Epidemiology of Aging A.M.Clarfield MD, FRCPC Professor of Gerontology Ben Gurion University, Israel Open Health Institute, Moscow Saturday, Jul 10 , 2004
Aging: A Biological Definition “A progressive, generalized impairment of function resulting in a loss of adaptive response to stress (loss of biological reserve) and in a growing risk of age-associated disease.“ After Kirkwood T, 1996
Demography • % elderly depends on : 1. fertility 2. mortality 3. migration
Stages of the Demographic Transition Bangladesh Israel Sweden
Survival Curves for Australian Males, 1988:Proportion Surviving (%)
Aggregate Changes in Severe Cognitive Impairment Among Older Americans: 1993-1998(Freedman VA et al. J Gerontol 2001)
Examined: 7443 (1993) and 7624 (1998) non-institutionalized elderly (70+) Percentage with “severe cognitive impairment”: 1993 = 6.1% 1998 = 3.6% } p<0.001
Trends in Institutionalization(Jacobzone S. Health Affairs, 2000)
What can explain this phenomenon? • Genetics?
What can explain this phenomenon? • Money/ education?
What can explain this phenomenon? • Classic public health measures e.g. Hygiene/ diet/ water/ milk ?
What can explain this phenomenon? • Medical technology ( atx, ASA, statins, stents?)
What can explain this phenomenon? • Secular trend (McKeown)
What can explain this phenomenon? • Lifestyle/health behaviour: - smoking - diet - exercise - alcohol
What can explain this phenomenon? • Use of aids: - canes, handrails - microwave ovens
What can explain this phenomenon? • Social support
What can explain this phenomenon? • Something else? • All of the above?
Age structure -Russia • 13.7% 65+ ( cf. Israel 10%, UK 18%) • % 60+ 1990: 16% 2015: 20% • Very rapid growth in old-old (80+)
The Situation in Russia • Catastrophic impact of WW 1, WW2 ,famine: - eg 36♂: 100 ♀ - female advantage for life expectancy is widest in the world: 10.4 yr. ( cf. 4 yr. in Israel ) • Low fertility % 65+ • poverty, esp. among 65+ ( pension, cost of living)
The Situation in Russia • Degradation of health and social services • life expectancy in the middle aged men (trauma, alcohol, suicide) • MORE OLD PEOPLE