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Society is aging:
There are more older people, with, at the end of the last (20th) century:
In the Americas, the growth rate of the 60+ age group is expected to be 3.5 times that of the total population by 2010. The consequence is an ageing society, with a proportionately high
(and increasing) number of older people. This combination of a shift from high to low mortality and high
to low fertility, which results in population aging, is called the
"demographic transition". But society is aging at a different rate
in different countries. Demographic transition in developing and developed
countries
The greatest differences are between the developed and developing countries. A simple index which illustrates the differences between countries is: the number of people aged 60 / the number of people aged under 15 In 1997, this index was 82 in Canada and 9 in Nicaragua,
illustrating the discrepancies between nations. However, the shift
to an older society in the developing nations is expected to catch
up with that of the developed countries. Population pyramid - Latin America (1995 and 2025) Population pyramid - Europe (1995 and 2025) Not only are there more old people but there has been an increase in the old-old. In the last century:
Not only are there more old people, but there is an increase in the old-old. Percentage of population aged 80 and over, 1994 and 2020 (Butler, RN. Population aging and health. Brit Med J 1997; 315: 1082-1084) The increases in life expectancy vary geographically. Life expectancy in different countries. In most parts of the
world, women tend to live longer than men do. However, in the
western world the gender gap is narrowing.
Although people in developing countries do not live as long, there are many more old people in them:
By 2025, China may have 285 million people aged over 60 years - more than the total present population of the US. Although people in developing countries do not live as long, there are many more of them Health and the aging of society Aging is accompanied by physiological changes and illnesses:
Special medical features of illness in old age FEATURES OF THE ILLNESS Insidious onset (a slow reduction of function may be wrongly accepted as an inevitable part of aging) Multiple pathology. Failure in one system may lead to failure in another Ð a cascade effect. No one disease dominates the clinical picture Multiple organ failure Multiple causes of the same symptom. Symptoms which are common to a number of diseases of old age are confusion, falls, incontinence, immobility. These have been called the Geriatric Giants Chronic incurable diseases more common than in younger people (leading to the epidemiological transition, see below) FEATURES OF PRESENTATION AND DIAGNOSIS Late presentation (the Iceberg phenomenon, see below) Presentation with a social problem which may obscure an underlying disease or complicate its management Intellectual failure and inability to communicate may complicate history-taking, diagnosis and management Different presentation to the young. For example: Multiple factors combine to produce atypical presentation Old people seem less sensitive to visceral than articular pain Reduced response of the reticulo-endothelial system, so that leukocytosis and lymphadenopathy are less evident in infections FEATURES OF MANAGEMENT Multiple drug use which may complicate management Some drugs cause as well as cure health problems and this may be critical in older people The geriatric giants Epidemiological transition The iceberg phenomenon
Older people tend to under-report medical and social problems (the iceberg phenomenon) Delaying illness, prolonging life The changes and conditions that accompany old age are seldom
apparent before middle age, but then their incidence doubles
exponentially every 5 years or so.
Age-related conditions may be delayed by the same factors that increase lifespan:
Age-related conditions may be delayed by the same factors that increase lifespan Geographical variations in these factors mean that death rates
from specific causes vary with country. The reduction in mortality from chronic diseases means that older people then become more likely to die from some other cause. It may also mean that there is increased morbidity and disability because of these conditions, if their incidence does not decrease. Life prolonged, disability increased? How big is the increase in years of active life of a good
quality? There are three different theories about the impact on population health of the factors that lead to longer lifespans:
The types of condition that patients have that contribute to relative disability, according to a UK community practice survey. Their relative importance will be different in different countries. (Brocklehurst) Causes of death in developing regions by year (Brocklehurst) Number of chronically disabled Americans aged 65 and over, 1982-1986. This shows that not only are we living longer, we are healthier for longer. (Butler, RN. Population aging and health. Brit Med J 1997; 315: 1082-1084) Older women are more likely to be disabled than older men. Although the "active life expectancy" of women is longer, the expected period of terminal disability and dependency is about twice that for men. We are unlikely to achieve our full natural lifespans because,
with longer lifespans, there is:
Therefore, healthcare workers will need to cope with increased pressure on health and social care resources. The existence of more old people and more survivors of serious diseases has meant an increase in the incidence of morbidity and non-life-threatening but disabling chronic diseases and conditions |