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Forecasts of life expectancy are an important component of public policy that influence age-based entitlement programs such as social security and Medicare. An analysis carried out in relation to the effect of obesity on longevity concludes that the steady rise in life expectancy during the past two centuries may soon come to an end.

Background. This study compares mortality outcomes of Medicaid-reimbursed nursing home residents with and without do-not-resuscitate (DNR) orders in two diverse states. Methods. We used 1994 Minimum Data Set Plus (MDS+) information on 3215 nursing home residents from two states. We used Kaplan-Meier analyses to examine unadjusted mortality among those with and without DNR orders across states. We used a proportional hazard regression with main and interaction variables to model the likelihood of survival in the nursing home. Results. Approximately 27% of nursing home residents with DNR orders in State A die within the year, and approximately 40% of nursing home residents with DNR orders in State B die within the year. Regression results indicate that neither having a DNR order nor state of residence were independently associated with mortality. However, residing in State B and having a DNR order was associated with an increased risk of mortality compared with all others in the sample (risk ratio = 1.73; 95% confidence interval = 1.09, 2.75). Conclusion. This study demonstrates that DNR orders are associated with varying mortality across states. Future research is needed to identify the reasons why state level differences exist.

Objectives. This study examines the relationship between prior living arrangements and average activities of daily living (ADL) function upon nursing home admission across two states. Methods. Minimum Data Set Plus records from 1993 and 1994 on 4,837 Medicaid reimbursed nursing home residents aged 65 years and older from two states were used. Medicaid reimbursed residents were chosen because Medicaid reimbursement policies differ at the state level, and such differences might affect admission characteristics across states. Ordinary least squares models were used to examine the correlates of the number of ADL limitations (range 0-7) upon nursing home admission. Results. Residents in state A had a mean of 5.36 ADL limitations, whereas residents in state B had a mean of 4.83 limitations. Those who lived alone entered the nursing home with 0.61 fewer ADL limitations (p < .001) than those who lived with others. Living alone in state A reduced this association through an increase of 0.31 ADL limitations (p = .012). Discussion. Older Medicaid recipients who live alone enter the nursing home with better physical function than those who live with others. The difference in function between those who live alone and those who live with others varies across the two states.

Background. The Patient Self-Determination Act of 1991 requires that nursing homes reimbursed by Medicare or Medicaid inform all residents upon admission of their rights to enact care directives in the event of terminal illness. This study investigated the relationship between care directive use and resident functional status. Methods. We analyzed a version of the Minimum Data Set (MDS+) from a single state. We selected residents who were admitted to a nursing home in the first half of 1993 and followed them in the nursing home through the end of 1994. We created logistic models to examine independent correlates associated with having an advance directive or a do-not-resuscitate (DNR) order on admission. We then created similar logistic models to examine independent correlates associated with writing an advance directive or DNR order subsequent to admission. Results. Of the 2,780 residents, 11% (292) had advance directives and 17% (466) had DNR orders upon admission. Of those without care directives upon admission, 6% (143) subsequently had an advance directive and 15% (339) subsequently had a DNR order. Cross-sectionally, older individuals and whites were more likely to have a care directive. Having poor cognitive and physical function was associated with having a DNR order upon admission. Longitudinally, longer stayers and whites were more likely to have an advance directive. Residents who lost physical function were more likely to have an advance directive and those who lost cognitive function were more likely to have a DNR order. Conclusions. Care directive use is influenced by a number of sociodemographic and functional characteristics.

Most elderly patients who receive gastrostomies while hospitalized appear to die within three years. Gastrostomies are feeding tubes placed through the abdomen to supply nutrition to patients who cannot or will not eat. Researchers reviewed 81,105 Medicare patients over 65 years of age who received gastrostomy tubes. Fifteen percent died while hospitalized, and 24% died within 30 days of discharge. The mortality rate continued to rise after discharge, and 81% of gastrostomy patients died within three years of feeding tube placement.

This paper describes the allcause mortality experience, following a fracture of the hip, of 712027 persons covered by the Medicare program from 1984 through 1987. White women experienced the lowest mortality rate (17.2 per 1000 person-months), followed by Black women (22.9 per 1000 person-months), Black men (33.5 per 1000 person-months), and White men (33.7 per 1000 person-months). The observed race-sex differences in survival were found at all ages and regardless of the number of comorbid conditions listed with the discharge diagnosis. While these data demonstrate marked race-sex differences in survival following hip fracture, the cause of these differences is not immediately apparent and demands further investigation. (Am J Public Health. 1992;82:1147-1150)

