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Aging Outside the Box. Stanford Continuing Studies James F. Fries, MD October 24, 2007 Slides Available at A Personal Background. Information Science, Chronic Disease Databank Model, ARAMIS (Arthritis, Rheumatism, and Aging Medical Information System)

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aging outside the box

Aging Outside the Box

Stanford Continuing Studies

James F. Fries, MD

October 24, 2007

Slides Available at

a personal background
A Personal Background
  • Information Science, Chronic Disease Databank Model, ARAMIS (Arthritis, Rheumatism, and Aging Medical Information System)
  • Outcomes of Chronic Illness (HAQ)
  • Compression of Morbidity
  • Medical Self-Care
  • Disease Criteria, NSAID Gastropathy, Inverting the Pyramid, Improving Outcomes in Arthritis
on reductionist science
  • Science as Observation,

Science as Experiment

  • Truth as Correspondence (James),

Truth as Cohesion (Dewey)

class schedule
Class Schedule

General Themes

  • October 17 – Longevity
  • October 24 – Compression of Morbidity
  • October 31 – Declining Disability
  • November 7 – Aging and Health Policy
  • December 5 – Synthesis and Application
the compression of morbidity


A Classic 1980 Article for Discussion: Concept, Logic, Data, Errors

Citations and Google

Readings: Fries 1980, Vita 1998, Wang 2002

the compression of morbidity central thesis

The Compression of Morbidity: Central Thesis

The age at first appearance of aging and chronic disease symptoms can increase more rapidly than life expectancy

errors in the classic article1
Errors in the Classic Article
  • “Number of very old will not increase” – It will, but driven by birth cohorts and early life survival
  • Lifespan = 85 years – more like 90 + but close
  • Standard Deviation of Age at Death = 4 years; it’s always been 8 years (Figure 5)
  • Centenarians 1:10,000; No, more than 1:100
origins of the compression of morbidity hypothesis
  • Center for Advanced Study in the Behavioral Sciences
  • The Plasticity of Aging: Baltes, Riley, Loftus, Seligman, Valliant, Fries
  • An Interdisciplinary Light Bulb Clicks On
  • The Realities of Life Span: Crapo
elements of the paradigm shift
Elements of the Paradigm Shift
  • Natural and Premature death
  • Postponement Replaces Prevention
  • The Epidemiologic Transitions: Acute (infection) to Chronic (heart) to Aging (frailty)
  • Or: Early Death, Little Morbidity to Expansion of Morbidity to Compression of Morbidity
critics of the compression of morbidity hypothesis
Critics of the Compression of Morbidity Hypothesis
  • Demographers vested in contrary predictions
  • Basic Scientists fearing lost grant funds
  • Humanists positing ‘blaming the victim’
  • Gerontologists wanting time to prepare
  • Pessimists believing it will never happen
evidence for compression of morbidity
Evidence for Compression of Morbidity
  • Longitudinal studies document morbidity compression by social class, exercise, education level, combined risk factors
  • National surveys of disability since 1982 show current disability decreases of over 2% a year
  • Randomized studies in seniors show disability and cost reductions with health risk improvements
university of pennsylvania study 1986 2007
University of Pennsylvania Study 1986-2007

Three Lifestyle Risk Factors at Age 68

  • Overweight or obese
  • Cigarette smoking
  • No regular vigorous activity

Three Risk Groups:

-LOW=zero risk factors

-MODERATE=1 risk factor

-HIGH=2 or 3 risk factors

university of pennsylvania attendees 1939 40 disability index by age and risk factor category
University of Pennsylvania Attendees 1939-40Disability Index by Age and Risk Factor Category

Disability Index


Vita et al, NEJM, 1998

university of pennsylvania study 20071
University of Pennsylvania Study, 2007
  • Conclusions:
    • Mortality reduction from low risk to high risk groups is about 4 years
    • Disability postponement from high to low risk groups is about 8 years
    • Healthy lifestyle-related risk factors in seniors, including normal weight, regular physical activity and smoking abstinence offer protection against disability despite the associated survival advantages over time

Exercise and Disability: A 21-Year StudyWang et al, Archives Internal Medicine, 2002: Chakravarty et al, Archives Internal Medicine, 2008 (in press)

538 Runners Club Members423 Community Controls

Average Age 58 in 1984

Average Age 79 in 2005

disability by age in runners and controls
Disability by Age in Runners and Controls

Mean Disability Score

Community Control (n=249)

Runners Club (n=369)

Age Category

Wang et al, Arch Int Med, 2002

exercise and disability conclusions
Exercise and DisabilityConclusions
  • Regular vigorous physical activity, including running and jogging, may postpone disability by 12 to 16 years, far more than more casual exercise.
  • Bone mineral density is increased by exercise; osteoporosis is decreased.
  • X-rays of knees are better in exercising subjects, even regular long-distance runners, than controls.