Changes in disability, selfrated health, comorbidities and psychological wellbeing in community-dwelling 75–95-yearold cohorts over two decades in Helsinki

Full Te ms & Condi ions o access and use can be ound a h p://www. and online.com/ac ion/jou nalIn o ma ion?jou nalCode=ip i20 Download by: [Tampe e Uni e si y] Da e: 07 Sep embe 2017, A : 22:19 Scandina ian Jou nal o P ima y Heal h Ca e ISSN: 0281-3432 (P in ) 1502-7724 (Online) Jou nal homepage: h p://www. and online.com/loi/ip i20 Changes in disabili y, sel - a ed heal h, como bidi ies and psychological wellbeing in communi y-dwelling 75–95-yea -old coho s o e wo decades in Helsinki Helena Ka ppinen, Kaisu H. Pi kälä, Hannu Kau iainen, Reijo S. Til is, Jaakko Val anne, Kä he Yode & Timo E. S andbe g To ci e his a icle: Helena Ka ppinen, Kaisu H. Pi kälä, Hannu Kau iainen, Reijo S. Til is, Jaakko Val anne, Kä he Yode & Timo E. S andbe g (2017) Changes in disabili y, sel - a ed heal h, como bidi ies and psychological wellbeing in communi y-dwelling 75–95-yea -old coho s o e wo decades in Helsinki, Scandina ian Jou nal o P ima y Heal h Ca e, 35:3, 279-285, DOI: 10.1080/02813432.2017.1358855 To link o his a icle: h p://dx.doi.o g/10.1080/02813432.2017.1358855 © 2017 The Au ho (s). Published by In o ma UK Limi ed, ading as Taylo & F ancis G oup. Published online: 07 Aug 2017. Submi you a icle o his jou nal A icle iews: 220 View ela ed a icles View C ossma k da a RESEARCH ARTICLE Changes in disabili y, sel - a ed heal h, como bidi ies and psychological wellbeing in communi y-dwelling 75–95-yea -old coho s o e wo decades in Helsinki Helena Ka ppinen a , Kaisu H. Pi k€ al€ a a , Hannu Kau iainen a,b , Reijo S. Til is c , Jaakko Val anne d,e ,K € a he Yode a and Timo E. S andbe g c, a Gene al P ac ice and P ima y Heal h Ca e, Uni e si y o Helsinki and Helsinki Uni e si y Hospi al, Helsinki, Finland; b P ima y Heal h Ca e Uni , Kuopio Uni e si y Hospi al, Kuopio, Finland; c Ge ia ics, Uni e si y o Helsinki and Helsinki Uni e si y Hospi al, Helsinki, Finland; d School o Medicine, Uni e si y o Tampe e, Tampe e Uni e si y Hospi al, Tampe e, Finland; e Ge on ology Resea ch Cen e , Uni e si ies o Jy € askyl€ a and Tampe e, Tampe e, Finland; Ins i u e o Heal h Sciences/Ge ia ics, Uni e si y o Oulu, Oulu Uni e si y Hospi al, Oulu, Finland ABSTRACT Objec i e: To explo e changes in sel - epo ed disabili ies, heal h, como bidi ies and psycho- logical wellbeing (PWB) in aged coho s o e wo decades. Design, se ing and subjec s: C oss-sec ional coho s udies wi h pos al su eys we e con- duc ed among communi y-dwelling people aged 75, 80, 85, 90 and 95 yea s in 1989 (n¼660), 1999 (n¼2598) and 2009 (n¼1637) in Helsinki, Finland. Main ou come measu es: Sel - epo ed i ems on disabili y, sel - a ed heal h (SRH), diagnoses and PWB we e compa ed be ween coho s o he same age. S anda dized mo ali y a ios (SMRs) we e calcula ed o each s udy yea o explo e he ep esen a i eness o he samples compa ed o gene al popula ion o same age. Resul s: A signi ican ly lowe p opo ion o he 75–85-yea -olds o he la e s udy yea s epo ed going ou doo s daily, al hough his g oup had imp o emen s in bo h SRH and PWB sco es. The numbe o como bidi ies inc eased o e ime among 75–85-yea -olds. The only signi ican change ha could be e i ied among 90- and 95-yea -olds be ween 1999 and 2009, was he lowe p opo ion o pa icipan s going ou doo s daily. The end o le eling-o in disabili ies was no explained by he SMRs (0.90, 0.71 and 0.60 o 1989, 1999 and 2009). Conclusions: The la es olde people’s coho s showed an end o p e iously epo ed imp o e- men s in disabili ies, despi e ha ing a o able ends in SRH and PWB. P ima y ca e may be aced wi h inc easing need o app op ia e se ices o hei senio membe s. ARTICLE HISTORY Recei ed 13 Janua y 2017 Accep ed 6 June 2017 KEYWORDS Coho compa ison; physical unc ioning; sel - a ed heal h; psychological wellbeing; oldes -old; communi y-dwelling In oduc ion A la ge p opo ion o gene al p ac i ione s’(GP) pa ien s a e olde people. This sha e will inc ease in he u u e. Resea che s wo ldwide ha e in es iga ed whe he inc easing li e expec ancies o popula ions en ail addi ional yea s o mo bidi y o disabili y among olde people, o could he pe iod o mo bidi y and dis- abili y be comp essed [1]. The e a e da a suppo ing hese heo ies in di e en Eu opean coun ies [2]. Resea che s ha e mainly in es iga ed unc ional limi a- ions o disabili y ends in successi e coho s [3]. Howe e , a o able ends in disabili y do no neces- sa ily mean imp o ed heal h and wellbeing o olde people: looking u he in o como bidi ies, sel -pe cep- ions o heal h and psychological wellbeing (PWB) would inc ease knowledge o coho ends, and hei needs o heal h se ices. Olde people’s disabili ies, como bidi ies and wellbeing is a ele an opic when conside ing p ima y ca e esou ces. A la ge numbe o s udies ha e sugges ed ha he la e bo n coho s o he oldes -old show less unc- ional limi a ions [4,5] o less disabili ies han he ea - lie bo n coho s [4–7]. S udies ha e consis en ly sugges ed ha he p e alence o disabili y in he olde popula ion dec eased o e wo decades un il ea ly 2000 [4,6,8–10]. Howe e , some s udies ha e CONTACT Helena Ka ppinen [email p o ec ed] Gene al P ac ice and P ima y Heal h Ca e, P.O. Box 20, 00014 Uni e si y o Helsinki, Finland ß2017 The Au ho (s). Published by In o ma UK Limi ed, ading as Taylo & F ancis G oup. This is an Open Access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion-NonComme cial License (h p://c ea i ecommons.o g/licenses/by-nc/4.0/), which pe mi s un es ic ed non-comme cial use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed. SCANDINAVIAN JOURNAL OF PRIMARY HEALTH CARE, 2017 VOL. 35, NO. 3, 279–285 h ps://doi.o g/10.1080/02813432.2017.1358855 Downloaded by [Tampe e Uni e si y] a 22:19 07 Sep embe 2017 sugges ed ha he p e alence o unc ional limi a ions and/o disabili y ha e emained s able he ea e o e en inc eased in la e bo n olde coho s [11–13], especially in he younge -aged coho s [10,14,15]. Time ends in he oldes -old popula ions 85 yea s and olde show mixed indings [7,9,12,14,16] among la e coho s compa ed wi h he ea lie coho s. Sel - a ed heal h (SRH) measu es he indi idual’s own pe cep ions o he /his heal h s a us. I is signi i- can ly associa ed wi h objec i ely measu ed heal h, and i has p ognos ic alue [3,9]. The ew s udies ha epo ed ime ends in SRH ha e shown mixed esul s especially om 1980 o 2003 [3,9]. The ew s udies ha epo ed