Academic literature on the topic 'Old-age mortality compression'

This paper examines adult and old-age mortality differentials in Canada between 1930 and 2007 at the provincial level, using theCanadian Human Mortality Database and the flexible smoothing P-spline method in two-dimensions well-suited to the study of smallpopulations. Our analysis reveals that provincial disparities in adult mortality in general, and among the elderly population in particular,are substantial in Canada. Moreover, based on the modal age at death and the standard deviation of ages at death above the mode,provincial disparities at older ages have barely reduced over time, despite the great mortality improvements in all provinces since the early 20th century. In the last few years studied, evidence of the shifting mortality regime was found among females in most Western and Central provinces, while all males were still undergoing an old-age mortality compression regime.

“Active aging” connotes a radically nontraditional paradigm of aging which posits possible improvement in health despite increasing longevity. The new paradigm is based upon postponing functional declines more than mortality declines and compressing morbidity into a shorter period later in life. This paradigm (Compression of Morbidity) contrasts with the old, where increasing longevity inevitably leads to increasing morbidity. We have focused our research on controlled longitudinal studies of aging. The Runners and Community Controls study began at age 58 in 1984 and the Health Risk Cohorts study at age 70 in 1986. We noted that disability was postponed by 14 to 16 years in vigorous exercisers compared with controls and postponed by 10 years in low-risk cohorts compared with higher risk. Mortality was also postponed, but too few persons had died for valid comparison of mortality and morbidity. With the new data presented here, age at death at 30% mortality is postponed by 7 years in Runners and age at death at 50% (median) mortality by 3.3 years compared to controls. Postponement of disability is more than double that of mortality in both studies. These differences increase over time, occur in all subgroups, and persist after statistical adjustment.

In recent years, economic and social historians have made increasing use of anthropometric records (principally, records of human height and weight) to investigate changes in human health and well-being. This paper summarises some of the main findings of this research and demonstrates the remarkable increases in human height which have occurred during the course of the present century. The paper also examines the relationship between changes in average height and changes in life expectancy. Although most of the evidence assembled by anthropometric historians has been derived from records relating to schoolchildren and young adults, their work has profound implications for the study of health in old age. The concluding section examines the relevance of this work to current debates on the decline of mortality, the ‘compression of morbidity’ and the future of social policy.

Introduction: Tracheomalacia can result from long-standing compression by a large goiter. The cartilaginous rings of the trachea may be weakened or destroyed by long-standing compression, causing loss of structural support. Tracheomalacia after resectioning of benign goiter compressing trachea was an important issue. It has extended the time of mechanical ventilation, increased the risk of failure extubating and mortality. Materials and Methods: Descriptive and prospective study. From November 2014 to January 2017, we have collected 102 patients who had benign goiter compressing trachea and had thyroidectomy. Tracheomalacia was diagnosed and managed intra and postoperatively. Results: Recognition of women accounted for the majority of 81.4%. The average age was 54.5 years old and the average duration of goiter was 5 years. The patients were hospitalized with the main symptom of dysphagia accounting for 21.6% and difficulty breathing when lying down was 16.7%. On CT scan, the average Goiter was 270g, the average narrow airway diameter was 8.4 mm, of which 12.7% of patients had narrow tracheal diameter <5mm. The rate of tracheomalacia was 4.9%. There were statistically significant differences between the 2 groups with and without tracheomalacia: elderly patients (p = 0.041); goiter long-standing time (p = 0.07); symptoms of positional dyspnea on lying (p = 0.003) and tracheal diameter compressed (p = 0.001). Conclusion: Tracheomalacia should be noted in patients older than 65 years old, goiter exist longer than 5 years and goiter is over 200g.

BACKGROUND: Olfactory groove meningiomas comprise 4-10% of the intracranial meningiomas. Generally they give signs of brain compression due to great size they reach before diagnosis. In this study, the clinical outcome of patients with olfactory groove meningiomas surgically treated was analyzed. METHOD: 17 patients operated on from 1988-2006. Female: 16, Male: 1. Age: 19-76 years-old (mean=53.12± 13.11). Follow-up: 1-209 months (mean=51.07±12.73. Bifrontal/bifrontal-bi-orbital approaches were used. Outcome was analyzed using survival/recurrence-free Kaplan-Mayer curves. RESULTS:16 had WHO grade 1; one grade 2 meningiomas. Resection Simpson's grade 1 was in achieved in 64.7%, grade 2 in 29.4% and grade 3 in 5.9%. There was no recurrence during the follow-up. Global and operative mortality were 11.8%. Main postoperative complications were osteomielitis (11.8%) and pneumonia (5.9%). CONCLUSION: Extensive approaches allowed total resection of most olfactory groove meningiomas with no recurrence during the follow-up, but operative mortality and local complications were high.

