Epidemiology Of Aging Research Articles

GERONTOLOGIC BIOSTATISTICS: MERGING WITH DATA SCIENCE AND TOWARD PERSONALIZED MEDICINE

Abstract The sub-discipline of gerontologic biostatistics (GBS) was introduced in 2010 to emphasize the special challenges encountered in the design and analysis of research studies of older persons. These challenges center on the multifactorial nature of human aging, characterized by the parallel and progressive deterioration of diverse organ and cellular systems that eventually results in death. Ten years after the introduction of GBS, which initially focused on important aspects of design and analysis that ensure their statistical validity, we update how GBS has been enriched by evolving practices. We present individual sessions on three seminal developments in the practice of GBS: integration of data science and multiple streams of data, including those automated and or multidisciplinary in nature; enhanced methods of addressing the heterogeneity of treatment effects from health-related interventions for older patients; and how interactive visualization can help specific patients locate themselves along the continuum of individualized treatment effects. We conclude our presentation with a session that reviews three prominent trends in the validation of the heterogeneity inherent to the assessment of health among older adults. Reflecting this era of big gerontological data, we discuss several established modeling approaches for validation, the proliferation of signal intensive behavior phenotypes, and the deep characterization of phenotypes through OMICS studies and multimodal approaches. All talks discuss pitfalls and areas of future development and draw from published studies. We are submitting as an interest group collaborative panel submission between two interest groups: Epidemiology of Aging and Measurement, Statistics and Design.

Traumatic Brain Injury in Older Adults: Epidemiology, Etiology, Rehabilitation, and Outcomes

Purpose: Traumatic brain injury (TBI) is a major public health problem, affecting millions of people worldwide each year. TBI presents as a major cause of death and disability in older adults, which is significant in the setting of older adults living longer. Falls are the leading cause of TBI in older adults, and normal sensory, motor, and cognitive changes that occur with aging increase the risk of falling. Multiple medical and cognitive comorbidities put older adults at increased risk for sustaining a TBI, and complicate recovery. Preexisting comorbid conditions, such as hypertension, diabetes, and heart disease, when combined with polypharmacy and aging effects compound the risks, severity, and outcomes following TBI. This clinical focus article addresses the normal effects of aging, the epidemiology of aging, and the relationship of aging to risks, consequences, and prognosis following TBI in older adults. In addition, discussion focuses on medical care and treatment, acute and chronic consequences, and assumptions and controversies in approaches to management of acute TBI in this population. The processes for assessment and treatment of cognitive communication during rehabilitation are explained in detail, including specific measures and strategies for both the acute and chronic phases of rehabilitation. Conclusions: Outcomes following TBI in older adults include persisting cognitive and functional limitations that often require some level of support. However, studies have shown that there are elderly patients with severe TBI who benefit from rehabilitation and may have more favorable outcomes. Determining prognosis after TBI is challenging relative to long-term functional consequences, due to the aging process. Therefore, the best intervention for TBI in older adults is prevention of TBI. As the aging population continues to increase in the United States, the need to design and implement evidence-based, cost-effective measures that focus on prevention of the leading causes of TBI in older adults becomes more urgent.

Lower urinary tract symptoms against the background of benign prostatic hyperplasia (LUTS/BPH) and testosterone deficiencyare there any links? General questions of terminology, methodology and age epidemiology

Lower urinary tract symptoms against the background of benign prostatic hyperplasia (LUTS/BPH) and testosterone deficiencyare there any links? General questions of terminology, methodology and age epidemiology

HIV and Aging in Mainland China: Implications for Control and Prevention Research.

The last 15years have witnessed a dramatic change in HIV-related epidemiology amidst improvements in treatment and care in China. With proper treatment, HIV is now considered a chronic disease. As a consequence, many people living with HIV (PLWH) now present age-related comorbidities. We reviewed 13 topical issues concerning the epidemiology of aging with HIV in mainland China. Many of aging-related issues associated with the biological and physical aspects of living with HIV addressed in mainland China are consistent with the global literature. Greater prevalence of age-related comorbidities among PLWH was observed. Beyond biological mechanisms associated with HIV infection and traditional risk factors, other factors play a vital role in the aging process among PLWH. A stronger focus on screening, prevention, and management of non-HIV co-morbidities among PLWH is now warranted. Macro-social factors need to be integrated into next generation of clinical and/or behavioral HIV research to inform disease progression and management as well as prevention.

