From the Christensen paper, it was great to read a synthesis of information on how the aging process, morbidity, disability, and mortality has changed in the past couple of centuries in developed countries. I was waiting, however, for an actual paragraph/section that assessed mental health as its own category. Mental health, depression, and “psychological” distress/symptoms/autonomy are each mentioned, but only within the context of other issues/challenges/consequences. I was a little surprised by this, considering the fact that mental illness is a major source of lost productivity and years of life lived with disability. It would be interesting to see the topic covered on its own in this sort of discussion, potentially after the paragraph about disability. From what I recall, the prevalence of several mental illnesses, like depression, are increasing and starting earlier in life, and many of these conditions can be chronic. The authors mention very briefly that depression prevalence is decreasing, though that was in the Netherlands, and other countries may have differing data.
It was also surprising to see that, as people get into very old age, women tend to have higher levels of “functional limitations” than men, and that this “male advantage” seems to be pretty consistent at the oldest ages. I wonder if this is in part due to musculoskeletal issues and osteoporosis? We generally think of women has having the health advantage, so it was interesting to see this occurring, and maybe as everyone lives longer, it looks like that advantage may even out.
I was also left wondering how climate change may impact health and wellbeing. It’s outside the scope of the Christensen article, but it may make for an interesting follow-up.
From the Preston paper, I would have liked to have seen a little more information on how the death rate estimation was done for the BMI categories. While their analysis seems totally legit, I’m curious if any adjustment was made for modifications in the risk of death associated with treatment of conditions that are associated with a higher risk of death among those with higher BMI. For example, treatment of diabetes, use of antihypertensive medications, and use of cholesterol-lowering drugs have all been associated with lower mortality. I would think that outcomes for conditions with modifiable risks now may be better than they were in the time period that the data were originally collected, so it would be interesting to see if the projections take this into account. (I think this is part of what Christensen notes.)