1. EPIDEMIOLOGY OF AGING DEFINITION AND INTRODUCTION TO RESEARCH IN THIS AREA PRESENTATION OF AGING AND PHYSICAL ACTIVITY AS AN EXEMPLAR FOR RESEARCH IN THE EPIDEMIOLOGY OF AGING DEFINITION AND INTRODUCTION TO RESEARCH IN THIS AREA PRESENTATION OF AGING AND PHYSICAL ACTIVITY AS AN EXEMPLAR FOR RESEARCH IN THE EPIDEMIOLOGY OF AGING

2. EPIDEMIOLOGY OF AGING THE STUDY OF THE AGE- RELATED DISTRIBUTION AND CAUSES OF DISEASE, DISABILITY, AND MORTALITY IN HUMAN POPULATIONS.

3. EPIDEMIOLOGY OF AGING CHRONOLOGICAL AGE IS ASSOCIATED WITH INCIDENCE AND PREVALENCE OF MOST HEALTH OUTCOMES. DESPITE THIS AGE ASSOCIATION, THERE IS CONSIDERABLE VARIATION IN HEALTH OUTCOMES WITHIN AGE CATEGORIES. CHRONOLOGICAL AGE IS ASSOCIATED WITH INCIDENCE AND PREVALENCE OF MOST HEALTH OUTCOMES. DESPITE THIS AGE ASSOCIATION, THERE IS CONSIDERABLE VARIATION IN HEALTH OUTCOMES WITHIN AGE CATEGORIES.

4. EPIDEMIOLOGY OF AGING WHY ARE OLDER PEOPLE AT ELEVATED RISK FOR DISEASE, DISABILITY, AND DEATH?

5. EPIDEMIOLOGY OF AGING ACCUMULATION OF ENVIRONMENTAL/BEHAVIORAL INSULTS. REDUCED IMMUNOLOGICAL SURVEILLANCE ACCUMULATION OF ENVIRONMENTAL/BEHAVIORAL INSULTS. REDUCED IMMUNOLOGICAL SURVEILLANCE

6. EPIDEMIOLOGY OF AGING WHY IMPORTANT? – AGING OF THE HUMAN POPULATION – HEALTH AND VITALITY OF AN AGING POPULATION – QUALITY OF LIFE AND COST OF CARE WHY IMPORTANT? – AGING OF THE HUMAN POPULATION – HEALTH AND VITALITY OF AN AGING POPULATION – QUALITY OF LIFE AND COST OF CARE

7. EPIDEMIOLOGY OF AGING AGING OF THE U.S. POPULATION, PERCENTAGE AGED 65+ YEARS BY YEAR 19004.0% 19408.0% 1980 11.5% 2000 12.6% 2030 20.0% AGING OF THE U.S. POPULATION, PERCENTAGE AGED 65+ YEARS BY YEAR 19004.0% 19408.0% 1980 11.5% 2000 12.6% 2030 20.0%

8. EPIDEMIOLOGY OF AGING THERE IS CONSIDERABLE VARIABILITY BY REGION OF THE COUNTRY, 2000 – FLORIDA18.1% – CALIFORNIA 10.4% – ALASKA 5.8% THERE IS CONSIDERABLE VARIABILITY BY REGION OF THE COUNTRY, 2000 – FLORIDA18.1% – CALIFORNIA 10.4% – ALASKA 5.8%

9. EPIDEMIOLOGY OF AGING RACE, ETHNICITY, AND AGE, U.S. 2000 2050 NH white 83.5% 64.2% NH black 8.1 12.2 NH Asian/PI 2.4 6.5 Hispanic 5.6 16.4 RACE, ETHNICITY, AND AGE, U.S. 2000 2050 NH white 83.5% 64.2% NH black 8.1 12.2 NH Asian/PI 2.4 6.5 Hispanic 5.6 16.4

10. EPIDEMIOLOGY OF AGING Global Differences in the Aging of the Population – Number of years required to increase the percentage of people aged 65+ from 7% to 14%. – France: 115 years (1865-1980) – Japan: 26 years (1970-1996) – Chile: 20 years (2000-2020) – Tunisia 15 years (2020-2035) Global Differences in the Aging of the Population – Number of years required to increase the percentage of people aged 65+ from 7% to 14%. – France: 115 years (1865-1980) – Japan: 26 years (1970-1996) – Chile: 20 years (2000-2020) – Tunisia 15 years (2020-2035)

11. EPIDEMIOLOGY OF AGING Improvements in life expectancy are not constant. Not a “force of nature.” Life expectancy is quite fragile. Improvements in life expectancy are not constant. Not a “force of nature.” Life expectancy is quite fragile.