NEW INSIGHTS INTO LONELINESS AND ITS TREATMENT IN OLDER ADULTS: Session 108

Loneliness is a well-studied construct in the social sciences, in the epidemiology of aging and increasingly in gerontology but it is a relatively uncommon focus in psychiatric research. Loneliness is a perceived state of social and emotional isolation that is distinct from objective social isolation. Loneliness is understood to be both a perception and an emotion and may be a form of psychosocial stress. In large population-based studies, there is strong evidence that both loneliness and lower social engagement are independent predictors of accelerated cognitive decline and incident AD dementia. Psychosocial factors influencing loneliness are well known whereas little is known of the neurobiology and pathological correlates of loneliness, particularly in older people. The goal of this session is to illustrate the importance of social function and wellbeing to longitudinal cognition and Alzheimer's disease progression in older adults. The four speakers will provide data from their own research examining associations of loneliness and social engagement to cognition and Alzheimer's disease biomarkers. Dr. Joanna McHugh Power will describe six-year data defining patterns of loneliness and social isolation that are most predictive of semantic memory declines in over 8,000 participants from the Irish Longitudinal Study of Ageing. Dr. Nancy Donovan (Chair) will present a cross-sectional study defining associations of greater loneliness with higher cortical amyloid burden and regional tau deposition in a sample of cognitively normal older adults from the Harvard Aging Brain Study. Kelsey Biddle from Dr. Donovan's group will describe longitudinal data from the Harvard Brain Study examining cortical amyloid deposition, cognition and psychosocial factors that are predictive of decline in social engagement over 3 years among cognitively normal elderly. Dr. Phaedra Bell will present data from a pilot study focusing on lonely older adults to assess the impact of a multimodal intergenerational intervention on ratings of loneliness and mood in these participants. Finally, Dr. McHugh Power (Discussant) will lead the speakers in a panel discussion, along with Q&A involving session attendees.

Chapter 9 - Epidemiology of aging and associated cognitive disorders: Prevalence and incidence of Alzheimer's disease and other dementias

The study of the incidence and prevalence of dementia is important to understand the distribution of dementing illness among age and sex groups, and for the detection of possible causes of these disorders. A variation in the incidence or prevalence of dementia, especially Alzheimer's disease (AD) by region or specific populations can be because of greater or lesser exposure to the causal agents of dementia. For example, in the past the striking differences in the incidence of coronary heart disease (CHD) led to the understanding of the relationship between dietary factors, such as saturated fat and dietary cholesterol, and the incidence of CHD. However, there is a high prevalence of dementia in elderly individuals around the world, and multiple studies conducted in industrialized and nonindustrialized countries have shown an age-standardized prevalence of dementia ranging from 5% to 7% in most countries. Dementia is not a specific disease but rather a constellation of cognitive changes and disability due to several "causes," i.e., AD, Lewy bodies, vascular disease, drugs, and alcohol. Whether there is a trend for reduced incidence of dementia has to be further evaluated. It is possible that the improvement in the treatments of risk factors, especially vascular disease, has resulted in decreased incidence. However, this could result in an increase in prevalence, since the improved therapies for risk factors will lead to increased longevity in patients with dementia.

An Exploration of the Knowledge of Informal Caregivers on Ageing Related Health Conditions at Matero and Chawama Old People’s Homes, Zambia

Caring for older adults requires a multidisciplinary approach and this includes a primary caregiver and a knowledge of the physiology and epidemiology of aging. The objective of this study was to explore the knowledge of caregivers on ageing-related health conditions at Matero and Chawama old peoples’ homes in Lusaka. A qualitative case study design with a sample size of 12 based on the criteria of theoretical saturation was used. The results showed caregivers’ views on ageing-related health conditions, common ageing-related health conditions seen at both nursing homes, clinic/hospital and nursing home management of these conditions. The challenges faced by caregivers were revealed and they included attitude of the elderly, inadequate equipment, lack of transport, financial challenges, work overload and participant’s characteristics like personal needs, their age and gender influencing caregivers’ work output. Caregivers knew most of the ageing-related health conditions and are knowledgeable on the nursing management of these conditions. There are various things affecting knowledge of caregivers on ageing health and management skills. Various challenges such as financial challenges, lack of transport, and inadequate equipment were also pointed out and are seen to greatly influence the work output of caregivers.

