohr, B., ... & Grill, E.
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(2020). The times we are born into and our lifestyle choices determine our health trajectories in older age - Results from the KORA-Age study. Preventive medicine, 133, 106025
Stephan, A. J., Strobl, R., Schwettmann, L., Meisinger, C., Ladwig, K. H., Linkohr, B., Thorand, B., Peters, A., & Grill, E.