ends up o 2009 ha e sugges ed ei he s able o wo sening SRH [17]. The p e alence o dis- eases seems o be inc easing in he la e bo n coho s [8–11,17,18]. Time ends in some aspec s o PWB ha e been s udied in gene al adul popula ions. The la e bo n 65–69-yea old coho s o he Finnish E e g een p o- jec in 2004 ound li e mo e meaning ul han hei coun e pa s in 1996 o 1988 [19]. Howe e , he e is a sca ci y o s udies ha explo e ime ends in PWB o olde people and he oldes old, and we a e no awa e o any ecen published s udies. The s udies ha ha e in es iga ed heal h ends be ween coho s o he same age ange seldom epo PWB, heal h and disabili y in he same pape . We epo ed in ou p e ious s udy in 2001 ha he aged samples aken in 1999 showed imp o ed physical unc ioning and PWB, compa ed wi h he samples o same age ha we e s udied 10 yea s ea lie [20]. We ha e ex ended ou esea ch in he p esen s udy o compa e p e ious s udy yea (1989, 1999) samples o he same age g oups o samples o he co esponding ages ha we e ob ained in 2009. The aim o his p e- sen s udy was o in es iga e he changes in sel - epo ed disabili y, SRH, como bidi ies and PWB in communi y-dwelling coho s o people aged 75–95 yea s o e wo decades. Ma e ials and me hods This s udy is based on Helsinki Ageing S udy [20] and combines da a o h ee popula ion-based, c oss-sec- ional s udies wi h census da a, which we e ob ained in 1989, 1999 and 2009. Random samples o commu- ni y-dwelling people in Helsinki, Finland, we e e ie ed om he popula ion egis e in 1989 (N¼898; 300 each o 75- and 80-yea -olds g oups and 298 o he 85-yea -olds g oup), in 1999 [N¼3921; 1000 each o 75, 80 and 85-yea -olds g oups in add- i ion o all 90 (734) and also all 95-yea -olds (187)], and in 2009 [N¼2633; 600 each o he ou g oups om 75 o 90, and also all 95-yea -olds (233)]. A ques- ionnai e wi h iden ical i ems was mailed o eligible people in Helsinki, Finland, and e-sen once o hose no esponding a each ime poin . We excluded pe - sons wi h unknown add ess, he deceased and hose who we e pe manen ly ins i u ionalized. The esponse a es o 1989, 1999 and 2009 we e 93% (n¼660), 80% (n¼2598) and 73% (n¼1637), espec i ely. The su ey ques ionnai e in e alia inqui ed abou demog aphic i ems (educa ion, ma i al s a us). Ou c oss-sec ional su eys gi en in all h ee ime-poin s 1989, 1999 and 2009 included iden ical i ems on sel - epo ed disabili y (i.e. di icul ies in pe o ming some daily ac i i ies). The subjec s we e in i ed o espond o he ollowing: whe he hey go ou doo s daily (yes/ no), hey need ano he pe son’s help daily (yes/no) and hey need ano he pe son’s help o ge ou o bed (yes/no). Responden s we e in i ed o e alua e hei SRH, which was ca ego ized as good (heal hy/qui e heal hy) and poo (qui e unheal hy/unheal hy). Pa icipan s we e in i ed o epo he occu ence o hei diag- nosed majo diseases (yes/no), and he Cha lson como bidi y index was calcula ed acco dingly [21]. The ques ionnai e e alua ed PWB acco ding o esponses o six ques ions [22,23]. These six ques ions ha e shown good es – e es eliabili y [24] and signi i- can p ognos ic alidi y o mo ali y [23]. The ques- ions inqui e abou (1) li e sa is ac ion (yes/no), (2) eeling use ul (yes/no), (3) ha ing plans o he u u e (yes/no), (4) ha