Aging, Health, and Quality of Life for Older People Living With HIV in Sub-Saharan Africa: A Review and Proposed Conceptual Framework.

The number of people living with HIV (PLWH) over 50 years old in sub-Saharan Africa is predicted to triple in the coming decades, to 6-10 million. Yet, there is a paucity of data on the determinants of health and quality of life for older PLWH in the region. A review was undertaken to describe the impact of HIV infection on aging for PLWH in sub-Saharan Africa. We (a) summarize the pathophysiology and epidemiology of aging with HIV in resource-rich settings, and (b) describe how these relationships might differ in sub-Saharan Africa, (c) propose a conceptual framework to describe determinants of quality of life for older PLWH, and (d) suggest priority research areas needed to ensure long-term gains in quality of life for PLWH in the region. Differences in traditional, lifestyle, and envirnomental risk factors, as well as unique features of HIV epidemiology and care delivery appear to substantially alter the contribution of HIV to aging in sub-Saharan Africa. Meanwhile, unique preferences and conceptualizations of quality of life will require novel measurement and intervention tools. An expanded research and public health infrastructure is needed to ensure that gains made in HIV prevention and treamtent are translated into long-term benefits in this region.

Epidemiology of ageing with HIV: what can we learn from cohorts?

: The last decade has seen a dramatic change in the demographic structure of the population of people living with HIV (PLWH). The majority of PLWH who start treatment with combination antiretroviral therapy now have good virological and immunological responses and this has resulted in improvements in life expectancy. In addition, there have also been continued new HIV diagnoses (and new HIV infections) in those aged more than 50 years. The average age of those attending HIV clinics has therefore increased, with this trend expected to continue into the future. As the cohort of PLWH has aged, so the spectrum and burden of age-associated noncommunicable comorbidities (AANCCs) in the cohort has increased. PLWH are likely, therefore, to have increased healthcare needs for the foreseeable future. Although it appears that the average age at diagnosis of several AANCC is lower in PLWH, current evidence remains insufficient to demonstrate that HIV infection leads to either accelerated or accentuated aging. The results from several well designed longitudinal cohorts, with appropriately matched control groups, will provide more robust evidence to confirm a potential impact of HIV on the incidence of these AANCC. However, regardless of the impact of HIV itself, the role of other, non-HIV, factors is becoming increasingly important, with coinfection with other viral infections and lifestyle factors playing an increasing role in the development of many AANCC. It is likely that attempts to reduce smoking prevalence and obesity may be associated with important reductions in the incidence of some of these events in the future.

Content validity of the Geriatric Health Assessment Instrument.

ABSTRACTObjective Assess the content validity of the Elderly Health Assessment Tool with low education.Methods The data collection instrument/questionnaire was prepared and submitted to an expert panel comprising four healthcare professionals experienced in research on epidemiology of aging. The experts were allowed to suggest item inclusion/exclusion and were asked to rate the ability of individual items in questionnaire blocks to encompass target dimensions as “not valid”, “somewhat valid” or “valid”, using an interval scale. Percent agreement and the Content Validity Index were used as measurements of inter-rater agreement; the minimum acceptable inter-rater agreement was set at 80%.Results The mean instrument percent agreement rate was 86%, ranging from 63 to 99%, and from 50 to 100% between and within blocks respectively. The Mean Content Validity Index score was 93.47%, ranging from 50 to 100% between individual items.Conclusion The instrument showed acceptable psychometric properties for application in geriatric populations with low levels of education. It enabled identifying diseases and assisted in choice of strategies related to health of the elderly.

Programa de Pós-Graduação em Gerontologia – PPGERO/UFPE: 1º curso stricto sensu do Norte-Nordeste do Brasil

