1. Increasing the length of healthy life: demographic and epidemiological reflections Jean-Marie Robine INSERM – EPHE, Paris and Montpellier, France Vivre et être actif -beaucoup- plus longtemps: Perspectives sociales, démographiques et de santé SPF Sécurité sociale, Bruxelles, 12 janvier 2015

2. The three theories of the 1980s The compression of morbidity: According to Fries, life expectancy was close to its maximum in the 1980s. Medical and health behaviors progress can only reduce the number of bad years to a small part of the life expectancy (Fries, 1980). The expansion of morbidity: On the opposite side, according to Gruenberg and Kramer, the same medical progress will increase the survival of frail elderly people such as those with dementia (Gruenberg, 1977; Kramer, 1980). The dynamic equilibrium: Between these two extreme futures, Manton proposed a dynamic equilibrium in which increased survival is offset by better control of chronic diseases, keeping the proportion of life lived in good health more or less constant (Manton, 1982).

3. The longevity revolution Worries about the future health status of the older population led the health authorities to build up population health surveillance systems in the 1980s including repeated cross sectional health surveys which allowed the functional health status of older people to be monitored. But no theory on health at that time was anticipating the longevity revolution which is currently occurring in most developed countries and which has led to impressive numbers of nonagenarians and centenarians.

4. The longevity revolution

5. Change in the number of centenarians in Europe vs. Japan Europe vs. Japan

8. Mechanism

9. Distribution des durées de vie individuelles en France depuis 1827 - pour 100.000 filles à la naissance Change over time in the distribution of the ages at death in France since 1827, female - for 100.000 newborn

10. Distribution des durées de vie individuelles en France depuis 1827 - pour 100.000 filles à la naissance Change over time in the distribution of the ages at death in France since 1827, female - for 100.000 newborn The longevity revolution

11. Compression vs. shifting mortality

12. Bongaarts, 2005, 2009

13. Fries, 1980

14. How long are adult life durations d(x) series Modal length of life (M) Deviation above M Maximum life span Distribution of the ages at death in Switzerland 1876-1880, 1929-1932, 1988-1993

15. Europe vs. Japan Robine and Saito, 2009

16. Change in the number of centenarians in Europe vs. Japan Europe vs. Japan

17. Maximum life span in Japan (empirical observations)

18. Warning: Divergence and variability

19. Trends in life expectancy at age 65 Denmark, the United States and the Netherlands

20. Trends in life expectancy at age 65

21. Number of centenarians (100+)

22. Population ageing

23. (i.e., % of the older people within the total population)

24. Population ageing France Germany (i.e., % of the older people within the total population) Demographic dependancy ratio

25. The oldest old support ratio

26. World wide decline in the oldest old support ratio As the number of people aged 50-74 for each person aged ≥ 85

27. Disability-free life expectancy France vs. Sweden

28. In France, women spend 42% of their years of life without disability (all disability levels conbined) versus 73% in Sweden Disability-free life expectancy at age 65 France vs. Sweden - in 2010 -

29. Trends in disability-free life expectancy at age 65

30. Compression of disability?

31. Dynamic equilibrium?

32. Expansion of disability?

33. Le cas des Pays Bas (Engelaer et al, in Robine et al, 2013) Netherlands, 1985-2010 Sources: Engelaer et al, in Robine et al, 2013

34. Trends in prevalence of dementia

35. Decline in the prevalence of dementia Larson et al, NEJM 2013

36. Thank you for your attention!

37. Increasing the length of healthy life: demographic and epidemiological reflections Jean-Marie Robine INSERM – EPHE, Paris and Montpellier, France Vivre et être actif -beaucoup- plus longtemps: Perspectives sociales, démographiques et de santé SPF Sécurité sociale, Bruxelles, 12 janvier 2015

39. Mortality and life expectancy above age 100

40. Number of oldest old in France by single age, 80 years and over