ing zes o li e (yes/no), (5) eeling dep essed (seldom o ne e /some imes/o en o always) and (6) su e ing om loneliness (seldom o ne e /some imes/o en o always) [23]. Responses ‘no’ o ques ions 1–4 and ‘o en o always’ o ques ions 5 o 6 con ibu e 0 aw poin s o he agg ega ed sco e. Responses ‘some imes’ o ques ions 5 o 6 con ibu e o he o al wi h 1 =2 aw poin s. The esponses ‘yes’ o ques ions 1–4 and ‘seldom o ne e ’ o ques ions 5 o 6 con ibu e 1 aw poin each o he o al sco e. We c ea ed a o al PWB sco e om he esponses o hese six ques ions. The PWB sco e o each s udy pa icipan was hen calcula ed by di iding he sum o al o aw poin s by he numbe o ques ions he pa icipan had answe ed. A sco e o 1 ep esen ed he bes possible PWB sco e and 0 he poo es PWB sco e [25]. The mo ali y da a we e e ie ed om he cen al egis e s du ing a ou -yea ollow-up o each c oss- sec ional coho . The s anda dized mo ali y a ios (SMRs) we e calcula ed so ha we could compa e he mo ali y o each s udy sample wi h he whole Finnish popula ion o espec i e age a each ime poin . This 280 H. KARPPINEN ET AL. Downloaded by [Tampe e Uni e si y] a 22:19 07 Sep embe 2017 enables us o assess he ep esen a i eness o each sample. The expec ed numbe o dea hs was calcu- la ed on he basis o sex-, age- and calenda -pe iod- speci ic mo ali y a es o he Finnish popula ion. The SMRs we e calcula ed as he a io o obse ed and expec ed numbe o dea hs acco ding o S a is ics Finland. The co esponding 95% con idence in e als (CIs) we e de ined assuming a Poisson dis ibu ion o he obse ed numbe o dea hs. In he igu es, we desc ibe aw da a o each age coho . In ou analyses, we compa ed 75–85-yea -olds and 90–95-yea -olds sepa a ely, because hese age g oups ha e shown somewha di e en ends in dis- abili y in p e ious s udies [7,9,12,14]. Gene alized linea mixed-models we e used o de e mine he adjus ed ela ionships be ween he samples o each age g oups o e he s udy yea s. These basic models included he main e ec s (yea and age) and hei in e ac ion. All hese analyses pe o med we e adjus ed o gende , educa ion and widowhood. A signi ican coho end be ween he s udy yea s is indica ed by p<.05 o lin- ea i y o he s udy yea e ec , o o he s udy yea e ec . The age e ec p<.05 ema ks he ob ious si u- a ion whe e disabili y/SRH/como bidi ies o PWB changes wi h highe age in he g oup. These esul s ha e mo e powe , i p o he in e ac ions is highe han .05 indica ing no o he in e ac ions. The no mal- i y o each a iable was es ed by using he Shapi o–Wilk W es . All analyses we e pe o med using STATA so wa e ( e sion 13.1), S a aCo p, LP, College S a ion, TX. Resul s In hese c oss-sec ional coho s o olde communi y- dwelling people (1989, 1999 and 2009), he p opo ion o males among he 80- and 85-yea -old pa icipan s inc eased signi ican ly om 1989 o 2009. Widowhood among 75-, 80- and 85-yea -olds dec eased signi i- can ly om 1989 o 2009. Fu he mo e, he educa- ional s a us imp o ed signi ican ly in all aged coho s excep among he 95-yea -olds (Table 1). The SMR was 0.90 (95% CI 0.78–1.03) o he 1989 sample, whe eas he co esponding a ios o he 1999 and 2009 samples we e 0.71 (95% CI 0.64–0.76) and 0.60 (95% CI 0.54–0.66). This indica es ha he esponden s ep esen ed i e sample o popula ion