Objective: To present the Postgraduate Program in Gerontology on a Masters degree, while being the pioneer course in North-Northeast on this field of study. Method: to create the Program, the following steps were taken: 1. Survey on Aging and Postgraduate programs in the field of gerontology in Brazil; 2. Development of the Proposal of the Postgraduate Program in Gerontology at the Federal University of Pernambuco – PPGERO/UFPE. Results: Definition of the main subject of study – Gerontology; Research Guidelines – Aging and Health/Aging, Culture and Society; Course characterization – Master degree, annual screening, 14 vacancies, 30 credits, including 14 compulsory and 16 electives. Compulsory subjects – Aging, Health and Interdisciplinarity; Gerontology, Society and Culture; Methodology of Scientific Research in Gerontology; Research Seminars in Gerontology. Elective courses – Aging: Biological and Physiological Aspects; Demography and Epidemiology of Aging; Bioethics Applied to Gerontology; Advanced Seminars in Gerontology; Planning and Management of Elderly Care Services; Health Economics Fundamentals in the Heed of the Elderly; Cognition and Aging; Old Age, Power and Gender Relations. Conclusions:The implementation of the Master in Gerontology atthe Federal University of Pernambuco reaffirms the social role of an institution committed to the production of scientific knowledge and development of researchers in the emerging field, suppressing a regional need in terms of stricto sensu education in Gerontology.

Introduction to Special Issue for 20th Anniversary of the NIA Centers for the Demography and Economics of Aging

This special issue of the Journal of Population Ageing celebrates the 20th anniversary of the NIA Centers on the Demography and Economic s of Aging,, publishing a set of five invited papers by distinguished scholars based on their presentations at the 2014 session of the RAND Summer Institute on Aging. We, and the Journal editors, thought that this would be an appropriate and useful tribute to the work of the centers, since the RAND Summer Institute (RSI) is almost the same age as the centers and over the years has attracted center affiliates both as master lecturers and as trainees. The five articles in this issue, though not a comprehensive review of the field, provide a sense both of the advances of the last two decades and of the great work still to be done. The centers program began as supplements to Demography Centers funded by the National Institute of Child Health and Human Development, which along with the National Institute on Aging is part of the National Institutes of Health. With one exception, housed at the National Bureau of Economic Research, the early centers were very focused on demography, and they were fractionated with few common projects across centers. The idea behind the RSI was to provide basic lectures in each of several areas both to attract new scholars into research on aging and to form a more integrated research program. The first forum was held in Chicago in the afternoon prior to the start of the Annual Meeting of the Population Association. On the plane to Chicago one of us (RS) noticed that Dr. Robert Wallace, a physician epidemiologist, was his way to the University of Iowa, and cornered him and persuaded him to delay his trip and give an impromptu presentation on epidemiology of aging – one of the best that afternoon. The Centers have become much more integrated than at first. They work together on many projects, sharing costs and contributing ideas. They now form the essential infrastructure for the social sciences related to aging. The RSI has undergone a similar Population Ageing (2015) 8:1–5 DOI 10.1007/s12062-015-9114-2

COMPREHENSIVE GERIATRIC ASSESSMENT (CGA): IS IT NECESSARY FOR TREATMENT OF CANCER PATIENTS? INTERDISCIPLINARY EFFORTS AND IMPORTANCE OF ITS IMPLEMENTATION IN A CANCER CENTER PROGRAM IN LATIN AMERICA

CGA is gaining importance in treatment of elderly cancer patients, since ageing is a global phenomenon. That shift in demographics has huge impact in healthcare. However, the more reliable validated way to apply CGA in Geriatric Oncology is an open research field so far. The efforts to find the best interdisciplinary approach for conducting CGA in daily clinical practice demand a worldwide multi-institutional collaboration. This presentation will review some topics in Geriatric Oncology, highlighting strategies and difficulties of implementing such a unit. Daily routine of a interdisciplinary Geriatric Oncologic team work will be discussed, to put into the context of a high volume cancer hospital, the daily needs of caring for elderly oncology patients. Attending public will discuss, among other topics: a) epidemiology of aging and cancer around the world; b) efforts to better care in geriatric oncology; c) CGA in cancer patients; d) important points in geriatric oncology in different settings (public or private; acute or intensive care unit, ambulatory, nursery, hospice, home care); e) administrative and financial support for geriatric oncology. In A. C. Camargo Cancer Center, in Sao Paulo, Brazil, we are starting a project hoping for government grant, aiming to: □ Detect predictive factors of complications in oncological treatment □ Propose treatment protocols adapted to functional capacity, to avoid over and under treatment. □ Offer ways to rehabilitation of reversible vulnerability and frailty, with combined interprofessional work. □ Prevent additional common complications in elderly: falls, polypharmacy, undernutrition, depression, sarcopenia, for example. □ Detect early signs of psychological or cognitive alterations that may contribute to additional deficits. □ Offer home, ambulatory and hospital support to all patients, specially for the ones that cannot receive specific cancer treatment. □ Combine assistance to comorbidities with the oncology team. Topics above will be illustrated by our experience, initiated in 2010, in the implementation of a Geriatric Oncology Unit in A. C. Camargo Cancer Center – one of the largest oncology hospitals in Latin America – specially how to apply a time-consuming elderly evaluation in a high volume cancer center for multidisciplinary treatment. In our initial retrospective cohort, the incorporation of CGA in daily practice was feasible and useful to predict needs and complications of systemic cancer treatment, like dose adjustment, ability to complete proposed treatment, and hospitalisation. Next step should be to look for correlations with markers of efficacy, such as survival and quality of life. We believe that the comparison of different approaches in Geriatric Oncology may help to improve their applications in many settings and services, with good ideas being applied with local contextualisation. Those efforts will directly benefit elderly cancer patients. Disclosure of interest: None declared