12. Decline in Life Expectancy in Russia, 1990-94 Life expectancy declined from 63.8 years to 57.7 years for men. Life expectancy declined from 74.4 years to 71.2 years for women. 75% of the decline in life expectancy was due to increased mortality rates for ages 25-64 years. Causes of death included cvd, injuries, influenza, chronic liver disease, cirrhosis and other alcohol-related diseases. Life expectancy declined from 63.8 years to 57.7 years for men. Life expectancy declined from 74.4 years to 71.2 years for women. 75% of the decline in life expectancy was due to increased mortality rates for ages 25-64 years. Causes of death included cvd, injuries, influenza, chronic liver disease, cirrhosis and other alcohol-related diseases.

13. Elderly Support Ratio, 2000-2030 Ratio = Number of people aged 65+ per 100 aged 20-64 USA – 2000 21 per 100 – 2030 37 per 100 Ratio = Number of people aged 65+ per 100 aged 20-64 USA – 2000 21 per 100 – 2030 37 per 100

14. Elderly Support Ratio 2000-2030 2000 2030 Italy 29 49 Japan 27 52 China 12 26 India 9 15 Guatemala 8 11 2000 2030 Italy 29 49 Japan 27 52 China 12 26 India 9 15 Guatemala 8 11

15. EPIDEMIOLOGY OF AGING MAJOR AGE-ASSOCIATED CAUSES OF DEATH – CARDIOVASCULAR DISEASE – CANCER – CHRONIC OBSTRUCTIVE PULMONARY DISEASE – DIABETES MAJOR AGE-ASSOCIATED CAUSES OF DEATH – CARDIOVASCULAR DISEASE – CANCER – CHRONIC OBSTRUCTIVE PULMONARY DISEASE – DIABETES

16. EPIDEMIOLOGY OF AGING AGE-SPECIFIC COLORECTAL CANCER INCIDENCE RATES (Per 100,000 in population) WM WF BM BF <65 20.4 14.7 25.3 20.4 65+ 408.0 269.3 385.8 286.1 AGE-SPECIFIC COLORECTAL CANCER INCIDENCE RATES (Per 100,000 in population) WM WF BM BF <65 20.4 14.7 25.3 20.4 65+ 408.0 269.3 385.8 286.1

17. EPIDEMIOLOGY OF AGING COGNITIVE FUNCTION Moderate/Severe Memory Impairment Male Female 65-69 5.3 3.8 85+ 37.3 35.0 COGNITIVE FUNCTION Moderate/Severe Memory Impairment Male Female 65-69 5.3 3.8 85+ 37.3 35.0

18. EPIDEMIOLOGY OF AGING Moderate or severe memory impairment defined as four or fewer words recalled (out of 20) on combined immediate and delayed recall tests. Source: Health and Retirement Survey.

19. EPIDEMIOLOGY OF AGING DEPRESSIVE SYMPTOMS Males Females 65-69 12.1 18.0 85 + 22.5 23.0 DEPRESSIVE SYMPTOMS Males Females 65-69 12.1 18.0 85 + 22.5 23.0

20. EPIDEMIOLOGY OF AGING DEPRESSIVE SYMPTOMS ARE DEFINED AS FOUR OUT OF EIGHT SYMPTOMS FROM AN APPREVIATED CES-D SCALE. SOURCE: HEALTH AND RETIREMENT SURVEY DEPRESSIVE SYMPTOMS ARE DEFINED AS FOUR OUT OF EIGHT SYMPTOMS FROM AN APPREVIATED CES-D SCALE. SOURCE: HEALTH AND RETIREMENT SURVEY

