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Disability and morbidity in ageing cohorts – Where are we going to? Karen Andersen-Ranberg, MD, PhD Dept. of Geriatrics, Odense University Hospital Danish.

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Presentation on theme: "Disability and morbidity in ageing cohorts – Where are we going to? Karen Andersen-Ranberg, MD, PhD Dept. of Geriatrics, Odense University Hospital Danish."— Presentation transcript:

1 Disability and morbidity in ageing cohorts – Where are we going to? Karen Andersen-Ranberg, MD, PhD Dept. of Geriatrics, Odense University Hospital Danish Ageing Research Centre, University of Southern Denmark Care of Older People in Portugal: Time for Geriatric Medicine Fundaçao Calouste Gulbenkian and the EUGMS

2 The Ageing Society A trend in society of longer life expectancy and a birth-rate falling or remaining low, leading to a change in the composition of the populations, with an increasing number of older persons relative to both the number of children and young people and the number of people of working age.

3 Improved survival of the oldest old Probability of survival age 80  90 years, Industrialized countries; 1950  2002 WomenMen 195015-16%12% 200237%25% Japan today: probability >50% for women

4 Probabilities of dying before their next birthday - changes over 50 years 1950  2003 80+ y olds: Lower probability of dying 80 y ♀ 90 y ♀ 80 y ♂ 90 y ♂ Christensen et al. Lancet 2009;374:1196

5 An emerging age group: the centenarians Females (N) aged 100+ in Sweden (1861 to 2008) aged 105+ in Japan (1947 to 2007)

6 What are the consequences? In terms of - Morbidity - Disability - Healthy lifeexpectancy

7 Future trends in morbidity and disability rates will be crucial determinants of societies’ ability to meet the challenges of population ageing

8 Health is a multidimensional notion Several indicators are needed to capture trends in health deterioration  Risk factors   diseases and conditions   loss of function and mobility   dependent on the environmental context  disability

9 Mobility trends  In general: Improvements in MOBILITY of 65+y olds Improvements in southern Europe Stagnation in northern Europe and Japan Evidence of recent worsening in Sweden and UK

10 Disability trends  In general: DISABILITY prevalence falling In basic activities of daily living (B-ADL) In instrumental activities of daily living (I-ADL) Stagnation in Spain Evidence of recent worsening in USA and UK (65-69y) baby boomers

11 Healthy life expectancies Disease-free health expectancy Life years with morbidity have increased in parallel with increase in some diseases and conditions Life expectancy in perceived good health Life years in good self-perceived health generally rising Disability-free life expectancy (HLY) has evolved differently dependent on severity of disability: decrease for the most severe levels of disability increase for the least severe levels of disability

12 Disability free life expectancy – HLY European Community Household Panel (1995-2003)  Q:”Are you hampered in your daily activities by any physical or mental health problem, illness or disability?”  “moderate”/“severe” = disabled  65+ year olds SEFIDKUKIENLBEDEATFRESPTITGR M F RiseStagnationRise

13 Disability free life expectancy – HLY Meta-analysis 25 EU countries HLY at age 50 years (HLY 50y ): men - 14,5 years women - 13,7 years Meta-regression macro-indicators associated with HLYs 50y Positively associated: both sexes wealth, expenditure, labor force participation, education, GDP, expenditure on care for older people Positively (men): life-long learning Negatively (men): long-term employment

14 Diseases - morbidity  Most data based on self-reported morbidity – Underestimate!  But in general, (both self-reported and medical records) an INCREASE in morbidity (comorbidity)  Why? older people have an increased medical knowledge older people have an increased awareness of their rights from ’gratitude’ generations to ’demand’ generations older people benefit improved health services and earlier diagnostics less traumatic medical and surgical interventions They survive with their diseases!

15 Diseases - morbidity  In general: increase in prevalence of chronic diseases in older people, especially Heart disease: although lower incidence, even lower mortality Diabetes Hypertension: most studies show an increase Leg ulcers Lung problems Dementia ????? Inconsistent Hip fracture: decrease in Denmark; increase in Austria

16 Cancers  Increases in total cancer incidence, due to  population ageing Colo-rectal cancer Melanoma  screening for cancers Breast cancer Prostate cancer  the environment Lung cancer (women)

17 Symptoms of diseases  Increases  Pain  Psychological distress  General fatigue  Dizziness  Breathing  Musculoskeletal pain  Obesity – 3.8%/y 65+ year old

18 Health Survey for England Rice et al. Rejuven Res 2010 Cross-sectional; community-dwellers; Comparing health status of 50-60 year olds of 2 birth cohorts: WW2 birth cohorts (born 1936-1945) Post-WW2 birth cohorts (born 1946-1955)

19 Health Survey for England Rice et al. Rejuven Res 2010 The postWW2 generation shows Increases in BMI Self-reporting long-standing illness/disability chronic diseases self-reported health (no change/increase) endocrine/metabolic disorders Diabetes mental disorders heart and circulatory system conditions  Hypertension treatment (Blood pressure measured)  Heart attack bone, joint or muscle problems

20 * * * Israel SE DK IR DE CHAT FR ES IT GR BE NL PL CZ UK USA Korea Japan *PT *HU *SL *LU *ET www.share-project.org

21 European data The SHARE survey dynamic  longitudinel Income, security, wealth Children, social network, living conditions Health care, Morbidity, Disability, biomarkers Political decisions www.share-project.org

22 SHARE functional health by country and age groups Proportion of 50+ y olds with 1+ ADL limitation

23 SHARE Functional health 80+ y Having 1+ ADL limitation  Large variations across Europe!  50% of oldest old in Poland  18% of oldest old in Switzerland  Large variations across Europe!  50% of oldest old in Poland  18% of oldest old in Switzerland

24 SHARE Cognitive health 80+ y Having 2+ faults in Orientation

25 SHARE Mental health 80+ y 3+ depressive symptoms (EURO-D 12)

26 Geriatrics - attractive and important specialty Before the discovery that senescence could be postponed, geriatric medicine was viewed as a laudable but rather futile effort to palliate the misery of those in the process of dying. Today, however, geriatrics is becoming a more attractive and increasingly important specialty. ( Vaupel J. Biodemography of Human Ageing. Nature 2010)

27 Continued improvement of health trajectories by  enhancing living conditions and lifestyle earlier in life  improving public health efforts to, e.g. combat smoking and excess drinking obesity, low levels of exercise, poor diets  improving living conditions for older people  Improving care for older people with several ailments

28 Does it help? The German Lesson  Germany – before and after the reunification  Probability of dying in very old birth cohorts  Comparing the same birth cohorts in former West and East Germany  Higher probability of dying in East Germany  Germany – before and after the reunification  Probability of dying in very old birth cohorts  Comparing the same birth cohorts in former West and East Germany  Higher probability of dying in East Germany Source: Vaupel, Carey, Christensen. Science 2003

29 Does it help? The German Lesson  The same pattern for different birth cohorts of old and oldest old until the reunification  Higher probability of dying  In the oldest birth cohort  With advancing age  Living in East Germany  The same pattern for different birth cohorts of old and oldest old until the reunification  Higher probability of dying  In the oldest birth cohort  With advancing age  Living in East Germany Source: Vaupel, Carey, Christensen. Science 2003

30 Yes – it‘s never too late!  After the re-unification  Similar probabilities of dying  Probability of dying declined for oldest old in former East Germany to the level of former West Germany  In just 10 years!  After the re-unification  Similar probabilities of dying  Probability of dying declined for oldest old in former East Germany to the level of former West Germany  In just 10 years! Source: Vaupel, Carey, Christensen. Science 2003

31 Thank you!


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