Aging 1: 85-86, 1989

EDITORIAL

Aging and research in developing countries

The world is witnessing an astonishing in­crease in the absolute and relative numbers ofolder persons, and of the proportion of the veryold, particularly in the less developed countries.By the year 2025, three out of four of the world's1 billionelderly people will be livingin developingcountries, compared with about 50% in 1980.This demographic phenomenon raises a consid­erable challenge to public policy: it is a socialphenomenon without known historical prece­dent. Unfortunately, developing countries havelimited abilities to plan for a rapidly aging societywhen they are still facing problems associatedwith their younger populations. Although thespeed at which the population is aging is general­lyacknowledged and looked upon with concern,very little active planning has taken place.

Awareness of the issue concerning the ongo­ing shift to older populations was enhanced bythe historic World Assembly on Aging, con­vened by the United Nations in 1982. But part ofa continuing lack of awareness stems from a lackof complete and accurate data needed to formu­late policies and programs. Strengthening of na­tional research capability to generate such datahas been identified as an effective point of entryto promote the development of such policies andprograms at the national level.

Cross-national research has been shown to bea powerful method of identifying special as wellas universal risk factors in disease and disability,as well as protective factors that lead to healthyand productive aging. Furthermore, social andbehavioral scientists are seeking the properstrategies to use their investigations to optimizethe strength and potential strengths of olderpersons, and to improve their opportunities toperform rewarding roles in society. Such re­search can benefit older persons in developed aswell as in developing countries of the world.

To this end, the World Health Organization's

Advisory Committee on Health Research, rec­ommended the creation of an international re­search program on aging, as an integral part ofthe Organization's program on health of the el­derly. The recommendation was adopted by aresolution of the World Health Assembly, in May1987.

An important step to promote the coopera­tion of scientists to the accomplishment of theobjectives of the Program, was the agreementsigned in June 1987,between WHO and the U.S.National Institute on Aging, to host this research'component of the Global Program on the cam­pus of the National Institutes of Health of theUnited States of America. This arrangementprovided a unique opportunity for the WHO topotentiate its international capabilities with thetalents of the host institution.

As recommended by the WHO AdvisoryCommittee on Health Research, the Programwill promote cooperation among scientists anddefine directions for further research in the fol­lowingareas: determinants of healthy aging;age­associated dementias; age-related changes inimmune function and osteoporosis.

The project on Determinants of Healthy Ag­ing is one of the most promising avenues toidentify the biological, psychosocial, cultural,environmental and economic factors which af­fect healthy aging and health and social needs ofaging populations in different geographic andsocioeconomic settings. Comparability of thedata will be secured through the cross-culturalvalidation of standardized instruments. This pro­ject will include also the generation of data thatwill provide the proper scenario for the planningof the long-term care needs of the elderly withinthe existing national health services infrastruc­tures.

The project on age-related changes in immunefunction will focus on the nature of the increased

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susceptibility of older persons to infectious dis­eases, particularly as it relates to the effects ofaging on the immune system, and the responseof different aged populations to vaccines.

Some age-dependent diseases, those that in­evitably increase with age, represent a specialchallenge for the providers of health care. In theUnited States, for example, the cost for the careof osteoporosis and osteoporosis fractures, withan incidence of about 700,000 new fractures ev­ery year, exceeds 7 billion dollars annually. De­spite these facts, serious gaps in the knowledgeof osteoporosis and osteoporosis fractures stillexist, particularly in relation to cross-nationalepidemiological data. These gaps also concernthe possibility of prospectively identifying olderwomen at risk of fracture and the factors thatprotect them from fracturing, of preventingbone loss, and of suggesting the measures thatcan arrest the loss of bone.

Prevalence rates of age-associated dementiasrise markedly with age and threaten therefore toinundate the aging world with a devastating dis­ease that constitutes a heavy burden for thefamilies and the health care system. Population

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based data on age-associated dementias is notyet available from developing countries. Thecross-national multicenter study of the WHOResearch Program on Aging will use an etiologi­cally oriented epidemiological approach. Thevalue of scientifically sound cross-national stud­ies is considerable. Differences in incidencerates between countries or in distinct subpopu­lations may yield clues about risk factors relatedto difference in culture, environment, geneticmakeup or in health care delivery, which mightthen lead to new hypotheses about etiology.

Many scientists worldwide have already par­ticipated in the preparation of the Program'sresearch agenda, and have committed time andefforts to secure its success. It is expected todevelop an international network of collaborat­ing institutions, promoting active cooperationamong industrialized and developing countries.New alliances must be forged to provide theimpetus for action.

Jorge Litvak, M.D.Chief, Research Program on Aging

Global Program Health of the ElderlyWorld Health Organization