<p class="abstract"><strong>Background:</strong> Proximal femoral fractures are one of the most common fractures in old age patients. Fixation of these fractures is technically high demanding owing to the high risk of complications. The aim of our study is to analyze the outcomes of proximal femoral locking compression plate (PF-LCP) in these fractures.</p><p class="abstract"><strong>Methods:</strong> We retrospectively analyzed 18 proximal femoral fractures treated with PF-LCP from May 2012 to May 2015. There were 12 females (67%) and six males (33%) with an average age of 59.6 years (range, 32 to 84 years). The peritrochanteric fractures constituted by intertrochanteric and subtrochanteric fractures were classified by Boyd and Griffin classification along with Seinshemier’s classification, respectively. Among that, 14 cases (77%) were of intertrochanteric and four cases (23%) were of subtrochanteric fracture pattern. The functional outcome was evaluated by harris hip score and the parker palmer mobility score one year after surgery.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among 18 patients, 16 patients obtained fracture union without further intervention; two patients required additional bone grafting. There were no cases of hip screw cutting the femoral head. There was no post-operative mortality in our study. The average harris hip score was 85.5 (83-94). The assessment by parker and palmar mobility score was 7.6 (range 4-9).</p><strong>Conclusions:</strong> The PF-LCP is a good stable alternative in the treatment of complex proximal femoral fractures. It provides good to excellent bone healing with limited complications.

Introduction: Deep vein thrombosis (DVT) can lead to significant morbidity and mortality if not diagnosed and treated promptly. Currently, few methods aside from venous duplex scanning can rule out DVT in patients presenting to the Emergency Department (ED). Current screening tools, including the use of the subjective Wells score, frequently leads to unnecessary investigations and anticoagulation. In this study, we sought to determine whether two-site compression point-of-care ultrasound (POCUS) combined with a negative age-adjusted D-dimer test can accurately rule out DVT in ED patients irrespective of the modified Wells score. Methods: This is a single-center, prospective observational study in the ED of the Jewish General Hospital in Montreal. We are recruiting a convenience sample of patients presenting to the ED with symptoms suggestive of DVT. All enrolled patients are risk-stratified using the modified Wells criteria for DVT, then undergo two-site compression POCUS, and testing for age-adjusted D-dimer. Patients with DVT unlikely according to modified Wells score, negative POCUS and negative age-adjusted D-dimer are discharged home and receive a three-month phone follow-up. Patients with DVT likely according to modified Wells score, a positive POCUS or a positive age-adjusted D-dimer, will undergo a venous duplex scan. A true negative DVT is defined as either a negative venous duplex scan or a negative follow-up phone questionnaire for patients who were sent home without a venous duplex scan. Results: Of the 42 patients recruited thus far, the mean age is 56 years old and 42.8% are male. Twelve (28.6%) patients had DVT unlikely as per modified Wells score, negative POCUS and negative age-adjusted D-dimer and were discharged home. None of these patients developed a DVT on three-month follow-up. Thirty patients (71.4%) had either a DVT likely as per modified Wells score, a positive POCUS or a positive age-adjusted D-dimer and underwent a venous duplex scan. Of those, six patients had a confirmed DVT (3 proximal & 3 distal). POCUS detected all proximal DVTs, while combined POCUS and age-adjusted D-dimer detected all proximal and distal DVTs. None of the patients with a negative POCUS and age-adjusted D-dimer were found to have a DVT. Conclusion: Two-site compression POCUS combined with a negative age-adjusted D-dimer test appears to accurately rule out DVT in ED patients without the need for follow-up duplex venous scan. Using this approach would alleviate the need to calculate the Wells score, and also reduce the need for radiology-performed duplex venous scan for many patients.