o he same age each decade. Resul s conce ning he esea ch ques ion show changes in sel - epo ed disabili ies, heal h, como bid- i ies and PWB be ween he independen c oss-sec- ional coho s o e decades. Figu e 1 illus a es changes in indi idual i ems o sel - epo ed disabili y a di e en ages in 1989, 1999 and 2009. A signi ican ly lowe p opo ion o 75-, 80- and 85- yea -olds epo ed going ou doo s daily in he la e s udy yea s (p<.001 o linea i y o he s udy yea e ec , p<.001 o he age e ec , p¼.043 o he in e ac ions; adjus ed o gende , educa ion and widowhood). Also a signi ican ly lowe p opo ion o 90- and 95-yea -olds epo ed going ou doo s daily (p¼.030 o he s udy yea e ec , p<.001 o he age e ec , p¼.57 o he in e ac ions; adjus ed o gende , educa ion and widowhood). Fu he mo e, he e was only an age e ec be ween he 75-, 80- and 85-yea - olds conce ning he need o ano he pe son’s daily help (p¼.84 o linea i y o he s udy yea e ec , p<.001 o he age e ec , p¼.30 o he in e ac ions; adjus ed o gende , educa ion and widowhood), and simila ly among 90- and 95-yea -olds (p¼.14 o he s udy yea e ec , p<.001 o he age e ec , p¼.56 o in e ac ions; adjus ed o gende , educa ion and widowhood). The e was a di e ence be ween 75- and 85-yea -olds in needing help o ge ou o bed be ween he s udy yea s (p¼.022 o linea i y o he s udy yea e ec , p¼.0012 o he age e ec , p¼.82 o he in e ac ions; adjus ed o gende , educa ion and widowhood), bu among 90- and 95-yea -olds he e was only an age e ec (p¼.18 o he s udy yea e ec , p¼.019 o he age e ec , p¼.56 o he in e ac ions; adjus ed o gende , educa ion and widowhood). SRH was good in mos pa icipan s a all ages a each ime poin . A signi ican ly highe p opo ion o 75-, 80- and 85-yea -olds epo ed good SRH in he la e s udy yea s (p¼.028 o linea i y o he s udy yea e ec , p<.001 o he age e ec , p¼.32 o he Table 1. Cha ac e is ics o pa icipan s in s udy yea s 1989, 1999 and 2009. Cha ac e is ics 1989 n¼660 1999 n¼2598 2009 n¼1637 pValue a Males, n(%) 75 yea s 70 (28.6) 263 (35.8) 143 (35.8) .096 80 yea s 60 (27.3) 218 (30.4) 146 (37.2) .007 85 yea s 46 (23.6) 148 (23.0) 109 (30.5) .029 90 yea s 101 (23.1) 89 (24.0) .974 95 yea s 17 (25.8) 24 (20.3) .40 Widowed, n(%) 75 yea s 85 (35.0) 212 (29.4) 84 (21.0) <.001 80 yea s 102 (46.4) 308 (44.3) 120 (30.8) <.001 85 yea s 104 (57.8) 351 (56.0) 171 (48.4) .019 90 yea s 266 (63.2) 227 (61.5) .63 95 yea s 42 (66.7) 79 (67.5) .91 Educa ion <8 yea s, n(%) 75 yea s 159 (71.9) 370 (51.6) 141 (35.8) <.001 80 yea s 135 (70.3) 339 (49.8) 147 (38.1) <.001 85 yea s 133 (81.1) 363 (58.4) 115 (32.7) <.001 90 yea s 230 (55.4) 142 (39.0) <.001 95 yea s 35 (56.4) 58 (49.6) .38 a p o linea i y be ween he s udy yea s. SCANDINAVIAN JOURNAL OF PRIMARY HEALTH CARE 281 Downloaded by [Tampe e Uni e si y] a 22:19 07 Sep embe 2017 in e ac ions; adjus ed o gende , educa ion and widowhood). The e we e no signi ican di e ences in SRH o he 90- and 95-yea -olds be ween he s udy yea s (p¼.057 o linea i y o he s udy yea e ec , p¼.59 o he age e ec , p¼.63 o he in e ac ions; adjus ed o gende , educa ion and widowhood). The e was a signi ican inc ease in he Cha lson como bidi y index among 75–85-yea -olds in he la e s udy yea s compa ed o 1989 (p<.001 o linea i y o s udy