Evaluation of “Vital Aging-M”: A Psychosocial Program for Promoting Optimal Aging

Abstract

Europe has become the most aged continent: In the Europe of the Fifteen (EU-15), one in five Europeans is now older than 65, a proportion set to increase (Eurostat, 2000). Although the aging population should be considered a positive phenomenon – the expression of sociopolitical, educational, and bio-medical development – it also undoubtedly represents a challenge to science and society: Since age is associated with illness, and illness with disability, the increased size of the older population brings with it high social and health costs. Thus, on average, in EU-15, social and health expenditures for those over-65 represents 10.5% of gross domestic product (GDP) and half of all health costs (Eurostat, 2001). The estimate is that, in accordance with future population distribution, by 2020 it will be necessary to increase the expenditure in social and health care. Thus, the aging population implies not only that people will live longer, it is also highly likely that to some extent they live longer with disability. On the basis of the prevalence of illnesses and disability and life expectancy, disability-adjusted life expectancy (DALE, also healthy life expectancy) refers to the estimation of a person’s probability, at birth (or at a certain age), of living free of disability – in other words, of their expectancy of living healthily. A comparison of life expectancy at birth with disability-adjusted life expectancy also at birth (WHO, 2000) for the EU-15 shows that, on average (men and women), while life expectancy at birth (EU, 2000) runs from 79.6 (Sweden) through 75.8 (Portugal), disabilityadjusted life expectancy (WHO, 2000) runs from 73.1 years (France) to 69.3 (Portugal). If we take into consideration men and women, the lowest expectation of disability at birth is in Greece (5.0 years per men and 5.9 per women) and highest in Luxemburg (6.5 per men and 7.2 per women) with an average of 6.3 years in EU-15. Thus, bearing in mind that life expectancy is projected to increase in the forthcoming decades, we may predict many more years of disability. Consequently, the challenge represented by the aging of the population derives not from the population rates, but from the rates of disability involved and the costs thereof. On the other hand, an increasing life expectancy free of disability would imply a reduction in social costs and would produce greater well-being and quality of life for citizens. But will this occur? Is there any empirical evidence that disability rates can in fact be reduced – or that DALE can increase? The evidence we have comes from two types of data: predictions of disability rates through longitudinal studies and studies on successful, active, or optimal aging. Longitudinal studies show a decline in disability among the elderly in the last decades compared to what has been expected (Cutler, 2001; Manton & Gu, 2001). For example, the Federal Interagency Aging Related Statistics predicted in 1982 a disability rate of 7.5 for 1984, of 8.3 for 1989 and of 8.7 for 1994, but the true data showed disability rates of 7, 7.1, and 7.3, respectively. The post-hoc explanation for this epidemiological finding may lie, according to the World Health Organization (WHO, 2002), in a situation whereby progress in the prevention of illness, the compression of morbidity, and the promotion of health have actually led to a decrease in the percentage of older people with disability. In sum, as Fries and Crapo (1981) stated, theoretical and experimental observations from physiology, medicine, psychology, sociology, and other discipline support the lengthening not only of life expectancy, but also of disability-free life expectancy, vitality or the vigor curve, always against the limit of lifespan (p. 123). Our second source of evidence comes from those studies focusing on how individuals age or, more precisely, on the changes that occur across the course of life or as part of the aging process. From these studies, it is commonly accepted that the individual process of aging can be reduced to a combination of patterns of growth, stability, and decline (e.g., Baltes, 1987; Schroots; Fernandez-Ballesteros & Rudinger, 1999, Schroots & Birren, 1993). Thus, those sciences that contribute to the