Epidemiology of Aging A M Clarfield MD FRCPC

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

Scope of Problem : Large

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

Squaring of the curve: ideal situation

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

Squaring of the curve: ideal situation

Stages of the Demographic Transition Bangladesh Israel Sweden

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

Are today’s elderly healthier than yesterday’s?

Increase in life expectancy

Alois Alzheimer et al

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

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% } p<0. 001 1998 = 3. 6%

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

Trends in Disability (Women Only)

Are today’s elderly healthier than yesterday’s?

What can explain this phenomenon?

What can explain this phenomenon? n Genetics?

What can explain this phenomenon? n Money/ education?

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

What can explain this phenomenon? n Medical technology ( atx, ASA, statins, stents? )

What can explain this phenomenon? n Secular trend (Mc. Keown)

What can explain this phenomenon? n Lifestyle/health behaviour: - smoking - diet - exercise - alcohol

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

What can explain this phenomenon? n Social support

What can explain this phenomenon? n Something else? n All of the above?

The Situation in Russia

Age structure -Russia n 13. 7% 65+ ( cf. Israel 10%, UK 18%) n % 60+ 1990: 16% 2015: 20% n Very rapid growth in old-old (80+)

The Situation in Russia Catastrophic impact of WW 1, WW 2 , famine: - eg 36♂: 100 ♀ - female advantage for life expectancy is widest in the world: 10. 4 yr. ( cf. 4 yr. in Israel ) n Low fertility % 65+ n poverty, esp. among 65+ ( pension, cost of living) n

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

What is to be done?

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Thank You