yea e ec , p<.001 o he age e ec , p¼.13 o he in e ac ions; adjus ed o gende , edu- ca ion and widowhood). No signi ican di e ences we e obse ed among 90- and 95-yea -olds o e he s udy yea s (p¼.55 o he s udy yea e ec , p¼.25 o he age e ec , p¼.15 o he in e ac ions; adjus ed o gende , educa ion and widowhood). Figu e 2 illus- a es he ends in SRH and como bidi ies in indi id- ual age g oups in 1989, 1999 and 2009. Figu e 2 illus a es also he ends in PWB a di e - en ages o 1989, 1999 and 2009. In addi ion, in 75-, 80- and 85-yea -olds he PWB sco e imp o ed signi i- can ly om 1989 o 2009 (p¼.0055 o linea i y o he s udy yea e ec , p<.001 o he age e ec , p¼.39 o he in e ac ions; adjus ed o gende , educa ion and widowhood). Among 90- and 95-yea -olds, he e was no signi ican di e ence in PWB be ween he s udy yea s (p¼.49 o he s udy yea e ec , p¼.040 o he age e ec , p¼.50 o he in e ac ions; adjus ed o gende , educa ion and widowhood). Discussion This s udy add esses disabili ies, heal h, diseases and PWB, hus he domains indica ing need o p ima y ca e se ices o communi y-dwelling olde people. Old communi y-dwelling people in Finland gene ally eel well. Howe e , imp o emen s in sel - epo ed dis- abili y in ou communi y-dwelling coho s could no be seen om 1989 h ough 1999 o 2009. A lowe p o- po ion o 75–95-yea -olds go ou doo s daily. Como bidi ies inc eased om 1989 o 1999 bu a u - he inc ease was no obse ed in 2009. The SRH and PWB da a sugges ed imp o emen s in 75–85-yea -olds o e he s udy yea s. The s eng h o ou s udy lies in i being a ep e- sen a i e sample o communi y-dwelling olde people in Finland. Response a es we e e y good, al hough hese dec eased o each s udy ime poin o e he wo decades, which is a common phenomenon [5]. Ano he s eng h o ou s udy is ha we used iden ical ques ions a each ime poin . A limi a ion o his s udy is he small numbe o pa icipan s pa icula ly in he i s s udy sample (1989). This limi ed he s a is ical powe o he s udy o de ec small di e ences be ween he h ee s udy yea s. Addi ionally, he 90- and 95-yea -olds we e miss- ing in 1989, leading o explo ing coho ends among 90- and 95-yea -olds in only one decade, 1999–2009. Fu he mo e, we had a ai ly small numbe o i ems ela ed o disabili y. The esponse a e was signi ican ly lowe in he la e s udy yea s. The p opo ion o 75þ popula ion ins i u ionalized in Helsinki was 16.0%, 13.7% and 6.0% in 1989, 1999 and 2009, espec i ely. Mos people who would ha e esided in nu sing homes in 1989 o 1999 would now li e in home-like assis ed li ing acili ies. These acili ies a e no , how- e e , conside ed o be ins i u ional ca e in oday’s e - minology. This change in e minology may explain Age 75 80 85 Does no go daily ou doo s,% 0 10 20 30 40 50 60 70 80 90 100 90 95 S udy yea 1989 S udy yea 1999 S udy yea 2009 Age 75 80 85 Needs daily help,% 0 10 20 30 40 50 60 70 80 90 100 90 95 S udy yea 1989 S udy yea 1999 S udy yea 2009 Age 75 80 85 Needs help o ge ou o bed,% 0 10 20 30 40 50 60 70 80 90 100 90 95 S udy yea 1989 S udy yea 1999 S udy yea 2009 Figu e 1. Sel - epo ed physical unc ioning among communi y-dwelling olde people in Helsinki, Finland acco ding o hei age o he s udy yea s 1989, 1999 and 2009. P opo ions epo ing di icul ies o need o