Survival, disabilities in activities of daily living, and physical and cognitive functioning among the oldest-old in China: a cohort study
Open accessAbstract
Background The oldest-old (those aged ≥80 years) are the most rapidly growing age group globally, and are most in need of health care and assistance. We aimed to assess changes in mortality, disability in activities of daily living, and physical and cognitive functioning among oldest-old individuals between 1998 and 2008.Methods We used data from the Chinese Longitudinal Healthy Longevity Study. Three pairs of cohorts aged 80-89 years, 90-99 years, and 100-105 years (in total, 19 528 oldest-old participants) were examined; the two cohorts in each pair were born 10 years apart, with the same age at the time of the assessment in the 1998 and 2008 surveys. Four health outcomes were investigated: annual death rate, Activities of Daily Living (ADL), physical performance in three tests and cognitive function measured by Mini-Mental State Examination (MMSE). We used different tests and multivariate regression analyses to examine the cohort differences.Findings Controlling for various confounding factors, we noted that annual mortality among oldest-old individuals was substantially reduced between 0·2% and 1·3% in 1998-2008 compared with individuals of the same age born 10 years previously, and that disability according to activities of daily living had significantly reduced annually between 0·8% and 2·8%. However, cognitive impairment in the later cohorts increased annually between 0·7% and 2·2% and objective physical performance capacity (standing up from a chair, picking up a book from the floor, and turning around 360°) decreased anually between 0·4% and 3·8%. We also noted that female mortality was substantially lower than male mortality among the oldest-old, but that women's functional capacities in activities of daily living, cognition, and physical performance were worse than their male counterparts.Interpretation Advances in medications, lifestyle, and socioeconomics might compress activities of daily living disability, that is, benefits of success, but lifespan extension might expand disability of physical and cognitive functioning as more frail, elderly individuals survive with health problems, that is, costs of success.Funding National Natural Science Foundation of China, National Institute on Aging/National Institutes of Health, United Nations Funds for Population Activities.
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In a Chinese longevity study of the oldest old, compression of activities of daily living disability occurred, but life-span extension was associated with expansion of physical and cognitive disability because more frail elderly survived health problems.
“In this study, there was compression of activities of daily living disability, but life-span extension was associated with expansion of disability of physical and cognitive functioning because there were more frail elderly who survived health problems.175”
From Defining Optimal Brain Health in Adults: A Presidential Advisory From the American Heart Association/American Stroke Association (2017) · cites this paper as [175]
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- Authors
- Zeng, Y., Feng, Q., Hesketh, T., Christensen, K., & Vaupel, J. W.
- Affiliations
- Duke University (US)
- National University of Singapore (SG)
- University College London (GB)
- University of Southern Denmark (DK)
- Max Planck Institute for Demographic Research (DE)
- Corresponding author
- Zeng, Yi
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2017-04
- Volume
- 389
- Issue
- 10079
- Pages
- 1619-1629
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC5406246
- OpenAlex
- W2592677865
- Cited by
- 837
- References
- 31
- Citations by year
- 2026: 77 · 2025: 142 · 2024: 143 · 2023: 125 · 2022: 110 · 2021: 91 · 2020: 68 · 2019: 44 · 2018: 23 · 2017: 12 · 2016: 1
- FWCI
- 37.75
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- DukeSpace (Duke University) (submittedVersion, cc-by-nc-nd)
- UCL Discovery (University College London) (submittedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion)
- Funders
- National Natural Science Foundation of China (71110107025, 71233001, 71490732)
- National Institute on Aging/National Institutes of Health (R01AG023627-10; 2P01AG031719)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Aging and Gerontology Research
- Keywords
- oldest old, mortality trends, activities of daily living disability, physical performance, cognitive function, cognitive impairment, sex differences in aging, cohort differences, lifespan extension, Chinese Longitudinal Healthy Longevity Survey, China
- MeSH terms
- Activities of Daily Living, Age Factors, Aged, 80 and over, China, Cognition, Female, Humans, Longevity, Longitudinal Studies, Male, Psychomotor Performance, Surveys and Questionnaires, Cohort Studies, Exercise, Geriatric Assessment
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