People Are Remaining Healthier Later in
Life
A new study, conducted by David
Cutler, the Otto Eckstein Professor of Applied Economics, shows that, even as
life expectancy has increased over the past two decades, people have become
increasingly healthier later in life.
"With the exception of the year
or two just before death, people are healthier than they used to be,"
Cutler said. "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, 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."
The study results are based on data
collected between 1991 and 2009 from nearly 90,000 individuals who responded to
the Medicare Current Beneficiary Survey (MCBS). Cutler reported these findings
in work with Mary Beth Landrum of Harvard Medical School and Kaushik Ghosh of
the National Bureau of Economic Research.
"There are two basic scenarios
that people have proposed about the end of life," he said. "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," he continued. "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."
While researchers have tried to
tackle the question of which model is more accurate, different studies have
produced competing results. One reason for the confusion, Cutler suggested, 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."
The MCBS allows researchers to do
just that, Cutler said, by linking survey responses to participants' Medicare
records for the rest of their life, meaning researchers can calculate -- in
some cases to the day -- exactly how far participants were from death when they
answered the survey.
By comparing that data with survey
responses on how well people were able to care for themselves -- whether they
were able to cook, clean, bathe themselves, dress themselves, walk and manage
money -- Cutler was able to determine how healthy people were relative to how
close or far away they were from dying.
Going forward, Cutler hopes to
unravel the reasons why some conditions are today less debilitating than in the
past. Part of the change, he said, will certainly be chalked up to increased
access and improvements to care, but there are a host of other factors that
make answering the question "very very difficult."
"There seems to be a clear
relationship between some conditions that are no longer as debilitating as they
once were and areas of improvement in medicine," he said. "The most
obvious is cardiovascular disease -- there are many fewer heart attacks today
than there used to be, because people are now taking cholesterol-lowering
drugs, and recovery is much better from heart attacks and strokes than it used
to be. A person who suffered a stroke used to be totally disabled, but now many
will survive and live reasonable lives. People also rebound quite well from
heart attacks."
What's more, he said, as standards
of care have improved, so too has the public's knowledge of how to live
healthier lives.
"People are much better
educated about their health now," Cutler said. "People are taking
steps to help prevent long-term cognitive decline. We don't have any way yet to
slow down something like Alzheimer's or Parkinson's, but there is a lot we can
do for other health problems."
The research was sponsored by the
National Institute on Aging.
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Harvard
University (2013, July 29). Living longer, living healthier: People are
remaining healthier later in life. ScienceDaily. Retrieved July 29,
2013, from http://www.sciencedaily.com/releases/2013/07/130729083352.htm