Aging in the 21st century: a call for papers.

Abstract

T he aging of the world’s population has profound implications for medical care and health care systems. According to the United Nations, the number of people worldwide aged 60 years or older will increase from 1 in 10 currently to 1 in 5 by 2050. In some developed countries, that proportion will increase from 1 in 5 to 1 in 2 in 2050. The population 80 years or older is projected to increase from 11% of those older than 60 years now to 19% by 2050, and the number of centenarians is expected to increase 15-fold to 2.2 million. The rate of aging of the population is greatest in developing nations, a growing challenge for nations with few health care resources. By 2050, the ratio of people 65 years or older to those aged 15 to 64 years will double in developed nations and triple in developing nations. This demographic revolution will fundamentally affect both health care and society. As one example of the dramatic social and economic effects expected from this trend, the United Nations will hold the Second World Assembly on Ageing in April 2002. According to Nitin Desai, United Nations Under-Secretary-General for Economic and Social Affairs, “. . . Ageing is not a separate issue from social integration, gender advancement, economic stability or issues of poverty. It has developed a connection with many global agendas and will play, increasingly, a prominent role in the way society interacts with economic and social welfare institutions, family and community life and the roles of women. . . . Societies must respond to the extraordinary potential and range of variability in individual ageing, and seize the opportunity to rethink our notion of limits and recognize the farreaching benefits societies stand to gain from the continuing contributions of their older citizens.” The United States faces specific problems related to aging. The Congressional Budget Office estimates that Medicare spending will double in the next decade under existing laws (without a drug benefit), costing an estimated $3.3 trillion over the next decade—while 44 million people remain uninsured. The high cost of drugs for elderly patients is on the national agenda, with proposals for some drug benefits for the poorest individuals, even while some Medicare managed care organizations are discontinuing drug benefits. A federal study found that more than 90% of US nursing homes have too few workers to take proper care of patients but because of the cost involved, the federal government does not plan to set minimum staffing levels. The aging population will put further demands on this already stressed system. These demographic and societal trends have major and far-reaching implications for clinical care, medical research, and health care policy. Given the importance of these issues for physicians, JAMA and several of the Archives Journals will publish theme issues on aging in November 2002. We invite authors to submit manuscripts reporting original research, including randomized controlled trials and high-quality observational research; systematic reviews; and special communications and scholarly commentaries addressing aging issues. Topics may include interventions that prevent disease, reduce disability, or extend functional years, as well as interventions to improve the afflictions more frequent in older age: Alzheimer disease and other dementias, osteoporosis, frailty, mobility limitations, incontinence, cardiovascular disease, stroke, diabetes, and cancer. Other appropriate topics include providing high-quality care for older adults regardless of race/ethnicity, sex, or ability to pay, and care for persons nearing the end of life. Authors are advised to consult the JAMA Instructions for Authors for guidelines on manuscript submission and preparation. Manuscripts received before June 1, 2002, will have the best chance of acceptance for the November 13, 2002, JAMA theme issue.