21. EPIDEMIOLOGY OF AGING PERCENT OF MEN AND WOMEN AGED 60+ REPORTING TWO OR MORE HEALTH CONDITIONS MEN WOMEN 60-69 35 45 70-79 47 61 80+ 53 70 PERCENT OF MEN AND WOMEN AGED 60+ REPORTING TWO OR MORE HEALTH CONDITIONS MEN WOMEN 60-69 35 45 70-79 47 61 80+ 53 70

22. EPIDEMIOLOGY OF AGING FUNCTIONAL LIMITATIONS AND DISABILITIES FALLS, INJURIES, ACCIDENTS FUNCTIONAL LIMITATIONS AND DISABILITIES FALLS, INJURIES, ACCIDENTS

23. EPIDEMIOLOGY OF AGING FUNCTIONAL LIMITATIONS – DIFFICULITIES IN THE PERFORMANCE OF GENERIC TASKS, E.G., THOSE RELATED TO UPPER- AND LOWER-BODY STRENGTH, BALANCE, AND FINE DEXTERITY.

24. EPIDEMIOLOGY OF AGING DISABILITY – DIFFICULTY OR INABILITY IN THE PERFORMANCE OF A SOCIAL ROLE CAUSED BY A PHYSICAL OR COGNITIVE PROBLEM.

25. EPIDEMIOLOGY OF AGING FALLS 30% OF PEOPLE AGED 65+ FALL EACH YEAR. 10-15% OF THOSE FALLS ARE CONSIDERED “SERIOUS/NON-FATAL” FALLS REPRESENT THE LEADING CAUSE OF ACCIDENTAL DEATH IN PEOPLE AGED 65 AND OLDER. FEAR OF FALLING IS A LEADING REASON FOR NOT ENGAGING IN PHYSICAL ACTIVITY. FALLS 30% OF PEOPLE AGED 65+ FALL EACH YEAR. 10-15% OF THOSE FALLS ARE CONSIDERED “SERIOUS/NON-FATAL” FALLS REPRESENT THE LEADING CAUSE OF ACCIDENTAL DEATH IN PEOPLE AGED 65 AND OLDER. FEAR OF FALLING IS A LEADING REASON FOR NOT ENGAGING IN PHYSICAL ACTIVITY.

26. EPIDEMIOLOGY OF AGING CAUSES OF FALLS IN THE ELDERLY - DIZZINESS - POOR COGNITIVE FUNCTION - VISION PROBLEMS - GENERAL FRAILTY - ENVIRONMENTAL HAZARDS CAUSES OF FALLS IN THE ELDERLY - DIZZINESS - POOR COGNITIVE FUNCTION - VISION PROBLEMS - GENERAL FRAILTY - ENVIRONMENTAL HAZARDS

27. EPIDEMIOLOGY OF AGING Types of studies – Clinic/Laboratory-Based Studies – Adapted Population Studies – Established Population Studies – Special General Population Studies – Special Chronic Disease Studies Types of studies – Clinic/Laboratory-Based Studies – Adapted Population Studies – Established Population Studies – Special General Population Studies – Special Chronic Disease Studies

28. EPIDEMIOLOGY OF AGING Types of Research Designs – Case-Control Studies – Longitudinal or Prospective Studies Types of Research Designs – Case-Control Studies – Longitudinal or Prospective Studies

29. EPIDEMIOLOGY OF AGING HEALTH PROMOTION NATIONAL INSTITUTE ON AGING STRATEGIC PLAN FOR 2001-05 CENTERS FOR DISEASE CONTROL, AGING WHITE PAPER HEALTH PROMOTION NATIONAL INSTITUTE ON AGING STRATEGIC PLAN FOR 2001-05 CENTERS FOR DISEASE CONTROL, AGING WHITE PAPER

30. EPIDEMIOLOGY OF AGING NIA STRATEGIC PLAN – PHYSICAL ACTIVITY Delay the onset of disabilities and disease Reduce the risk of falls and fractures Improve mood and depression Increase life span NIA STRATEGIC PLAN – PHYSICAL ACTIVITY Delay the onset of disabilities and disease Reduce the risk of falls and fractures Improve mood and depression Increase life span