Chronic Kidney Disease and the Aging Population

We want to thank Tonelli and Riella whom on behalf of the World Kidney Day Steering Committee 2014 puts focus on the epidemiology of aging and development of chronic kidney disease (CKD) (1). Their communication in Transplantation elegantly discusses different treatment alternatives for the elderly patient with CKD. The authors also describe challenges with respect to organ shortage, optimal immunosuppression, and health-related quality of life (HRQOL). We were surprised that Tonelli and Riella’s leave-out transplantation as an option in their concluding remark. During the last decade, our hospital has had a specific focus on elderly renal transplant recipients, and we would like to comment on some of the mentioned challenges. Organ shortage is a challenge. Increasing utilization of expanded criteria donors (ECD) is however possible. In our opinion, too many transplant centers worldwide are reluctant to use older deceased donors. We believe that modern immunosuppression (2) and machine perfusion can improve outcome of kidneys from ECDs (3). Our group has previously published data showing that even kidney transplants from deceased donors more than 75 years old perform acceptable as single transplants and should be considered for use in older recipients (4). In one selected situation, organs from a 90-year-old deceased donor were utilized (5). Both recipients are doing well with eGFR around 50 mL/min almost 5 years after engraftment (personal message). If more centers could be more open-minded and have an old-for-old program, the younger recipients would have shorter waiting time and the older recipients would have transplantation as a treatment option. Optimal immunosuppression is not established for older patients. Induction with interleukin-2 antagonist may be preferred. If one wants to use ATG induction, individualized T-cell monitored dosing is recommended. Outcome is improved if rejection is avoided (6). HRQOL also needs to be investigated. With modern dialysis, many older patients might have a better HRQOL in dialysis than after transplantation. Among adult kidney recipients, it is well accepted that transplantation provides a better HRQOL than permanent dialysis. But is this also the fact among older recipients? We are currently exploring HRQOL longitudinally in a population of patients older than 65 years with ESRD stage 5 who are on the active transplant list. Hopefully, this study (QUESTION65) will provide information about how HRQOL is changing between the different stages pre- and posttransplant (registered on www.clinicaltrial.gov). The study is ongoing, but preliminary results indicate improved HRQOL after transplantation (unpublished data). We therefore believe that Tonelli and Riella’s last sentence should be re-written: Perhaps more importantly, clinicians, patients, and their families can be comforted by the knowledge that timely specialist evaluation can help improve outcomes and reduce symptoms in older people with advanced kidney disease—whether they have selected conservative management, dialysis, or kidney transplantation as their treatment plan. Karsten Midtvedt 1 Kristian Heldal2,3 1 Department of Transplant Medicine Oslo University Hospital Oslo, Norway 2 Clinic of Internal Medicine Telemark Hospital Skien, Norway 3 Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway

Epidemiology of ageing, fracture and falls. Geographic and ethnic disparities in osteoporotic fractures

Searchable abstracts of presentations at key conferences on calcified tissues ISSN 2052-1219 (online)

