Decreased fertility and increased longevity have led to major changes in the age structure of the population. While there is no lack of pronouncements as to the health consequences of increased longevity, they are based on inadequate data sources and there is a lack of population-based, epidemiologic data relevant to these issues. In particular, the factors associated with increased longevity among the elderly are not well understood, and it is also not known if increased longevity is associated with """"""""added life to years"""""""" or only """"""""added years to life."""""""" Of critical importance is the assessment of outcomes additional to mortality and morbidity. Information on risk factors for mortality and morbidity and determinants of functional ability and quality of life is critical for evaluating the public health consequences of an aging population. We propose to utilize the Alameda County Study, a prospective, population-based study of residents of Alameda County, California, to address some of these issues. The Alameda County Study collected a broad set of data from a large sample of county residents on three occasions, 1965, 1974, and 1983, and has had a major impact on disease prevention and health promotion activities. Results from analyses of this data have been cited in the scientific press over 6,000 times, attesting to the strength and relevance of the study. With additional data collection in 1994, a 29-year follow-up, and a 1995 telephone follow-up we will be able to address the following important issues: * Are behavioral, social, psychological, and functional status measures associated with mortality, morbidity, and functional status in the elderly, and do these associations vary with increasing length of follow-up? Are more proximal risk factors better predictors, or are risk factors which capture early exposures or patterns of exposure over almost three decades better predictors of risk? * Are these factors associated with variations in active life expectancy? * Are there age, period, and cohort (APC) effects with respect to the prevalence and incidence of chronic conditions and symptoms, or measures of physical, social, or psychological functioning? * How are the natural history of behavioral, social, psychological, and functional status measures interrelated? Do changes in one lead to changes in others? The results of these analyses will help to clarify the consequences of increased longevity of the elderly, and will provide additional evidence on the role of potential interventions in middle age and beyond in improving the health and quality of life of the growing number of elderly persons.
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