31. EPIDEMIOLOGY OF AGING CDC PLAN – Key Component to Healthy Aging – Increases strength – Reduces risk of death – Improves mood – Improves muscular performance, flexibility, and mobility CDC PLAN – Key Component to Healthy Aging – Increases strength – Reduces risk of death – Improves mood – Improves muscular performance, flexibility, and mobility

32. EPIDEMIOLOGY OF AGING If it’s such a good thing…… – Many Americans are not engaging in physical activity. – Although more and more older adults are aware of the benefits of physical activity, only one-third exercise regularly. If it’s such a good thing…… – Many Americans are not engaging in physical activity. – Although more and more older adults are aware of the benefits of physical activity, only one-third exercise regularly.

33. EPIDEMIOLOGY OF AGING STUDY OF PHYSICAL PERFORMANCE AND AGE-RELATED CHANGES IN SONOMANS (SPPARCS PROJECT) – Sonoma residents aged 55 and older (n = 2096) – Home and laboratory assessments. Four assessments over a 8.5 year period. – Focus on the effects of leisure-time physical activity and health, functioning, and survival. STUDY OF PHYSICAL PERFORMANCE AND AGE-RELATED CHANGES IN SONOMANS (SPPARCS PROJECT) – Sonoma residents aged 55 and older (n = 2096) – Home and laboratory assessments. Four assessments over a 8.5 year period. – Focus on the effects of leisure-time physical activity and health, functioning, and survival.

34. EPIDEMIOLOGY OF AGING PHYSICAL ACTIVITY …. – DECLINES WITH AGE – MEDICAL AND NON-MEDICAL CAUSES PHYSICAL ACTIVITY …. – DECLINES WITH AGE – MEDICAL AND NON-MEDICAL CAUSES

35. EPIDEMIOLOGY OF AGING FEMALES AGED 55-64 ARE MORE LIKELY THAN MEN OF THE SAME AGE TO LIMIT OR AVOID LTPA BECAUSE OF THE ABSENCE OF AN EXERCISE COMPANION. NEARLY 1/3 OF WOMEN AGED 75+ REPORT THE ABSENCE OF AN EXERCISE COMPANION AS A LEADING REASON. AMONG MARRIED COUPLES, THE LTPA OF THE SPOUSE WAS THE BEST PREDICTOR OF THE SUBJECT’S LTPA. FEMALES AGED 55-64 ARE MORE LIKELY THAN MEN OF THE SAME AGE TO LIMIT OR AVOID LTPA BECAUSE OF THE ABSENCE OF AN EXERCISE COMPANION. NEARLY 1/3 OF WOMEN AGED 75+ REPORT THE ABSENCE OF AN EXERCISE COMPANION AS A LEADING REASON. AMONG MARRIED COUPLES, THE LTPA OF THE SPOUSE WAS THE BEST PREDICTOR OF THE SUBJECT’S LTPA.

36. EPIDEMIOLOGY OF AGING WHY IS THE ABSENCE OF AN EXERCISE COMPANION MORE SERIOUS FOR FEMALES THAN FOR MALES?

37. EPIDEMIOLOGY OF AGING PERCENT AGED 65+ MARRIED BY GENDER IN THE U.S. Male Female 75.1% 42.9% PERCENT AGED 65+ MARRIED BY GENDER IN THE U.S. Male Female 75.1% 42.9%

38. EPIDEMIOLOGY OF AGING STRATEGIES TO ENHANCE HEALTH AND FUNCTIONING THROUGH PHYSICAL ACTIVITY – RWJ PROGRAM IN “ACTIVE FOR LIFE” – RWJ PROGRAM IN “ACTIVE ENVIRONMENTS” STRATEGIES TO ENHANCE HEALTH AND FUNCTIONING THROUGH PHYSICAL ACTIVITY – RWJ PROGRAM IN “ACTIVE FOR LIFE” – RWJ PROGRAM IN “ACTIVE ENVIRONMENTS”