Health and Illness at the Age of 90

Väestö ikääntyy nopeasti, ja nopeimmin kasvava ikäryhmä ovat yli 85-vuotiaat. Monet sairaudet yleistyvät iän myötä, mutta arkitieto kertoo hyvin iäkkäiden olevan pääosin hyväkuntoisia ja melko terveitä. Väestötason tietoa vanhoista vanhimpien terveydentilasta ja sairauksista on kuitenkin julkaistu kansainvälisestikin katsoen vähän. Tämä väitöskirjatyö tutki 90-vuotiaan väestön terveyttä eri näkökulmista. Neljä viidestä 90-vuotiaasta oli naisia, mutta vähälukuiset miehet olivat kaikilla mittareilla mitattuna naisia terveempiä. Suurin osa 90-vuotiaista asui kodissaan, oli liikuntakykyisiä ja hyvämuistisia. Silti lähes kaikilla oli useita pitkäaikaisia sairauksia, sydän- ja verisuonisairaudet tärkeimpänä ryhmänä. Useimmat 90-vuotiaat kokivat terveytensä tavanomaiseksi tai hyväksi sairauksista ja lääkityksestä huolimatta. Jos yleisesti 90-vuotiaiden terveydentila oli hyvä, heistä kuitenkin lähes puolet joutui sairaalahoitoon ainakin kerran seurantavuoden aikana. Keskimääräinen sairaalapäivien määrä vuoden aikana oli 41 päivää jokaista 90-vuotiasta kohti laskettuna. Ikään ja erityisesti sairastumiseen liittyi suuri kuolleisuus, ja lähes 20 % 90-vuotiaista kuoli seurantavuoden aikana. Jos suuri osa 90-vuotiaista olikin hyvämuistisia, dementia osoittautui olevan myös tässä ikäryhmässä eniten sairaalahoitopäiviä vaativa sairaus. Muita pitkiin hoitoihin johtavia sairauksia olivat sepelvaltimotauti ja aivohalvaus. Vain noin yksi kahdestakymmenestä 90-vuotiaasta elää 100-vuotiaaksi. Tässäkin ikäryhmässä kuolleisuus liittyy pitkäaikaisiin sairauksiin, mutta ennen kaikkea toimintakykyyn. Pitkää ikää ennustivat parhaiten hyväksi koettu terveydentila, hyvä muisti ja itsenäinen liikuntakyky. Tietyt sairaudet erityisesti sydänsairaudet, syöpä, diabetes, dementiaa ja infektiot usea sairaus samanaikaisesti ja runsas lääkitys lisäsivät kuolleisuutta. Mikään aiemmin todettu sairaus ei kuitenkaan yksin johtanut varmuudella kuolemaan neljän vuoden seuranta-aikana. Ei ole ilmeistä viitettä siitä, että 90 vuotta täyttäneet olisivat lähitulevaisuudessa terveempiä, mutta heidän määränsä kasvaa nopeasti. Yhteiskuntamme tulee varautua tarjoamaan tarpeita vastaavaa asianmukaista hoitoa ja palveluja vanhoista vanhimpien väestölle.The oldest-old population is expanding rapidly. Currently in 2009, 0.6% of the population in Finland is 90 years old or older. There is a need for clinical information about this group that actively uses the social and health care but as a marginal population has not been systematically studied. This thesis work studied the health and illnesses of the 90-year-olds with an aim to obtain population level information from several perspectives. The target population was all people born in 1907-1910 and living in the city of Tampere at the age 90. Sources of information used were medical records, city hospitals patient register and discharge database, a mailed questionnaire, testing for mobility and cognition, and finally population register data for mortality. Four of five 90-year-olds were women (79%). More than two-thirds of the 90-year-olds lived in the community (72%). One-year mortality was nearly 20%. Morbidity was higher than in younger populations. Though women were more numerous, the few surviving 90-year-olds men appeared healthier. The most common diagnosis groups in the patient history were cardiovascular diseases (78%), gastrointestinal diseases (59%), infections (54%), and injuries (50%). An average of eight chronic or severe diseases were mentioned in the patient history indicating multiple co-morbidities. The diagnosis of dementia was mentioned in every fourth case (27%); most of the demented 90-year-olds were living in institutions. Of all 90-year-olds, one third (38%) were able to move using no or a light support, 8% were bedridden. Of the community-living 90-year-olds, 78% reported their current health as good or average, which result is similar to reports from younger generations. Poor self-rated health was associated with heart disease, stroke, rheumatoid arthritis, Parkinson s disease, or depression. The agreement of self-reported and medical records data was relatively good. As expected, many of the diagnosed diseases were underreported in the mailed questionnaire. However, dementia, depression, and arthritis were reported more often than doctors had recorded them. During one year, 43% of 90-year-olds men and 50% of 90-year-olds women were admitted to hospital. The mean length of stay for men was 19 days, for women 46 days. Of the 90-year-olds, 7% were permanently staying in hospitals. The most common diagnoses at discharge were cardiovascular diseases, infections, psychiatric diseases including dementia, and trauma. Of those who had been admitted to hospital once or more within the year, 32% died during the year, while the percentage for those not admitted was only 6%. Altogether, one third (36%) of the original population lived to age 94. Factors associated with survival were living in the community, no earlier history of certain diseases (heart diseases, cancer, diabetes, dementia, and infections), only a few co-morbidities, fewer than four medicines in daily use, good cognitive state, and good mobility. There were only a few men alive at age 90, and their mortality stayed high. The strongest negative influences on survival were detected with living in an institution and with dementia, which often co-existed. The 90-year-olds suffered from numerous chronic diseases influencing mobility and cognition, and they were still actively treated in hospitals. In connection to poor self-rated health, living in institutions, need for hospital care, and mortality, dementia seemed to be the greatest risk for health at age 90. This study supports the hypothesis that nonagenarians while still considered oldest-old are at the older end of usual aging processes with numerous diseases and high mortality due to the diseases. There is no obvious indication that the nonagenarians would be healthier in the near future. Our society will have to be prepared to provide adequate care for the needs of the growing population of the oldest-old