The ageing of the population is a contemporary phenomenon, but its foundations were laid decades ago. Changing age structures and the consequent demographic ageing has only recently become the subject of theoretical (re)consideration, since the theory of demographic transition only values fertility and mortality trajectories. The emergence of ?new? demography takes into account the momentum created by the previous trends in population dynamics and explains the future rejuvenation or ageing of the population. The importance of inherited age structure can be illustrated using an approach that represents distorted cohort flows, showing that baby booms and baby busts can play a crucial role in the future ageing of the population. While in the past it was fertility that predominantly affected age structure, recent research has revealed that changes in life expectancy are becoming a more prominent factor in shaping expected population ageing trends. The general theory of population ageing would have to consider the possible compression of morbidity, dynamic equilibrium, or the expansion of morbidity, since the future course of (healthy) life expectancy is determining the scope of the old and fragile population. The status of theory in demography has long been problematic, since the ?grandiose? theory of demographic transition had to be reevaluated. Modern approaches apply more flexible theoretical frameworks to explain contemporary demographic changes and provide a conceptual background. As such, the important paradigm for the demography of ageing should be the prospective paradigm, which uses information about the longevity of the population and transposes it to population ageing research. The theory of population metabolism seems to adequately define why population ageing is important for cohorts and generation change, especially in cases where distorted cohort flows create prominent cohort oscillation. The need to create adequate policies for changing age composition morphology is highlighted in the domain of institutional adaptation, where the concept of population balance can provide the appropriate framework. Also, as life events tend to take place more often at certain points in the life cycle - for example during adulthood and entering old age - the idea of population densities should be further explored.

Abstract Background: Multiple endocrine neoplasia type 1 (MEN1) is an inherited tumor syndrome with autosomal dominant inheritance. Thymic neuroendocrine tumors (NETs) are known manifestations of MEN1 occurring in 2-8% of patients. However, thymomas, a type of thymic epithelial tumors, have only been described in rare case reports. They markedly differ from thymic NETs in their natural history, morphology, prognosis, and therapeutic options. Here we present a case of an aggressive, recurrent thymoma associated with MEN1. Case Report: A 58-year-old Caucasian female with a family history of MEN1 was diagnosed with a prolactinoma at age 15 when she presented with irregular menses, galactorrhea, headaches and visual field defects. She was referred to our institution for further evaluation where genetic testing confirmed the diagnosis of MEN1. Throughout the years, she developed primary hyperparathyroidism, non-functional pancreatic neuroendocrine tumors, Zollinger-Ellison syndrome, bilateral adrenal hyperplasia, and bronchial carcinoid. At the age of 49, magnetic resonance imaging (MRI) and computed tomography (CT) scan of the chest incidentally demonstrated a 2.5 x 6 x 10-cm anterior mediastinal mass, with marked compression of the left brachiocephalic vein and encasement of the superior vena cava. Biopsy was consistent for malignant cells of thymic epithelial origin. A median sternotomy with en bloc resection with SVC resection and reconstruction, mediastinal lymph node dissection and placation of the right hemidiaphragm were performed. Pathology revealed WHO type B3 thymoma extending into the pulmonary parenchyma with positive tissue margins but negative lymph node involvement. Following surgery, she underwent adjuvant radiation therapy with a total dose of 59 Gy. Annual screening showed disease remission. However, nine years after initial presentation, surveillance CT scans revealed a pleural base mass with mass effect on the superior portion of the IVC, as well as hypoattenuated masses within the liver. Positron emission tomography with fluorodeoxyglucose (18FDG PET-CT) confirmed multiple metastatic lesions involving thorax and abdomen. Biopsy of the retrocaval soft tissue subxiphoid mass revealed epithelioid cells in a background of lymphocytes consistent with recurrent thymoma. She was subsequently staged as IV B thymoma and was recommended to start systemic chemotherapy. Conclusion: We described a case of an aggressive thymoma in a patient with MEN1 syndrome demonstrating that their association exists and the clinical presentation can be aggressive. Thus, it is important for practitioners to screen for thymic tumors routinely in patients with MEN1 for early detection as they can be a major cause of mortality. Although further studies are needed, improving the detection of these tumors could significantly contribute to reducing MEN1-related deaths.