help wi h 95% con idence in e als. 282 H. KARPPINEN ET AL. Downloaded by [Tampe e Uni e si y] a 22:19 07 Sep embe 2017 why he esponse a e o communi y-dwelling olde people appa en ly dec eased in ou s udy. The indings o un a o able ends in disabili y in ou s udy a e in line wi h some p e ious s udies [9,10,14,15]. The le eling-o in sel - epo ed unc ion- ing in 2009 amongs ou communi y-dwelling pa ici- pan s canno be explained by he lowe p opo ion being ins i u ionalized as sugges ed ea lie [5,20], because he SMRs o ou pa icipan s dec eased e e y decade. The SMRs o ou c oss-sec ional samples mean ha su i al du ing a ou -yea ollow-up among ou esponden s in 1989 was app oxima ely 10% highe han su i al among Finnish popula ion o espec i e ages (backg ound popula ion) in 1989. Su i al o ou coho s in 1999 was 29%, and in 2009 40% highe han su i al o all Finnish olde people o he same ages, espec i ely. This indica es ha he pa icipan s in ou la e s udy yea s su i ed longe han hei espec i e backg ound popula ion and, hus, hey ep- esen he i e p opo ion o hei backg ound popu- la ion compa ed o he esponden s o ea lie s udy yea s. Seasonal wea he condi ions in Finland nei he explain he disabili y ends. The ques ionnai es we e mailed du ing la e au umn in 1989, in slippe y mid- win e in 1999, bu he 2009 ques ionnai es we e mailed in summe . In e es ingly, he la ges p opo ion o esponden s no going ou doo s on a daily basis was ound in he summe 2009 sample. The e o e, he p opo ion o hose p esen ing disabili y in he la es s udy yea could plausibly be an unde es ima ion. Possible mechanisms o any le eling-o in unc- ioning could be he inc easing p e alence o diabe es and obesi y and seden a y li es yle, which e ec i ely p edispose subjec s o ail y and mobili y limi a ions [13,26–28]. These inc easing ends ha e been epo ed all o e he wo ld. Ou esul s sugges ha heal h ca e se ices, especially p ima y ca e should be p epa ed o he u u e wi h inc easing numbe o olde people wi h mo e disabili ies. GPs a e he key pe sons o plan p e en i e se ices and p ocedu es o hese pa ien s. Ou esul s sugges ha abou 5% mo e o hose aged 85 and 90, and 10% mo e o hose aged 95 need daily help in he 2009 coho han in he espec i e coho o 1999. This means a signi i- can ly inc easing bu den o p ima y heal h ca e. The Cha lson como bidi y index measu emen s sug- ges ed an inc ease in como bidi ies om 1989 o 1999, bu i le eled-o he ea e . The inc easing num- be o diseases has been epo ed ea lie om 1980 o 1990 [8,9,11,13,17,18]. This may pa ly be explained by an inc ease in diagnos ic ac i i y among he oldes -old especially in p ima y heal h ca e a e 1989. Fo example, ailing-memo y complain s o os eopo osis we e diagnosed wi h a ela i ely low equency, un il demen ia and os eopo osis d ugs became a ailable. Howe e , diseases such as cance , a h i is and dia- be es show inc easing ends in olde la e bo n coho s [8,10,13]. SRH demons a ed imp o emen s om 1989 o 2009. The e a e ew published s udies ha in es i- ga ed ends in SRH. Some s udies ha in es iga ed ime pe iods om 1978 o 2003 show simila indings o ou s [3,29] al hough he e a e also con adic o y indings [9]. The SRH in ou samples may e lec imp o ed social wellbeing and also imp o ed