Frailty, heart disease, and stroke: the Compression of Morbidity paradigm.

Frailty, the loss of physiologic organ reserve with age, and chronic illness, such as heart disease and stroke, which may accelerate the development of frailty, become the dominant determinants of ill-health in those who escape the hazards of early and mid-life. The Compression of Morbidity paradigm holds that if the average age at first chronic infirmity is postponed, and if this postponement is greater than increases in life expectancy, then average cumulative lifetime morbidity will decrease, squeezed between a later onset and the time of death. The National Long-Term Care Survey, National Health Interview Survey, and other data document declining U.S. disability trends since 1982; accelerating recently, at about 2% per year. The decline in mortality is only 1% a year, documenting Compression of Morbidity in the U.S. population. Frailty, increasing exponentially because of linear declines in multiple organ systems, mandates converging morbidity and mortality rates as longevity increases. Longitudinal studies now link good health risk status with reduced lifetime disability; those with few health risks have only one-fourth the disability of those who have more risks, and the onset of disability is postponed from 7 to 12 years. Randomized controlled trials of senior health enhancement programs have shown reduction in health risks, improved health status, and decreased medical costs. Current health enhancement opportunities can increase health gains for seniors under the umbrella paradigm of the Compression of Morbidity. Effective interventions to prevent or postpone heart disease and stroke will decrease lifetime morbidity.