Ageing and health – authors' reply

Correspondence
Since population is a dynamic terised by diversity.4 This suggests that continuum of generations, there are the dis tinc tion between the “third age” issues in every age group to deal with and the “fourth age” (fi rst developed by information is based on forecasts. to secure healthy longevity as a whole.
the histo r ical sociologist, Peter Laslett5) We declare that we have no confl icts of interest.
is high ly proble matic, with the fourth expectancy with new records for age (of “decline and decrepitude”, to sprints is misleading: we do not suggest that all of us will live as long as koga.tk@asakura-med.or.jp
for our fears and negative sentiments the world record (currently 122 years). Asakura Medical Association Hospital, Asakura, Our fi gure 1 shows that life expectancy Fukuoka 838-0069, Japan (TK); and Oshita Clinic, Hiroshima, Japan (YO) Given the increasing population of is increasing at roughly the same rate in older people, and especially the very many developed countries. We discuss Christensen K, Doblhammer G, Rau R, Vaupel JW. Ageing populations: the challenges old, morbidity compression could be the poor performance of the USA.
ahead. Lancet 2009; 374: 1196–208.
Matton L, Duvigneaud N, Wijndaele K, et al. Secular trends in anthropometric of individuals with moderate or severe in life expectancy. to decelerated characteristics, physical fi tness, physical disabling conditions, and longer dying biological ageing” but to reductions in activity, and biological maturation in Flemish trajectories. Research and practice death rates at older ages. First published adolescents between 1969 and 2005.
Am J Hum Biol 2007; 19: 345–57.
needs to develop a coherent view of in 1994,1 the discovery that deaths at Malina RM. Physical fi tness of children and ageing that combines realistic appraisal adolescents in the United States: status and
secular change. Med Sport Sci 2007; 50: 67–90.
of rising health needs with age and a fi nding about the biology of ageing.
Houston DK, Ding J, Nicklas BJ, et al. The characteristic of all stages of the life that psychosocial factors in ageing physical performance in the Health, Aging and Body Composition study. Int J Obes 2007; 31: 1680–87.
I declare that I have no confl icts of interest.
Neovius M, Kark M, Rasmussen F. Association between obesity status in young adulthood and disability pension. Int J Obes 2008; 32: 1319–26.
mikebury@btinternet.com
60 years, the frequency of self-reported In their Review on ageing popu la tions,1 Department of Health and Social Care, Royal Kaare Christensen and collea gues take TW20 0EX, UK long itudinal study of the entire Danish ised survival curve”. Such a view is not Vaupel JW. Ageing populations: the challenges ahead. Lancet 2009; 374: 1196–208.
Bury M. Arguments about ageing: long life and clear that the idea of a fi xed maximum its consequences. In Wells N, Freer C, eds. The Thatcher, R. The demography of centenarians in England and Wales. Popul Trends 1999; 96: 5–24.
Suzman RM, Willis DP, Manton KG, eds. The Oldest Old. Oxford: Oxford University Press, Laslett P. A Fresh Map of Life: the Emergence of the Third Age. London: Weidenfi eld & Nicolson, the reason for the rising number of Authors’ reply
centenarians in high-income countries Jay Olshansky and Bruce Carnes raise their death, but also that postponement such as the UK.
incorrect or misleading objections. of this individual decline makes it In approaching the health profi le of Our fi rst paragraph describes our possible for us to live in reasonable older populations, it is important, as forecasting method. A 12-fold or good physical and psychological health Christensen and colleagues note, to dis- 25-fold increase in the number of to the highest ages.
tinguish between mild, moderate, and centenarians over the next century is exceeded by the increase of about point out that increasing childhood ity. To do otherwise is to run the risk of 100-fold on average seen between obesity and declining physical 1900–07 and 2000–07. If death rates abilities of younger generations may pen dent or incapacitated. Research has are declining at older ages, cohort counteract progress in health and shown over many years that even after life expectancy can be considerably lifespan. The remarkable increase in the ages of 85 or 90 years, life is charac- greater than period life expectancy.