Au cours du siècle dernier, nous avons pu observer une diminution remarquable de la mortalité dans toutes les régions du monde, en particulier dans les pays développés. Cette chute a été caractérisée par des modifications importantes quant à la répartition des décès selon l'âge, ces derniers ne se produisant plus principalement durant les premiers âges de la vie mais plutôt au-delà de l'âge de 65 ans. Notre étude s'intéresse spécifiquement au suivi fin et détaillé des changements survenus dans la distribution des âges au décès chez les personnes âgées. Pour ce faire, nous proposons une nouvelle méthode de lissage non paramétrique souple qui repose sur l'utilisation des P-splines et qui mène à une expression précise de la mortalité, telle que décrite par les données observées. Les résultats de nos analyses sont présentés sous forme d'articles scientifiques, qui s'appuient sur les données de la Human Mortality Database, la Base de données sur la longévité canadienne et le Registre de la population du Québec ancien reconnues pour leur fiabilité. Les conclusions du premier article suggèrent que certains pays à faible mortalité auraient récemment franchi l'ère de la compression de la mortalité aux grands âges, ère durant laquelle les décès au sein des personnes âgées tendent à se concentrer dans un intervalle d'âge progressivement plus court. En effet, depuis le début des années 1990 au Japon, l'âge modal au décès continue d'augmenter alors que le niveau d'hétérogénéité des durées de vie au-delà de cet âge demeure inchangé. Nous assistons ainsi à un déplacement de l'ensemble des durées de vie adultes vers des âges plus élevés, sans réduction parallèle de la dispersion de la mortalité aux grands âges. En France et au Canada, les femmes affichent aussi de tels développements depuis le début des années 2000, mais le scénario de compression de la mortalité aux grands âges est toujours en cours chez les hommes. Aux États-Unis, les résultats de la dernière décennie s'avèrent inquiétants car pour plusieurs années consécutives, l'âge modal au décès, soit la durée de vie la plus commune des adultes, a diminué de manière importante chez les deux sexes. Le second article s'inscrit dans une perspective géographique plus fine et révèle que les disparités provinciales en matière de mortalité adulte au Canada entre 1930 et 2007, bien décrites à l'aide de surfaces de mortalité lissées, sont importantes et méritent d'être suivies de près. Plus spécifiquement, sur la base des trajectoires temporelles de l'âge modal au décès et de l'écart type des âges au décès situés au-delà du mode, les différentiels de mortalité aux grands âges entre provinces ont à peine diminué durant cette période, et cela, malgré la baisse notable de la mortalité dans toutes les provinces depuis le début du XXe siècle. Également, nous constatons que ce sont précisément les femmes issues de provinces de l'Ouest et du centre du pays qui semblent avoir franchi l'ère de la compression de la mortalité aux grands âges au Canada. Dans le cadre du troisième et dernier article de cette thèse, nous étudions la longévité des adultes au XVIIIe siècle et apportons un nouvel éclairage sur la durée de vie la plus commune des adultes à cette époque. À la lumière de nos résultats, l'âge le plus commun au décès parmi les adultes canadiens-français a augmenté entre 1740-1754 et 1785-1799 au Québec ancien. En effet, l'âge modal au décès est passé d'environ 73 ans à près de 76 ans chez les femmes et d'environ 70 ans à 74 ans chez les hommes. Les conditions de vie particulières de la population canadienne-française à cette époque pourraient expliquer cet accroissement.
Over the course of the last century, we have witnessed major improvements in the level of mortality in regions all across the globe, in particular in developed countries. This remarkable mortality decrease has also been characterized by fundamental changes in the mortality profile by age. Indeed, deaths are no longer occurring mainly at very young ages but rather at advanced ages such as above age 65. Our research focuses on monitoring and understanding historical changes in the age-at-death distribution among the elderly population. We propose a new flexible nonparametric smoothing approach based on P-splines leading to detailed mortality representations, as described by actual data. The results are presented in three scientific papers, which rest upon reliable data taken from the Human Mortality Database, the Canadian Human Mortality Database, and the Registre de la population du Québec ancien. Findings from the first paper suggest that some low mortality countries may have recently reached the end of the old-age compression of mortality era, where deaths among the elderly population tend to concentrate into a progressively shorter age interval over time. Indeed, since the early 1990s in Japan, the modal age at death continues to increase while reductions in the variability of age at death above the mode have stopped. Thus, the distribution of age at death at older ages has been sliding towards higher ages without changing its shape. In France and Canada, women show such developments since the early 2000s, whereas men are still boldly engaged in an old-age mortality compression regime. In the USA, the picture for the latest decade is worrying because for several consecutive years in that timeframe, women and men have both recorded important declines in their modal age at death, which corresponds to the most common age at death among adults. The second paper takes a look within national boundaries and examines regional adult mortality differentials in Canada between 1930 and 2007. Smoothed mortality surfaces reveal that provincial disparities among adults in general and among the elderly population in particular are substantial in this country and deserve to be monitored closely. More specifically, based on modal age at death and standard deviation above the mode time trends, provincial disparities at older ages have barely reduced during the period studied, despite the great mortality improvements recorded in all provinces since the early XXth century. Also, we find that women who have reached the end of the old-age compression of mortality era in Canada are respectively those of Western and Central provinces. The last paper focuses on adult longevity during the XVIIIth century in historical Quebec and provides new insight on the most common adult age at death. Indeed, our analysis reveals that the modal age at death increased among French-Canadian adults between 1740-1754 and 1785-1799. In 1740-1754, it was estimated at 73 years among females and at about 70 years among males. By 1785-1799, modal age at death estimates were almost 3 years higher for females and 4 years higher for males. Specific living conditions of the French-Canadian population at the time could explain these results.