Epidemiology of Aging A.M.Clarfield MD, FRCPC Professor of Gerontology Ben Gurion University, Israel...

Epidemiology of Epidemiology of AgingAging

A.M.Clarfield MD, A.M.Clarfield MD, FRCPCFRCPC

Professor of Gerontology Professor of Gerontology Ben Gurion University,Ben Gurion University,

Israel Israel

Open Health Institute, Moscow Open Health Institute, Moscow Saturday, Jul 10 , 2004 Saturday, Jul 10 , 2004

Scope of Problem : Large

Aging: A Biological Aging: A Biological DefinitionDefinition

““A progressive, generalized A progressive, generalized impairment of function impairment of function resulting in a loss of adaptive resulting in a loss of adaptive response to stress (loss of response to stress (loss of biological reserve) and in a biological reserve) and in a growing risk of age-growing risk of age-associated disease.“associated disease.“ After Kirkwood T, 1996

Squaring of the curve: Squaring of the curve: ideal situationideal situation

DemographyDemography

% elderly depends % elderly depends on :on :

1. fertility1. fertility

2. mortality2. mortality

3. migration 3. migration

Squaring of the curve: Squaring of the curve: ideal situationideal situation

Stages of the Demographic Stages of the Demographic TransitionTransition

Bangladesh Israel Sweden

Survival Curves for Australian Survival Curves for Australian Males, 1988:Males, 1988:

Proportion Surviving (%)Proportion Surviving (%)

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

Increase in life expectancyIncrease in life expectancy

Alois Alzheimer et al

Prevalence of AD in US:3 Prevalence of AD in US:3 ProjectionsProjections

( Arch Neurol 2003 )( Arch Neurol 2003 )

Aggregate Changes in Aggregate Changes in Severe Cognitive Severe Cognitive

Impairment Among Impairment Among Older Americans: Older Americans:

1993-19981993-1998 (Freedman VA et al. J Gerontol (Freedman VA et al. J Gerontol

2001)2001)

Examined: 7443 (1993) and 7624 Examined: 7443 (1993) and 7624 (1998) non-institutionalized (1998) non-institutionalized elderly (70+)elderly (70+)

Percentage with “severe cognitive Percentage with “severe cognitive impairment”: impairment”:

19931993 == 6.1%6.1%

19981998 == 3.6%3.6%} p<0.001

Trends in Trends in InstitutionalizationInstitutionalization

(Jacobzone S. (Jacobzone S. Health AffairsHealth Affairs, , 2000)2000)

Trends in Disability Trends in Disability (Women Only)(Women Only)

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

What can explain this What can explain this phenomenonphenomenon??

What can explain this What can explain this phenomenon?phenomenon?

Genetics? Genetics?

Money/ education?Money/ education?


Classic public health measures Classic public health measures e.g. Hygiene/ diet/ water/ e.g. Hygiene/ diet/ water/ milk ?milk ?


Medical technology ( atx, ASA, Medical technology ( atx, ASA, statins, stents?) statins, stents?)


Secular trend (McKeown)Secular trend (McKeown)

What can explain this phenomenonWhat can explain this phenomenon??


Lifestyle/health behaviour:Lifestyle/health behaviour:

- - smoking smoking

- diet- diet

- - exercise exercise

- alcohol - alcohol

Use of aids:Use of aids:

- canes, handrails- canes, handrails

- microwave ovens- microwave ovens


Social support Social support

What can explain this phenomenon?

Something else? Something else? All of the above?All of the above?


The Situation in RussiaThe Situation in Russia

Age structure -RussiaAge structure -Russia 13.7% 65+ ( cf. Israel 10%, UK 13.7% 65+ ( cf. Israel 10%, UK

18%)18%)

% 60+ 1990: 16%% 60+ 1990: 16%

2015: 20%2015: 20%

Very rapid growth in old-old Very rapid growth in old-old (80+)(80+)


Catastrophic impact of WW 1, Catastrophic impact of WW 1, WW2 ,famine:WW2 ,famine:

- eg 36- eg 36♂: 100 ♀♂: 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 Low fertility % 65+% 65+ poverty, esp. among 65+ poverty, esp. among 65+

( ( pension, pension, cost of living)cost of living)


Degradation of health and social Degradation of health and social services services

life expectancy in the middle aged life expectancy in the middle aged men (trauma, alcohol, suicide)men (trauma, alcohol, suicide)

MORE OLD PEOPLEMORE OLD PEOPLE

What is to be doneWhat is to be done??

Thank Thank YouYou

Epidemiology of Aging A.M.Clarfield MD, FRCPC Professor of Gerontology Ben Gurion University, Israel...

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