The workshop on “Determinants of Health Longevity in China” (MPIDR), Rostock, Germany August 2-4, 2004 Lengthening of life and emergence of the oldest.

The workshop on “Determinants of Health Longevity in China”

(MPIDR), Rostock, Germany August 2-4, 2004

Lengthening of life and emergence of the oldest old: can we extend the healthy longevity

survey in Hong Kong?

By CHEUNG, S.L. Karen[1] YIP S. F. Paul[2], CHI Iris[3] and ROBINE Jean-Marie[4]

[1] Department of Demography, University of Rome “La Sapienza”[2] Department of Statistics and Actuary Science, The University of Hong Kong [3] Sau Po Ageing Centre, The University of Hong Kong [4] INSERM and Health and Demography team, Department of Biostatistics, University of Montpellier 1

Life expectancy at birth Vs

Modal length of life

Increase in life expectancy at birth and modal length of life, males and females

after the 1960s

55

65

75

85

95

1950 1960 1970 1980 1990 2000 2010

F_Mode

M_Mode

F_e0

M_e0

Increase in life expectancy at age 80, males and females, from 1971 to 2001

4

6

8

10

12

1965 1970 1975 1980 1985 1990 1995 2000 2005

Females

Males

Compression of mortality with normal indicators, males and females, 1976 and 2001

0

1000

2000

3000

4000

5000

0 20 40 60 80 100 120 140

1976

2001

Males

Infant mortality

Premature mortality

Highest value indicated by M+4SDM+

M

Lowest value indicated by M-4SDM+

0

1000

2000

3000

4000

5000

0 20 40 60 80 100 120 140

1976

2001

Females

Infant mortality

Premature mortality

M

Highest value indicated by M+4SDM+

Lowest value indicated by M-4SDM+

Three dimensions on the rectangularization of survival curve, males and females,

1976 and 2001

0.0

0.2

0.4

0.6

0.8

1.0

1.2

0 0.5 1 1.5 2

Normalized age

1976 Actual lx

1976 Theoretical lx

2001Actual lx

2001 Theoretical lx

Females

Max accelerationsymmetric to max deceleration

M

Maxdeceleration

M+4SD(M+)

M-4SD(M+)

lxlx

0.0

0.2

0.4

0.6

0.8

1.0

1.2

0 0.5 1 1.5 2

Normalized age

1976 Actual lx

1976 Theoretical lx

2001Actual lx

2001 Theoretical lx

Males

M-4SD(M+)

Max accelerationsymmetric to max deceleration

M

Maxdeceleration

M+4SD(M+)

lxlx

Objectives

1. Describe and monitor the change in oldest-old and centenarians in HK2. Collect, review and synthesize Health surveys since 1980s3. Explore the possibility to launch a Longitudinal Survey on Healthy Longevity in HK

Data sources

1. Micro Known Mortality dataset, 1976-20012. Census estimated and projected populations

Increase in the absolute number of deaths of oldest old by single age for both sexes,

from 1976 to 2001

0

200

400

600

800

1000

1200

1975 1980 1985 1990 1995 2000

80818283848586878889909192939495969798

Rate of increase in deaths of oldest old (logarithmic scale) by single age for both sexes,

from 1976 to 2001

10

100

1000

10000

1975 1980 1985 1990 1995 2000

80818283848586878889909192939495969798

Increase in the absolute number of deaths at age 99+, males and females,

from 1976 to 2001

0

50

100

150

200

250

300

1970 1975 1980 1985 1990 1995 2000 2005

Females

Males

Increase in the proportion of 65+, 75+ and 85+ for both sexes,

1961-2001, and prospects up to 2031

0

5

10

15

20

25

30

1961 1971 1981 1991 2001 2011 2021 2031 2041

%

65+

75+

85+

Increase in the absolute number of oldest old for both sexes, 1981-2001 (census years)

0

5

10

15

20

25

1981 1986 1991 1996 2001

Thousands

8081828384858687888990919293949596979899

Increase in the absolute number of oldest-old (aged 80+), males and females,

1981-2001 (census years)

0

20

40

60

80

100

1981 1986 1991 1996 2001

Thousands

Females

Males

Increase in the absolute number of centenarian (aged 100+), males and females,

1981-2001 (census years)

0

100

200

300

400

500

600

700

1981 1986 1991 1996 2001

Females

Males

Since the 1980s several studies conducted locally on various topics

among elderly populations…

…can we extend the Chinese Longitudinal Survey on Healthy

Longevity in Hong Kong?