PWB. Age 75 80 85 Good sel - a ed heal h, % 0 10 20 30 40 50 60 70 80 90 100 90 95 S udy yea 1989 S udy yea 1999 S udy yea 2009 Age 75 80 85 Cha lson como bidi y index 0,0 0,5 1,0 1,5 2,0 2,5 3,0 3,5 4,0 90 95 S udy yea 1989 S udy yea 1999 S udy yea 2009 Age 75 80 85 Psychological well-being 0,4 0,5 0,6 0,7 0,8 0,9 1,0 90 95 S udy yea 1989 S udy yea 1999 S udy yea 2009 Figu e 2. Sel - a ed heal h, he Cha lson como bidi y index [21] and psychological wellbeing [25] among communi y-dwelling olde people in Helsinki, Finland acco ding o hei age in s udy yea s 1989, 1999 and 2009. P opo ions epo ing good sel - a ed heal h wi h 95% con idence in e als, and he mean Cha lson como bidi y index and mean psychological well-being wi h 95% con idence in e als. SCANDINAVIAN JOURNAL OF PRIMARY HEALTH CARE 283 Downloaded by [Tampe e Uni e si y] a 22:19 07 Sep embe 2017 In con as o he wo isome end in disabili y, he PWB e lec ed imp o ing wellbeing om 1989 un il 2009. Highe educa ion and lowe p opo ions o wid- owed esponde s p obably con ibu e o his posi i e inding. Se e al p e ious coho s udies ha e epo ed highe educa ional le els [28,30]. Howe e , his is he i s s udy o explo e ime ends in PWB also among he oldes -olds, as a as we a e awa e. Heal h ca e p o essionals need o unde s and he di e ence be ween olde people and younge adul s in his o y aking: a mul imo bid olde pe son wi h se e al ele- an issues o discuss may a e SRH o PWB highe han a younge pe son would possibly do. In conclusion, ou s udy used su icien ly la ge sam- ples o in es iga e some domains o disabili y, heal h and PWB among communi y-dwelling olde people in Helsinki. The indings sugges a le eling-o a e deca- des o imp o emen s in disabili y, and inc ease in como bidi ies, despi e a o able ends in mo ali y, SRH and PWB. This may uly indica e inc easing needs o app op ia e, accessible and p e en i e p ima y ca e se ices in u u e yea s. Disclosu e s a emen No po en ial con lic o in e es was epo ed by he au ho (s). Funding The s udy was suppo ed by he Academy o Finland (G an 48613), he Lions O ganiza ion (Punainen Sulka-Red Fea he ), he Ragna Ekbe g Founda ion, F imu a s i else, he Finnish Founda ion o Ca dio ascula Resea ch and Helsinki Uni e si y Cen al Hospi al. No es on con ibu o s Helena Ka ppinen, MD, is a Clinical Teache o Gene al P ac ice and P ima y Heal h Ca e a he Uni e si y o Helsinki, Finland. She is esponsible o he design, in e p e - a ion o he esul and w i ing he manusc ip . Kaisu H. Pi k€ al€ a, PhD, is a P o esso o Gene al P ac ice and P ima y Heal h Ca e a he Uni e si y o Helsinki. She is a ge ia ician esponsible o concep ion o he design, ga he - ing da a and conduc ing he s udy. Hannu Kau iainen, PhD, is a Bios a is ician a he Uni e si y o Helsinki, Helsinki Uni e si y Hospi al, and Medca e Founda ion. He is esponsible o s a is ical analyses. Reijo S. Til is, PhD, is an Eme i us P o esso o Ge ia ics a he Uni e si y o Helsinki. 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Mo e educa ion may limi dis- abili y and ex end li e o people wi h cogni i e impai men . Am J Alzheime s Dis O he Demen. 2014;29:436–447. SCANDINAVIAN JOURNAL OF PRIMARY HEALTH CARE 285 Downloaded by [Tampe e Uni e si y] a 22:19 07 Sep embe 2017