[Longevity, disease, and duration of disability].
Disability and the resulting lowered quality of life are serious issues accompanying increased longevity. Active life expectancy #(8) can be to used to distinguish the number of years without disability from the number with disability; increases were found in both in longevity #(9, 19). With the same rate of age-related new disability in the cohorts between 1970 and 1990, the total disability increased three fold #(11). In elderly patients I showed that 1) the duration of disability of those at a specific age at death (predeath) #(1) increased with age, and it decreased in those who remained without disability, 2) the cumulative number of days of disability for patients who died at a specific age (a convolution function of predeath and mortality) #(2), approached a normal distribution, which is consistent with the central limit theorem, 3) competing risk with chronic disease in a patient greatly affects the incidence and duration of disability, 4) using the central limit theorem we can predict that preventing dementia will retard premature rectangularization of the disability-free survival curve, and will thus reduce the total disability, 5) disability is an example of how variation and selection of chronic diseases (disease Darwinism) can alter population structure. Insights into the evolution of senescence #(14-21), pleiotropy, and slower rates of molecular evolution in the core than at the border #(26, 27), reveal that the central nervous system is relatively robust and conservative for pleiotropy and may senesce relatively slowly, which support a new way of thinking #(3, 4) about old age. To minimize disability, public knowledge and education about an ideal lifestyle and the evolution of senescence is essential.
Matsushita
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Tokyo Metropolitan Geriatric Hospital.
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D006233:Persons with Disabilities; D006801:Humans; D008136:Longevity; D008875:Middle Aged; D013997:Time Factors