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

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.

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

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

An emerging age group: the centenarians

Females (N)

aged 100+ in Sweden (1861 to 2008)

aged 105+ in Japan (1947 to 2007)

What are the consequences?In terms of- Morbidity- Disability

- Healthy lifeexpectancy

Future trends in morbidity and disability

rates will be crucial determinants of societies’ ability to meet

the challenges of population

ageing

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

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

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

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

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

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

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!

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

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)

Symptoms of diseases

Increases Pain Psychological distress General fatigue Dizziness Breathing Musculoskeletal pain Obesity – 3.8%/y 65+ year old

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)

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

*

*

*

Israel

SE

DKIR

DE

CH ATFR

ES IT

GR

BENL PL

CZ

UK

USA

KoreaJapan

*PT

*HU*SL

*LU

*ET

www.share-project.org

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

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

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

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

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!)

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)

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

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

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

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

Thank you!