Health Status survey in Hong Kong since 1980s by General Household Survey or government agenciesSURVEY YEARS AGE LIMITS INCLUDE POP

IN INSTITUTIONS (YES/NO)

Doctor Consultation (GHS-STR#1, 2, 6, 7, 10, 15 and SSS-THSR#3, 8, 12)

(Nov/1982-Jan/1983), (July1982, (Jan/1983 and Sept/1983), (Jan/1989), (July/1990), (Aug-Sept/1992), (May-June/1996), (Sept-Nov/1999), (Jan-May/2001), (May-July/2002)

No restriction

No

Hospitalization (GHS-STR#7, 8, 13, 21) (SSS-THSR#3, 8, 12)

(May-July/1982), (Nov/1982-Jan/1983), (Oct-Dec/1984), (Oct- Dec/1989), (July- Sept/1991), (April-Aug/1995), (April-June/1998), (Sept-Nov/1999), (Jan-May/2001), (May-July/2002)

No restriction

No

Health Status of the population in HK (GHS-STR#10, 15, SSS-THSR#3, 8, 12)

(July/1992), (May-June/1996), (Sept-Nov/1999), (Jan-May/2001), (May-July/2002)

No restriction

No

Socio-demographic, health and economic profiles of elderly people and soon-to-be old (GHS-STR#27)

(July-Sept/2000) Elderly people = 60+ Soon to be old people =45-59

No

Persons with disabilities and chronic diseases (GHS-STR#28)

(Jan-Dec/2000) (mid-June to mid-July/2000) for institutions survey

No Yes

Major Health Status survey among elderly populations in Hong Kong since 1980s by Universities

HKU SURVEY YEARS AGE

LIMITS SAMPLE SOURCE

A Health Survey of the Elderly in Hong Kong by Iris Chi and Lee

Conducted in Summer 1988

55+ Sampling frame of households formulated from the 1986 By-Census

An Evaluation Study of the Health Promotion Program for the Elderly in HK by Iris Chi and Leung

Conducted in Dec/1991-March/ 1992

55+ Recruited from the Adult Health Promotion Program of St James’ Settlement

Validation of Measuring Instruments of Mental Health Status of the Elderly in Hong Kong By Chi, Iris and K. W. Boey

Published in 1992

60+ (60-69; 70-79; 80+)

Either normal elderly of the adult Service Division or patients of the Psychogeriatric Assessment Clinic in St James’ Settlement.

A Mental Health and Social Support Study of the Old-Old in Hong Kong, by Chi, Iris and K. W. Boey

Conducted in Feb-April/ 1992, published in 1994

70-74; 75-79; 80-84; 85+

Drawn from the recipients of Special Needs Allowance, Old Age Allowance and Disability Allowance

Baptist College SURVEY YEARS AGE

LIMITS SAMPLE SOURCE

Health Status, Cognitive Functioning and Dementia Among Elderly Community Population in Hong Kong, by William Liu, et al

Conducted in 1991 Cooperated with Department’s General Household Survey.

65+ (65-74; 75+)

Frames of quarters

City University and Lingnan University SURVEY YEARS AGE

LIMITS SAMPLE SOURCE

A study of the long-term care needs, patterns and impact of the elderly in HK by Raymond Ngan et al

Conducted in March-August/1994

60+ From St. James Settlement and United Christian Hospital

A study of family support, friendship, and psychological well-being among older women in HK by Siu and Phillips

Conducted in Feb 1999

Women aged 60-85

Recruited from three social service centers for the elderly (i.e. Kwai Chung, Lei Muk Shue, and Shek Lei

Quality of life of the Chinese elderly in HK: preliminary findings from two focus groups studies by Alfred Chan, Cheng and Phillips

Started in August 1999

60+

Recruited through multi-service centers for the elderly

CU SURVEY YEARS AGE

LIMITS SAMPLE SOURCE

A cross-sectional survey of the residents of homes for the elderly By Suzanne Ho, Jean Woo, et al

Published in 1989

60-69; 70-79; 80-89; 90+

Shatin and Tai Po Districts only Included populations in institutions

A survey of functional status and chronic diseases among elderly Hong Kong Chinese By Suzanne Ho, Jean Woo, et al

A baseline survey conducted in July 1991 – July 1992, longitudinal 18-month & 36-month follow-up

Young old = 70-79 Old-old =80 years +

Recruited by random sampling of the Old Age and Disability Allowance Schemes Included populations in institutions

From regional community geriatric assessment teams in eight ha hospital clusters

(Chu and Pei, 1997)

A specified hospital (e.g. Tuen Mun Hospital) (Mok et al, 1997) Family medicine clinics (Lam, 2000) Government outpatient clinics (Wun, Lee, Chan, 1998)

Other surveys among elderly populations also

found in Hong Kong BUT…

Problem of existing survey data by GHS or Universities

1. Cross-sectional surveys2. No raw dataset available to public, only population estimates provided on request3. Selectively analyzed and presented results4. Datasets are underused5. District and/ or hospital – restricted/driven6. Bias – sample source7. Mainly cross-sectional surveys, only one longitudinal

by CU, but not available for public8. Proportional sampling design – insufficient sample sizes – especially, 90-99 and 100+ and suppress the heterogeneity of the oldest-old9. Grouped 85+, 80+, or even 75+ as one category

Research Niches

• No research explain why the proliferation of oldest-old and centenarians

• No research on how different factors (i.e. socio-economic, behavioral, environmental and biological factors) influence the healthy longevity to oldest old and centenarians

• Research on their needs (i.e. social, health, care and welfare needs) is rare

• Little research shows whether a longer life with a worsening health

Thank you!