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Correspondence
achieved despite widespread tobacco a measure of non-conformity that limitations, un had characterised them throughout and the fi ndings’ contrast with those of their life. The nuns’ study3 found that large observational analyses2–4 suggest We concur with Michael Bury that future novices who showed more that confi rmation of the safety of co- there is no indication of a well defi ned imagination in essays written in their administration is warranted before fourth age and that a critical view of last year of secondary school fared clinical practice changes.
Fries’ “rectangularised survival curve” better intellectually and emotionally is not new.1 The absolute number when assessed 60 or 70 years later.
of people with disabilities is likely to Simone de Beauvoir addressed metabolite, and reduced CYP2C19 increase due to the large baby boomer the issue of passion invigorating life activity has been correlated with
cohorts approaching high ages. in her book La force de l’âge, and the inhibition of platelet aggregation
Available data suggest that the period great American psychiatrist George and increased cardiovascular events.5
of ill health that often precedes death E Vaillant warns on the cover of his Omeprazole is a moderately strong
is being delayed, not protracted: people
masterpiece, Aging Well: “Think diet CYP2C19 inhibitor. In O’Donoghue are generally reaching older ages in and exercise are keys to a long, healthy We declare that we have no confl icts of interest.
Quite so. I consult in a small nursing received moderately strong CYP2C19 home that boasts two centenarians. inhibitors, whereas 40% received One, a tall man, plays the harmonica pantoprazole. Subsequently, there are readily whenever requested to do questions that must be answered. Can so. The other, a tiny woman in a a moderately strong CYP2C19 inhibitor kchristensen@health.sdu.dk
wheelchair, joyfully knits coverlets for induce a state similar to a CYP2C19 Danish Aging Research Center, University of adults and for babies; she gives them polymorphism? In other words, can Southern Denmark, 5000 Odense C, Denmark (KC); University of Rostock, Rostock, Germany (GD, RR); to staff , family, and friends. Neither one and Max Planck Institute for Demographic Research, Vaupel JW, Lundström H. Longer life expectancy? I declare that I have no confl icts of interest.
mortality rates at advanced ages. In: Wise DA, ed. Studies in the economics of aging. Chicago: University of Chicago Press, 1994: 79–104.
akehoe@uwm.edu
Annu Rev Clin Psychol 2009; 5: 363–89.
Christensen K. Frequency and heritability of Vaupel JW. Ageing populations: the challenges ahead. Lancet 2009; 374: 1196-2008.
half of life: evidence from Danish twins over Perls T, Silver MH. Living to 100. New York: ical diff erences in CYP2C19 poly morph- 45. Psychol Med 2002; 32: 1175–85.
Christensen K, McGue M, Petersen I, Jeune B, Vaupel JW. Exceptional longevity does not result in excessive levels of disability. Linguistic ability in early life and Alzheimer’s Proc Natl Acad Sci USA 2008; 105: 13274–79.
disease in late life: fi ndings from the Nun
Study. JAMA 1996; 275: 1879.
little because of a low event rate, lower Ageing well is perhaps more easily Combination therapy
grasped by writers, poets, philoso phers, with clopidogrel and
phers. Christensen and colleagues refer proton-pump inhibitors
consistently to the ability to do activities JASM III has been on the speakers’ bureaux for of daily living, but hardly mention joy, Novartis and Boehringer Ingelheim. He has grants Michelle O’Donoghue and collea g ues’ from Novartis and the US National Institutes of post-hoc analysis of TRITON-TIMI Health. CDB declares no confl icts of interests.
A study of American centenarians p 989)1 suggests that use of a proton - James A S Muldowney III, *Cassandra D Benge able to live independently in the pump inhibitor (PPI) does not increase cassandra.benge2@va.gov
community2 showed that they shared cardiovascular events in patients taking a common trait: those who scored clopidogrel, despite pharmacokinetic VA Tennessee Valley Healthcare System, Nashville, highest on “life satisfaction” displayed www.thelancet.com Vol 375 January 2, 2010

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