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Epidemiology of Aging

Epidemiology of Aging

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Epidemiology of Aging

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  1. Epidemiology of Aging A.M.Clarfield MD, FRCPC Professor of Gerontology Ben Gurion University, Israel Open Health Institute, Moscow Saturday, Jul 10 , 2004

  2. Scope of Problem : Large

  3. 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

  4. Squaring of the curve: ideal situation

  5. Demography • % elderly depends on : 1. fertility 2. mortality 3. migration

  6. Squaring of the curve: ideal situation

  7. Stages of the Demographic Transition Bangladesh Israel Sweden

  8. Survival Curves for Australian Males, 1988:Proportion Surviving (%)

  9. Are today’s elderly healthier than yesterday’s?

  10. Increase in life expectancy

  11. Alois Alzheimer et al

  12. Prevalence of AD in US:3 Projections( Arch Neurol 2003 )

  13. Aggregate Changes in Severe Cognitive Impairment Among Older Americans: 1993-1998(Freedman VA et al. J Gerontol 2001)

  14. Examined: 7443 (1993) and 7624 (1998) non-institutionalized elderly (70+) Percentage with “severe cognitive impairment”: 1993 = 6.1% 1998 = 3.6% } p<0.001

  15. Trends in Institutionalization(Jacobzone S. Health Affairs, 2000)

  16. Trends in Disability (Women Only)

  17. Are today’s elderly healthier than yesterday’s?

  18. What can explain this phenomenon?

  19. What can explain this phenomenon? • Genetics?

  20. What can explain this phenomenon? • Money/ education?

  21. What can explain this phenomenon? • Classic public health measures e.g. Hygiene/ diet/ water/ milk ?

  22. What can explain this phenomenon? • Medical technology ( atx, ASA, statins, stents?)

  23. What can explain this phenomenon? • Secular trend (McKeown)

  24. What can explain this phenomenon? • Lifestyle/health behaviour: -  smoking - diet -  exercise - alcohol

  25. What can explain this phenomenon? • Use of aids: - canes, handrails - microwave ovens

  26. What can explain this phenomenon? • Social support

  27. What can explain this phenomenon? • Something else? • All of the above?

  28. The Situation in Russia

  29. Age structure -Russia • 13.7% 65+ ( cf. Israel 10%, UK 18%) • % 60+ 1990: 16% 2015: 20% • Very rapid growth in old-old (80+)

  30. 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)

  31. The Situation in Russia • Degradation of health and social services •  life expectancy in the middle aged men (trauma, alcohol, suicide) • MORE OLD PEOPLE

  32. What is to be done?

  33. ?

  34. Thank You