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. “ “ 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

6. Squaring of the curve: ideal situation

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

14. Squaring of the curve: ideal situation

15. Stages of the Demographic Transition BangladeshIsrael Sweden

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

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

18. Increase in life expectancy

19. Alois Alzheimer et al

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

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

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

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

24. Trends in Disability (Women Only)

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

27. What can explain this phenomenon?

28. Genetics? Genetics?

29. Money/ education? Money/ education? What can explain this phenomenon?

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

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

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

33. Lifestyle/health behaviour: Lifestyle/health behaviour: -  smoking -  smoking - diet - diet -  exercise -  exercise - alcohol - alcohol

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

35. Social support Social support What can explain this phenomenon?

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

37. The Situation in Russia

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

41. The Situation in Russia Catastrophic impact of WW 1, WW2,famine: Catastrophic impact of WW 1, WW2,famine: - eg 36 ♂: 100 ♀ - eg 36 ♂: 100 ♀ - female advantage for life expectancy is - female advantage for life expectancy is widest in the world: 10.4 yr. ( cf. 4 yr. in widest in the world: 10.4 yr. ( cf. 4 yr. in Israel ) Israel ) Low fertility  % 65+ Low fertility  % 65+  poverty, esp. among 65+ (  pension,  cost of living)  poverty, esp. among 65+ (  pension,  cost of living)

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

43. What is to be done?

44. ?

45. Thank You