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Disability and morbidity in ageing cohorts – Where are we going to?

Care of Older People in Portugal: Time for Geriatric Medicine Fundaçao Calouste Gulbenkian and the EUGMS. Disability and morbidity in ageing cohorts – Where are we going to?. Karen Andersen-Ranberg, MD, PhD Dept . of Geriatrics, Odense University Hospital

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Disability and morbidity in ageing cohorts – Where are we going to?

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  1. Care of OlderPeople in Portugal: Time for GeriatricMedicine Fundaçao Calouste Gulbenkian and the EUGMS Disability and morbidityin ageingcohorts – Wherearewegoing to? Karen Andersen-Ranberg, MD, PhD Dept. of Geriatrics, Odense University Hospital Danish Ageing Research Centre, University of Southern Denmark

  2. 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.

  3. Improvedsurvivalof the oldestold Probability of survival age 80  90 years, Industrialized countries; 1950  2002 Japan today: probability >50% for women

  4. 80+ y olds: Lowerprobability of dying Probabilities of dyingbeforetheirnextbirthday- changes over 50 years 1950  2003 80 y ♀ 80 y ♂ Christensen et al. Lancet 2009;374:1196 90 y ♀ 90 y♂

  5. An emerging age group: the centenarians Females (N) aged 100+ in Sweden (1861 to 2008) aged 105+ in Japan (1947 to 2007)

  6. Whatare the consequences?In terms of- Morbidity- Disability- Healthylifeexpectancy

  7. Future trends in morbidity and disability rates will be crucial determinants of societies’ ability to meet the challenges of population ageing

  8. 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

  9. Mobility trends • In general: Improvements in MOBILITY of 65+y olds • Improvements in southernEurope • Stagnation in northernEurope and Japan • Evidence of recentworsening in Sweden and UK

  10. Disability trends • In general: DISABILITY prevalencefalling • In basicactivities of dailyliving (B-ADL) • In instrumental activities of dailyliving (I-ADL) • Stagnation in Spain • Evidence of recent worsening in USA and UK (65-69y) baby boomers

  11. Healthylifeexpectancies • Disease-freehealthexpectancyLife years with morbidity have increasedin parallel with increase in some diseases and conditions • Life expectancy in perceivedgoodhealthLife yearsingoodself-perceivedhealthgenerallyrising • Disability-freelifeexpectancy (HLY)has evolved differently dependent on severity of disability: decrease for the most severe levels of disability increase for the least severelevels of disability

  12. Disabilityfreelifeexpectancy – HLYEuropean CommunityHousehold 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

  13. Disabilityfreelifeexpectancy – HLYMeta-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 people • Positively (men): life-long learning • Negatively(men):long-term employment

  14. Diseases - morbidity • Most data basedonself-reportedmorbidity – Underestimate! • But in general, (bothself-reported and medicalrecords) an INCREASE in morbidity (comorbidity) • Why? • olderpeople have an increasedmedicalknowledge • olderpeople have an increasedawareness of theirrights • from ’gratitude’ generations to ’demand’ generations • olderpeoplebenefit • improvedhealth services and earlierdiagnostics • lesstraumaticmedical and surgical interventions • Theysurvivewiththeirdiseases!

  15. Diseases - morbidity • In general: increase in prevalence of chronicdiseases in olderpeople, especially • Heart disease: althoughlowerincidence, evenlowermortality • Diabetes • Hypertension: most studies show an increase • Leg ulcers • Lung problems • Dementia ????? Inconsistent • Hip fracture: decreasein Denmark; increase in Austria

  16. Cancers • Increasesin total cancer incidence, due to • population ageing • Colo-rectal cancer • Melanoma • screening for cancers • Breast cancer • Prostate cancer • the environment • Lung cancer (women)

  17. Symptoms of diseases • Increases • Pain • Psychologicaldistress • General fatigue • Dizziness • Breathing • Musculoskeletalpain • Obesity – 3.8%/y 65+ yearold

  18. Health Survey for England Rice et al. Rejuven Res 2010 • Cross-sectional; community-dwellers; • Comparinghealth status of 50-60 yearolds of 2 birthcohorts: • WW2 birthcohorts (born 1936-1945) • Post-WW2 birthcohorts (born 1946-1955)

  19. Health Survey for England Rice et al. Rejuven Res 2010 The postWW2 generation shows Increasesin • BMI • Self-reportinglong-standingillness/disability • chronicdiseases • self-reportedhealth (nochange/increase) • endocrine/metabolicdisorders • Diabetes • mental disorders • heart and circulatory system conditions •  Hypertensiontreatment (Bloodpressuremeasured) •  Heart attack • bone, joint ormuscle problems

  20. * Korea Japan * * Israel SE UK *ET DK IR NL PL DE USA BE CZ *LU FR CH AT *HU *SL IT ES *PT GR www.share-project.org

  21. European dataThe SHARE survey Income, security, wealth Political decisions dynamiclongitudinel Health care, Morbidity, Disability, biomarkers Children, social network,living conditions www.share-project.org

  22. SHARE functionalhealthby country and age groups Proportion of 50+ y oldswith 1+ ADL limitation

  23. SHARE Functionalhealth 80+ yHaving 1+ ADL limitation • Large variationsacross Europe! • 50% ofoldestold in Poland • 18% ofoldestold in Switzerland

  24. SHARE Cognitivehealth 80+ yHaving2+ faults in Orientation • Large variationsacross Europe! • About 1/3 ofoldestold in Israel and Spain • Lessthan 10% ofoldestold in Switzerland

  25. SHARE Mental health 80+ y3+ depressive symptoms(EURO-D 12) • Depressive symptomsarehighlyprevalent • New EU-member countries (PL;CZ) • Mediterranean countries (IT,FR,ES,IL) • Lessprevalent in more northern countries and Switzerland (selectionbias!)

  26. Geriatrics - attractive and importantspecialty 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)

  27. 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 withseveralailments

  28. Germany – beforeand after thereunification Probabilityofdying in veryoldbirthcohorts Comparingthe same birthcohorts in former West and East Germany Higher probabilityofdying in East Germany Doesithelp? The German Lesson Source: Vaupel, Carey, Christensen. Science 2003

  29. The same patternfor different birthcohortsofoldandoldestolduntilthereunification Higher probabilityofdying In theoldestbirthcohort Withadvancingage Living in East Germany Doesithelp? The German Lesson Source: Vaupel, Carey, Christensen. Science 2003

  30. After there-unification Similarprobabilitiesofdying Probabilityofdyingdeclinedforoldestold in former East Germany tothelevelofformer West Germany In just 10 years! Yes – it‘snevertoolate! Source: Vaupel, Carey, Christensen. Science 2003

  31. Thankyou!

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