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Scooped by Seth Bilazarian, MD
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Good health lasts later in life

Good health lasts later in life | Heart and Vascular Health | Scoop.it

Based on data from the Medicare Current Beneficiary Survey, investigators found that, even as life expectancy has increased over the past two decades, people have become increasingly healthy later in life.

“With the exception of the year or two just before death, people are healthier than they used to be,” “Effectively, the period of time in which we’re in poor health is being compressed until just before the end of life. So where we used to see people who are very sick for the final six or seven years of their life, that’s now far less common.  People are living to older ages and we are adding healthy years, not debilitated ones.”

“There are two basic scenarios that people have proposed about the end of life,” “The first argues that what medical science is doing is turning us into light bulbs — that is, we work well until suddenly we die. This is also called the rectangularization of the life curve, and what it says is that we’re going to have a fairly high quality of life until the very end.

“The other idea says life is a series of strokes, and medical care has simply gotten better at saving us,” “So we can live longer because we’ve prevented death, but those years are not in very good health, and they are very expensive — we’re going to be in wheelchairs, in and out of hospitals and in nursing homes.”

Different studies have produced competing results. One reason for the confusion, is that such efforts are simply looking at the wrong end of someone’s life.  “Most of our surveys measure health at different ages, and then use a model to estimate how long people have to live,” he said.  “But the right way to do this is to measure health backwards from death, not forwards. We should start when someone dies, then go back a year and measure their health, then go back two years, three years, and so on.”

Seth Bilazarian, MD's insight:

This notion that there is two ways reserachers can think about the end of life is completely compatible with what happens to senior patients followed in my cardiology office.  Half of the 80 - 100 year olds complain that "the golden years are not very golden".  The other half see the office visit as an inconvence to their active and busy lives.  They cant wait to get out of the office to keep the schedule they've made for golf. tennis, bowling, skiing or social interactions. 

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Simple Sit Test Predicts Long Life

Simple Sit Test Predicts Long Life | Heart and Vascular Health | Scoop.it
How well middle-age and older adults can get up off the floor may predict their chances of long-term survival.
Each additional support needed to get to and rise from a sitting position on the floor -- knee, hands, etc. -- was associated with a 21% lower chance of survival over about 6 years of follow-up in a trial online in the European Journal of Preventive Cardiology.
The survival odds differed by 5.44-fold between the highest and lowest scorers on the sit-rise test after adjustment for age, sex, and body mass index.
A maximum of 10 points was possible, 5 for sitting and 5 for rising without any supports. Each support (hand, forearm, knee, side of leg, or hand on the knee) used took away 1 point; and participants could lose an additional 0.5 points for an unsteady performance.

Over the median 6.3 years of follow-up for mortality in state vital status registries, nearly 8% of the cohort died. Sit-rise test scores tended to be poorer at older ages, but the association between all-cause mortality and score persisted with adjustment for age as well as sex and body mass index.

The hazard ratios compared with the highest-scoring, 8-to 10-point group were (all statistically significant):
5.44 for lowest scores (0 to 3 points)
3.44 for scores of 3.5 to 5.5
1.84 for scores of 6 to 7.5
Seth Bilazarian, MD's insight:

"Ability to rise from the floor reflects muscle strength, coordination, balance, and flexibility needed for getting up out of a chair, bending over to pick up an item, and various other daily activities and is also tied to risk of falls"

Physicians & patients can recognize frailty when they see it and several strategies to objectify this have been developed.  This simple test has appeal.  The hardest part of implementing this for health care providers might be NOT helping an elderly person get up off the floor.

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