[Effectiveness of "Active health promotion in old age" : Results regarding compression of morbidity by target groups in 13.8 years of observation in LUCAS]

Abstract

Background and objective: Healthy ageing as defined by the World Health Organization (WHO) is the development and maintenance of functional competence. Unfavourable ageing is described by the term frailty and is characterised by a decline in functional reserves. The frailty process can be influenced in a positive way. Previous interventions concerned mostly hospital patients and residents of nursing homes. In this study we examined the maintenance of functional competence in an urban community setting.

Material and methods: The programme "Active health promotion in old age" was carried out by a health advisory team with geriatric expertise for independent persons 60 years and older without disabilities. Its effectiveness was evaluated in the Longitudinal Urban Cohort Ageing Study (LUCAS) over a period of 13.8 years. Survival and disability-free survival were calculated separately for persons with a high level of functional competence (many reserves) and persons with few functional reserves, using Kaplan-Meier curves. Adjustments were made for unequal distribution of age, gender, educational level, chronic diseases and functional status using multivariate Cox regressions. This methodology facilitates the study of interrelationships between mortality and morbidity (compression of morbidity) including an impact from life style interventions.

Results: Participants with a high level of functional competence had longer disability-free lifes (p < 0.001), and their average proportion of life time with disability was shorter than either for non-participants, or those with low functional competence.

Conclusion: There is evidence from these analyses on compression of morbidity that the health promotion programme had its strongest effects in persons with high functional competence, exactly those people for whom it has been developed.

Keywords: Compression of morbidity; Frailty; Functional competence; Healthy ageing; Robust.