Chronic Kidney Disease and the Aging Population

THE PROPORTION OF OLDER PEOPLE in the general population is steadily increasing worldwide, with the most rapid growth in low- and middle-income countries (27). This demographic change is to be celebrated, because it is the consequence of socioeconomic development and better life expectancy. However, population aging also has important implications for society, in diverse areas including health systems, labor markets, public policy, social programs, and family dynamics (26). A successful response to the aging population will require capitalizing on the opportunities that this transition offers, as well as effectively addressing its challenges. Chronic kidney disease (CKD) is an important public health problem that is characterized by poor health outcomes and very high health care costs. CKD is a major risk multiplier in patients with diabetes, hypertension, heart disease, and stroke, all of which are key causes of death and disability in older people (5). Since the prevalence of CKD is higher in older people, the health impact of population aging will depend in part on how the kidney community responds. March 13, 2014, will mark the celebration of the 9 th World Kidney Day (WKD), an annual event jointly sponsored by the International Society of Nephrology and the International Federation of Kidney Foundations. Since its inception in 2006, WKD has become the most successful effort to raise awareness among policymakers and the general public about the importance of kidney disease. The topic for WKD 2014 is “CKD in older people.” This article reviews the key links between kidney function, age, health, and illness and discusses the implications of the aging population for the care of people with CKD. Epidemiology of Aging The key drivers of population aging are socioeconomic development and increasing prosperity, which result in lower perinatal, infant and childhood mortality; lower risk of death in early adulthood due to accidents and unsafe living conditions; and improving survival of middle-aged and older people due to chronic disease. The resulting increases in life expectancy (together with the lower birth rates that typically accompany socioeconomic development) mean that older people account for a larger proportion of the general population (27). The extent of the resulting changes in population characteristics can be startling, especially for developing countries (Fig. 1). In contrast to the situation even two generations ago, people can expect to live for many years after the usual retirement age. For example, UK men and women aged 65 yr in 2030 can expect to live until age 88 and 91 years, respectively (22). Predicted life expectancy for today’s children is controversial, but experts estimate that 50% of UK children born in 2007 will live to at least 103 yr (22). Although it is clear that people are living longer, it is uncertain how much of the increased life expectancy will translate into years of good health. These demographic changes have dramatic potential implications for conditions such as CKD, for which the prevalence increases with age.

Editorial: Epidemiologic Reviews 2013--Special Issue on the Epidemiology of Aging

The papers in this volume (1–13 )r eflect substantial and diverse epidemiologic research activity on some of the major health problems of older people. When the call for papers was announced, no particular themes within this vast field of the epidemiology of aging were suggested or encouraged. This led to a series of reviews covering a breadth of modern and important topics. These topics touch many disciplines that dovetail with the science of aging, including evaluating putative social and biological risk factors for age-related change and survivorship, identifying biological processes and modern biomarkers of aging, and exploring aging outcomes in older populations, such as the issue of multimorbidity among older Americans and military veterans in Canada and other countries. Several papers review risk factors for altered cognitive function and dementia-related illnesses. Although firm conclusions are not always possible given the state of the science, important directions for moving forward are offered. The preventive potential of these works is always close to the surface. The papers also encompass some of the general themes and challenges of population aging research. The importance of life-course concepts in the epidemiology of aging is present in several reports. For example, the report by Dahl and Hassing (2) finds an association of midlife obesity and late-life cognitive function. Other reports also address the problem of accurately identifying early life exposures that predict late-life age-related changes. The incorporation of modern biological indicators of aging and survivorship, such as genetic and genomic factors (13) and telomere length (9), reflects the importance of molecular approaches to the long-standing quest for biomarkers of the progression of age-related change, biomarkers that are precise and robust across populations. As these biomarkers are validated, they will take their places as useful prognostic factors for personalized medicine. However, to be useful, such biomarkers need to be generally independent of untoward environmental exposures and the variety of diseases that are prevalent in older populations, a common problem noted in the report by Salive (6). Other reports in this volume denote the great variation in health and function among older populations, highlighting the challenges for defining preventive approaches for older persons that can reach large segments of this very heterogeneous group. Although new methodological approaches are always welcome, collectively this collection of review papers bespeaks the active international activity in population aging and points to directions in understanding aging mechanisms; defining potential biological, clinical, and social intervention studies to enhance successful aging; and providing more targeted, efficient, and effective approaches to delivering health services to older persons. The epidemiology of aging is alive and well!

