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Determinants of Successful Aging: Developing an Integrated Research Agenda for the 21st Century |

Measuring and Monitoring Success in Compressing Morbidity

James F. Fries, MD
[+] Article and Author Information

From Stanford University School of Medicine, Stanford, California.


Grant Support: By grants AG15815 and AR43585 from the National Institutes of Health to ARAMIS (Arthritis, Rheumatism, and Aging Medical Information System).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: James F. Fries, MD, Stanford University School of Medicine, 1000 Welch Road, Suite 203, Palo Alto, CA 94304.


Ann Intern Med. 2003;139(5_Part_2):455-459. doi:10.7326/0003-4819-139-5_Part_2-200309021-00015
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The Compression of Morbidity paradigm, which was presented as an hypothesis in 1980 (1), noted that most illness was chronic and occurred in later life and postulated that the lifetime burden of illness could be reduced if the onset of chronic illness could be postponed and if this postponement could be greater than increases in life expectancy. Figure 1 illustrates this concept. Estimated present lifetime morbidity is portrayed with three possible future scenarios: life extension, shift-to-the-right, and compression of morbidity. The lines represent the length of life, and the shaded triangles depict lifetime morbidity. Two arrows are shown for each scenario: The left arrow represents the median age at onset of chronic morbidity and the→represents the median age at death. Alternative health futures are determined by the relative movement of these arrows over time. If the arrows separate, lifetime morbidity increases, and if they come closer, morbidity is compressed. In each scenario, some extension of life expectancy is envisioned. The illustrative use of age 55 years as the present age of onset of chronic morbidity is drawn from our data showing this to be the median age of detectable chronic disability (2).

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Figure 1. Present lifetime morbidity, portrayed as the shaded area, is contrasted with three possible future scenarios.
Possible scenarios for future morbidity and longevity.
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Figure 2. Disability rates decline at about 2% per year; the declines accelerate in the most recent time period in the National Long-Term Care Survey ( ) and the National Health Interview Survey ( ). Declines are in both activities of daily living ( ) and instrumental activities of daily living ( ) in the NLTCS. In the NHIS, declines were similar for IADL but not significantly changed for ADL.
Recent trends in disability among older Americans.NLTCSNHISADLIADL
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Figure 3. Development of disability over a 13-year period from an average age of 58 years in runner's club and community control groups. Linear regression lines are adjusted for covariates and document postponement of disability in the fitness club group compared with controls, with differences increasing over time.
Regression of disability on time period (using bootstrap methods).
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