Epidemiology of Aging

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Epidemiology of Aging

• A.M.Clarfield MD, FRCPC
• Professor of Gerontology
• Ben Gurion University,
• Israel
• Open Health Institute, Moscow
• Saturday, Jul 10 , 2004

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Scope of Problem Large

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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.

After Kirkwood T, 1996
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Squaring of the curve ideal situation
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Demography

• elderly depends on
• 1. fertility
• 2. mortality
• 3. migration

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Squaring of the curve ideal situation
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Stages of the Demographic Transition
Bangladesh
Israel
Sweden
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Survival Curves for Australian Males,
1988Proportion Surviving ()
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Are todays elderly healthier than yesterdays?
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Increase in life expectancy
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Alois Alzheimer et al
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Prevalence of AD in US3 Projections( Arch
Neurol 2003 )
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Aggregate Changes in Severe Cognitive Impairment
Among Older Americans 1993-1998 (Freedman VA
et al. J Gerontol 2001)
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• Examined 7443 (1993) and 7624 (1998)
  non-institutionalized elderly (70)
• Percentage with severe cognitive impairment
• 1993 6.1
• 1998 3.6

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Trends in Institutionalization (Jacobzone S.
Health Affairs, 2000)
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Trends in Disability (Women Only)
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Are todays elderly healthier than yesterdays?
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What can explain this phenomenon?
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What can explain this phenomenon?

• Genetics?

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What can explain this phenomenon?

• Money/ education?

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What can explain this phenomenon?

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

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What can explain this phenomenon?

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

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What can explain this phenomenon?

• Secular trend (McKeown)

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What can explain this phenomenon?

• Lifestyle/health behaviour
• - ? smoking
• - diet
• - ? exercise
• - alcohol

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What can explain this phenomenon?

• Use of aids
• - canes, handrails
• - microwave ovens

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What can explain this phenomenon?

• Social support

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What can explain this phenomenon?

• Something else?
• All of the above?

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The Situation in Russia
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Age structure -Russia

• 13.7 65 ( cf. Israel 10, UK 18)
• 60 1990 16
• 2015 20
• Very rapid growth in old-old (80)

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The Situation in Russia

• Catastrophic impact of WW 1, WW2 ,famine
• - eg 36? 100 ?
• - female advantage for life expectancy is
  
• widest in the world 10.4 yr. ( cf. 4 yr.
  in
• Israel )
• Low fertility ?? 65
• ?poverty, esp. among 65
  (? pension, ?cost of living)

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The Situation in Russia

• Degradation of health and social services
• ? life expectancy in the middle aged men (trauma,
  alcohol, suicide)
• MORE OLD PEOPLE

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What is to be done?
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?
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• Thank You