Plenary IX Developments in the epidemiology of ageing

The ageing of the population is unprecedented in human history and still continuing. Average life expectancy has doubled in most human populations over past 20th century. The number of people aged 60 years and over in the UK is projected to increase from 12 million (20% of the population) in 2001 to 18 million in 2031 (30% of the population). The societal consequences are substantial. Issues include employment, for example, duration of active working life and duration of post retirement years, education, taxation and savings, pensions, and social structures. Health in an older population is a major issue, as this will influence the ability of older people to continue making active contributions as well as the amount and duration of dependency and need for long term care at the end of life. The risk of disability and ill health tends to increase with increasing age. By age 75 or so about half the population have some limitation in activity and about a fifth are unable to carry out some major activity. Much current debate concerns how best to treat, support, and care for, the projected great increase in persons with impairments, disability and handicap resulting from the ageing of the population. These numbers are projected to increase two to threefold over the next few decades. However, such morbidity projections are highly sensitive to small changes in incidence and prevalence of disability. Large international variations and secular trends indicate a large proportion of disability associated with ageing is potentially preventable or at least postponeable and research indicates that modifiable environmental factors, particular lifestyle factors such as diet, physical activity and smoking and infection may play a major role. A central challenge must be how we ensure optimal physical and psychological functioning at older ages in as many people as possible and identify policies that help maintain health and independence in an ageing population.

Health-related factors correlate with behavior trends in physical activity level in old age: longitudinal results from a population in São Paulo, Brazil.

BackgroundPhysical inactivity in leisure time is common among elderly in Brazil and this finding is particularly alarming considering that this population is greatly affected by chronic diseases. The identification of health factors that influence physical activity level (PAL) will help in the development of strategies for increasing PAL older adults. The current research aimed to identify variables that independently affect behavior trends in PAL over the course of two years among elderly.MethodsA survey entitled the Epidoso Project ("Epidemiology of aging") studied 1,667 community-based older individuals in São Paulo city, Brazil over the course of two years. Physical activity level was determined through questions about frequency and duration of physical activities. Body Mass Index was calculated; functional capacity was assessed through the ADL (activities of daily living) scale; cognition was assessed by Mini-Mental State Examination; and mental health was assessed through the Dysthymia Screening. Experiences of falls and fractures were also assessed. Subjects were divided into three groups according to their self-report of Physical Activity Level: a - Regularly Active; b - Insufficiently Active and c - Physically Inactive. Behavior trends in PAL were also measured after two years. Multivariate regression model methodology was used to test associations longitudinally.ResultsResults from the final model demonstrated that the risk of a not favorable behavior trend in PAL, which included the group who remained physically inactive and the group that displayed decreased PAL, in this cohort of older adults was significantly increased if the individual was female (OR = 2.50; 95% CI = 1.60-3.89; P < 0.01), older (80 y vs. 65 y, OR = 6.29, 95% CI = 2.69-14.67; P < 0.01), dependent on help from others for activities in the ADL scale (moderate-severe = 4-7+ vs. 0 ADLs) (OR = 2.25, 95% CI = 1.20-4.21; P < 0.011) or had experienced a history of falls with consequences (OR = 6.88, 95% CI = 0.91-52.01; P < 0.062).ConclusionsAge, gender, ADL scores and falls were associated with a not favorable behavior trend in PAL. Promotion programs should target these factors, reducing barriers to achieve desired changes in PAL.

Commentary on SPHERE (Strengthening Public Health Research in Europe) literature reviews

The work presented here is very instructive for public health professionals, researchers and decision makers. It is a kind of meta-research that provides data regarding the vitality of this field in Europe. More than 200 000 articles have been identified in this project. That gives an idea of the importance of the efforts devoted to public health research. It is encouraging to note that this scientific production has been increasing during the last decade and, overall, Europe should not be ashamed of its accomplishment. At the same time, this work raises the issues facing public health policymakers when they wish to promote an evidence-based approach. How to identify true knowledge in this huge amount of data? How to organize the systematic surveillance and synthesis of these results and to disseminate it in a timely way to the relevant policymakers? These are the main general questions rising from this report. I have a few methodological remarks, even if bibliometrics is not my own field of research. Potentially, all biological, sociological, economical, epidemiological, drug and law sciences could have been included in this analysis. Wisely, the authors have chosen a non-disciplinary approach, choosing the population aspects as the main criteria for selecting the relevant articles. In particular, the inclusion of a chapter related to public health management is especially useful. However the choice has also been made to analyse specifically the literature on genetic epidemiology. This field is notably an important one but so too would have been the epidemiology of ageing, for instance. This choice is not really explained and is not fully coherent with the global approach of this work. As an international project, one can also regret that the analysis provides no data concerning articles that have been …