Results from a study of mortality statistics for the US from the years 1950 through 1986 are presented, with particular focus on rates for the six major causes of death: heart disease, malignant neoplasms (commonly lumped together as 'cancer'), cerebrovascular disease (which affects the blood vessels in the brain), injuries, chronic obstructive lung disease (COPD), and pneumonia and influenza (which are considered as one category). Because perinatal conditions (disorders in the weeks before and after childbirth) were a major cause of death before 1970, these rates were also analyzed. Results showed a decline in all-cause mortality (deaths due to all causes; all rates expressed per 100,000 population) during the time surveyed from 963.8 to 873.2 deaths. The age-adjusted rate dropped from 841.5 to 541.7 deaths, a decrease of almost 36 percent. The death rates due to heart disease, and pneumonia, and influenza have remained constant, while those for cerebrovascular disorders, injuries, and perinatal conditions have decreased. Mortality due to malignant neoplasms and COPD has increased. If life is divided into four main segments, a leading cause of death is associated with each: birth to 1 year, perinatal conditions; 1 through 34 years, injuries; 35 through 64 years, cancer; and 65 years and older, heart disease. A discussion is presented of the classification system for heart disease. Injuries are the most significant cause of lost years of life before age 65; some consider injuries to be the most important public health problem today. To improve death rates, controlling alcohol and tobacco intake, and reducing cholesterol levels and blood pressure will be necessary. Given current trends, the proportion of people in the US greater than 80 years of age will increase. For them, heart disease is the main killer, and further research into its causes is warranted. (Consumer Summary produced by Reliance Medical Information, Inc.)

Objectives. One-fourth of all deaths in the United States occur after age 85 (646,900 of 2,392,619 total deaths in 1999). By 2050 (assuming 1999 age-specific death rates), 47.4% of all deaths will occur after age 85 (2,994,935 of 6,314,725 total deaths). As we age, heart disease becomes increasingly important relative to cancer as a cause of death. Thus, as age at death is postponed, future populations will be dying of different age-specific causes. The study objective was to project the effect of population aging on future proportionate mortality rates for heart disease and cancer. Methods. Using Census Bureau population projections and assuming 1999 age-specific death rates, the authors calculated the number of deaths from heart disease, cancer, and all causes in 10-year intervals from 2000 to 2050. Results. During this period, the total number of deaths for heart disease and cancer will increase 2.8-fold and 2.3-fold, respectively. The proportionate mortality rate for heart disease will increase from 30% to 33%, and the rate for cancer will drop from 23% to 20%. Discussion. Changes in age distribution between now and 2050 will cause heart disease to increase its dominance over all other causes of death, and proportionate mortality for cancer will decline.

Abstract A new scientific discipline arose in the late 20th century known as biodemography. When applied to aging, biodemography is the scientific study of common age patterns and causes of death observed among humans and other sexually reproducing species and the biological forces that contribute to them. Biodemography is interdisciplinary, involving a combination of the population sciences and such fields as molecular and evolutionary biology. Researchers in this emerging field have discovered attributes of aging and death in humans that may very well change the way epidemiologists view and study the causes and expression of disease. In this paper, the biodemography of aging is introduced in light of traditional epidemiologic models of disease causation and death.

Fracture of the hip occurs frequently and is a major cause of morbidity and mortality among women over the age of 65 in the US. The incidence of hip fractures varies by geographic region. The Health Care Financing Administration (HCFA) and the Department of Veterans Affairs (VA) maintain computerized databases of records of hospital discharges. Medical records of white women aged 65 and older were selected to determine the incidence of hip fracture by county of residence. A north-to-south geographic pattern was noticed, with higher rates of hip fracture in the South and lower rates in the North. A cluster of high incidence was noted in the counties in the southeastern US. A positive association was noted between hip fracture incidence and poverty level. There was a weak association between county fluoridated water supply and hip fracture incidence. Several hypotheses have been proposed to explain the increased incidence of hip fracture in the South. Incidence of traumatic falls leading to hip fracture, and risk factors for osteoporosis, such as dietary fluoride and calcium consumption, sunlight exposure, physical activity, alcohol use, and smoking, may be factors to examine further. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hip fracture is a major cause of illness and death among the elderly in the United States. Previous studies have determined that broken hips are more common among white women than white men, black women, and black men. The differences in risk for hip fracture among these last three groups have not been determined. Medicare records concerning hospitalization for hip fracture from 1980 to 1982 were analyzed; the patients were Illinois residents over age 65. Data were examined according to the race, age and sex of the patients. The rate of hip fracture was highest for white women and lowest for black men; white men and black women had intermediate rates of hip fracture. The percentage of patients who died during their hospital stay was: white women, 5 percent; black women, 8.2 percent; black men, 9.3 percent; and white men, 10.5 percent. The rate of discharge to nursing homes was: white women, 54 percent; black women, 30 percent; black men, 32 percent; and white men, 49 percent. These findings are in agreement with earlier studies of the demographics of hip fracture risk. (Consumer Summary produced by Reliance Medical Information, Inc.)