disability and morbidity in ageing cohorts – where are we going to? karen andersen-ranberg, md,...
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Disability and morbidity in ageing cohorts –
Where are we going to?
Karen Andersen-Ranberg, MD, PhDDept. of Geriatrics, Odense University HospitalDanish Ageing Research Centre, University of
Southern Denmark
Care of Older People in Portugal: Time for Geriatric Medicine
Fundaçao Calouste Gulbenkian and the EUGMS
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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.
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Improved survival of the oldest old
Probability of survival age 80 90 years, Industrialized countries; 1950 2002
Women Men
1950 15-16% 12%
2002 37% 25%
Japan today: probability >50% for women
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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
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An emerging age group: the centenarians
Females (N)
aged 100+ in Sweden (1861 to 2008)
aged 105+ in Japan (1947 to 2007)
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What are the consequences?In terms of- Morbidity- Disability
- Healthy lifeexpectancy
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Future trends in morbidity and disability
rates will be crucial determinants of societies’ ability to meet
the challenges of population
ageing
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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
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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
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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
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Healthy life expectancies
• Disease-free health expectancyLife years with morbidity have increased in parallel with increase in some diseases and conditions
• Life expectancy in perceived good healthLife 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
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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
SE FI DK
UK IE NL BE DE AT FR ES PT IT GR
M
F
Rise Stagnation Rise
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Disability free life expectancy – HLY
Meta-analysis 25 EU countries
HLY at age 50 years (HLY50y): men - 14,5 years women - 13,7 years
Meta-regression macro-indicators associated with HLYs50y Positively associated: both sexes wealth, expenditure, labor force participation, education, GDP, expenditure on care for older peoplePositively (men): life-long learningNegatively (men): long-term employment
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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!
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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
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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)
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Symptoms of diseases
Increases Pain Psychological distress General fatigue Dizziness Breathing Musculoskeletal pain Obesity – 3.8%/y 65+ year old
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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)
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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
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*
*
*
Israel
SE
DKIR
DE
CH ATFR
ES IT
GR
BENL PL
CZ
UK
USA
KoreaJapan
*PT
*HU*SL
*LU
*ET
www.share-project.org
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European dataThe SHARE survey
dynamic
longitudinel
Income, security, wealth
Children, social network,living conditions
Health care, Morbidity, Disability,
biomarkers
Political
decisions
www.share-project.org
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SHARE functional health by country and age groups
mean
0 %
10 %
20 %
30 %
40 %
50 %
60 %
Pre
va
lence
PL DE BE IL IT FR ES DK AU GR NL SE CZ CH
50-64y 65-79y 80+y
Proportion of 50+ y olds with 1+ ADL limitation
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SHARE Functional health 80+ yHaving 1+ ADL limitation
mean
0 %
10 %
20 %
30 %
40 %
50 %
60 %
Pre
va
lence
PL DE IL BE IT ES FR DK AU GR NL SE CZ CH
Large variations across Europe!
50% of oldest old in Poland 18% of oldest old in
Switzerland
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mean
0 %
10 %
20 %
30 %
40 %
50 %
Pre
va
lence
IL ES DE PL CZ IT SE GR FR DK BE AU NL CH
SHARE Cognitive health 80+ yHaving 2+ faults in
Orientation Large variations across
Europe! About 1/3 of oldest old in
Israel and Spain Less than 10% of oldest old
in Switzerland
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mean
0 %
10 %
20 %
30 %
40 %
50 %
60 %
70 %
Pre
va
lence
PL IT CZ FR ES IL GR AU BE DE NL SE DK CH
SHARE Mental health 80+ y3+ depressive symptoms
(EURO-D 12) Depressive symptoms are highly
prevalent New EU-member countries (PL;CZ) Mediterranean countries
(IT,FR,ES,IL) Less prevalent in more northern
countries and Switzerland (selection bias!)
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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)
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Continued improvement of health trajectories by
enhancing living conditions and lifestyle earlier in life
improving public health efforts to, e.g. combatsmoking and excess drinkingobesity, low levels of exercise, poor diets
improving living conditions for older people
Improving care for older people with several ailments
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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 Source: Vaupel, Carey, Christensen. Science 2003
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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 Source: Vaupel, Carey, Christensen. Science 2003
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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!Source: Vaupel, Carey, Christensen. Science 2003
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Thank you!