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Rejuvenation Research Gender differences in survival in old age (doi: 10.1089/rej.2014.1587) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.

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Gender differences in survivals in old age Jeremy M Jacobs MBBS1,2, Aaron Cohen MD1,2,3, Eliana Ein-Mor MA1,2, Jochanan Stessman MD1,2. Revised manuscript 24th September 2014

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The Jerusalem Institute of Aging Research, and

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The Department of Geriatrics and Rehabilitation, Hadassah-Hebrew University Medical

Center Mount Scopus, and Hebrew University-Hadassah Medical School, Mount Scopus, Jerusalem, Israel 3

Geriatric Division, Ministry of Health, Israel.

Address for correspondence and reprints: Jeremy M Jacobs Department of Geriatrics and Rehabilitation, Hadassah Hebrew-University Medical Center, Mt. Scopus. P.O. Box 24035, Jerusalem 91240, Israel. Tel: 972-2-5844473; Fax: 972-2-5810918; E-mail [email protected] Word count of manuscript 2980/ Abstract 216/ References 36/ Tables 3/ Figure 1

Running title: Gender and survival

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Rejuvenation Research Gender differences in survival in old age (doi: 10.1089/rej.2014.1587) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.

2 Abstract Background: Although increased survival among females is observed throughout much of adult life, supporting evidence among the oldest old is lacking. Objective: To examine the hypothesis that gender differences in survival diminish with advancing age. Methods: The Jerusalem Longitudinal Study follows a representative cohort born 192021, comprehensively assessed at ages 70, 78, 85, and 90 (n=463, 927, 1224, 673 respectively). Mortality data were collected from 1990-2013. Kaplan-Meier survival curves and Mortality Hazards Ratios (HR’s) were determined, adjusting for gender, marital status, education, loneliness, self-rated health, physical activity, functional status, neoplasm, diabetes mellitus, hypertension, ischemic heart disease. Results: Survival between ages 70-78 was 77.3% (n=358/463), 78-85 was 68.9% (n=635/927), 85-90 years was 71.1% (n=870/1224), and 90-93 years was 80.5% (n=542/673). With advancing age, the survival advantage among females vs. men declined: at ages 70-78 (85.6% vs. 71%, p 12 years schooling); financial status based upon self-reported difficulty getting through the month; marital status (married versus all others), living arrangements (living alone versus all others), and

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Rejuvenation Research Gender differences in survival in old age (doi: 10.1089/rej.2014.1587) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.

6 loneliness. Subjects were asked how often they felt lonely (dichotomized to not lonely versus lonely) (15,16).

Functional measures These included: physical activity levels. Subjects were questioned: “How often are you physically active?” answers being 1) < 4 hours/week, 2) about 4 hours/week, 3) at least an hour/day (e.g. regular physical activity such as walking), 4) vigorous sports at least 2/week (e.g. jogging, swimming). Physical activity was dichotomized to inactive (answer 1) versus active (answers 2, 3, or 4). This questionnaire was adapted from the Gothenburg 70-year olds Longitudinal Study and predicts functional status and morbidity among our cohort (17,18); frequency of leaving the house (dichotomized to less than 1/week versus more than 1/week); frequency of reading (dichotomized to rarely 1/week); functional status was assessed by self report according to direct questioning for each of the various basic Activities of Daily Living (ADL’s) (transfer, dressing, bathing, toilet hygiene, eating, continence) (19). Subjects were graded as either completely independent without any difficulty, independent with difficulty, or dependent on another person. Subjects who reported being independent yet with difficulty in at least one of the basic ADL’s were defined “performing ADL’s with difficulty”, and subjects requiring help from another person in one or more of the basic functions was defined being “Dependent on another person”; hearing was assessed using the whisper test (dichotomized to impaired or not); vision was assessed using Snellen chart testing, and dichotomized to impaired (best eye corrected vision ≤20/40) or not.

Common geriatric problems

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Rejuvenation Research Gender differences in survival in old age (doi: 10.1089/rej.2014.1587) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.

7 Evaluation included the following: Self-rated health was evaluated using the question: ‘‘Do you feel healthy in comparison to people your age?’’; sleep satisfaction; depression according to the Brief Symptoms Inventory (BSI) (20); cognitive status according to the Mini-Mental State Examination (MMSE) (21), with impairment defined as MMSE

Gender differences in survival in old age.

Although increased survival among females is observed throughout much of adult life, supporting evidence among the oldest old is lacking...
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