Evidence for Decline in Disability and Improved Health Among Persons Aged 55 to 70 Years: The Framingham Heart Study.

Evidence for Decline in Disability and Improved Health Among Persons Aged 55 to 70 Years: The Framingham Heart Study Allaire SH, LaValley MP, Evans SR, et al (Multipurpose Arthritis and Musculoskeletal Diseases Center, Boston University; Department of Neurology, Boston University School of Medicine; Boston University School of Public Health, Boston, Mass; Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Mass), Am J Public Health. 1999;89: 1678-1683.

This investigation analyzed data from the Framingham Heart Study (FHS) to determine whether there were secular changes in disability and health in2 generational cohorts. Comparisons were made between the original FHS subjects aged 55 to 70 years (n = 1,760) and their offspring and spouses (n = 1,688), who were in the same age range during this study as their parents were at the start of the original study. This study focused on this age group because, during this phase of the life course, age-related increases in the prevalence of disability and decline in health as well as retirement generally Occur.

Data collection was carried out employing a variety of assessments to ascertain cohort differences in disability, health, and demographic characteristics. Three measurements of disability were conducted: (1) physical activity (ie, pushing or pulling large objects; stooping, kneeling and crouching; reaching above and below shoulder level; handling small objects; standing longer than 15 minutes; sitting for 1 hour or more; lifting less than and more than 10 pounds), (2) gross motor function (ie, walking a half mile, walking up and down stairs to the second floor, doing heavy house work), and (3) activities of daily living (eg, bathing, dressing, eating, transferring). Ratings for the 3 measures were related to difficulty in performance or need for help from a device or person.

Self-perceived general health status was measured, and the prevalence of specific chronic diseases was determined. The chronic diseases of interest were cardiovascular diseases (including myocardial infarction, angina pectoris, congestive heart failure, stroke, and intermittent claudication, hypertension), diabetes, chronic obstructive pulmonary disease, and arthritis. Health behaviors were measured in terms of physical activity (ie, the amounts of rest and activity in a typical day, weight, smoking, alcohol consumption). Specific demographic characteristics were assessed, including age, sex, marital status, education, and employment status.

Cross-sectional comparisons of cohorts were done based on sex and adjusting for age differences between the samples. In addition, 2 subgroups were examined: individuals with chronic disease, and those without chronic disease. A subset of individuals with cardiovascular diseases was also analyzed.

An extensive analysis generated the following findings. Demographically, more women from the offspring cohort were married and were employed compared with women in the original cohort, whereas fewer men from the offspring cohort were employed compared with men in the original cohort. Demographic analysis also indicated that both men and women in the offspring sample achieved a higher education than their original cohort counterparts.

In general, the offspring cohort, as opposed to the original cohort, was found to have less disability and lower rates of chronic diseases, with the exception of diabetes; and fewer members of the offspring cohort perceived their health to be fair or poor. Subjects from the offspring cohort were more physically active, especially women, and less apt to smoke or ingest large amounts of alcohol. Both sexes among the offspring cohort, however, had increased body weight.

According to the researchers, the results suggest that disease prevention and health promotion activities have had positive effects. The authors indicated that a possible modulating factor was the higher education achievement of the offspring cohort. One problem that seemed inconsistent with the trend toward improved health was the increasing weight among the offspring cohort. They concluded that the findings indicate a secular change leading to not only a less disabled population, particularly among those persons with chronic diseases, but also a healthier population during the life period in which retirement usually takes place.

Ruth U Mitchell, PT, PhD The University of North Carolina at Chapel Hill Chapel Hill, NC