Healthy Aging PDF

Healthy aging -​ lectures twice per week -​ group assignment 15 nov registration -​ exam 70% and presentation 30% -​ Preparation literature WEEK 1 Literature Christensen, K., Doblhammer, G., Rau, R. and Vaupel J. (2009) Ageing Populations: The challenges ahead” Lancet 374: 1196 Main q...

Healthy aging -​ lectures twice per week -​ group assignment 15 nov registration -​ exam 70% and presentation 30% -​ Preparation literature WEEK 1 Literature Christensen, K., Doblhammer, G., Rau, R. and Vaupel J. (2009) Ageing Populations: The challenges ahead” Lancet 374: 1196 Main question of the article: are increases in life expectancy accompanies by a concurrent postponement of functional limitations and disability? -> research suggests that ageing process can be altered and that most people are living longer without severe disability -​ remarkable life expectancy gain in western countries and Japan. -​ most people born after 2000 will live longer -​ life expectancy is lengthening almost lineralry in most developed countries -​ consistent rise suggests that there may not be a natural limit to the human lifespan key findings -​ population re aging globally due to higher life expectancy and lower birth rates effects: 1.​ healthcare demand; aging population will increase the demand for healthcare services 2.​ economic impact: causes economic instability due to a smaller working age population increased pesion costs and higher dependency ratio 3.​ need for new policies 4.​ more focus on healhier lifestyles to alleviate healthcare costs -> societies must adapt to new challenges of aging population by promoting healthy aging, revisig healhtcare and soial policies Rowe, J. and Kahn, R. (1997) "Successful aging." The Gerontologist 37 increases in older persons in our society pose a challenge for biology, social, behavior and medicine. successful aging= going beyond just the absence of disease to include high physical and cognitive functioning as well as active engagement in life components of successful aging 1.​ avoidance of disease and disability: maintaining health to prevent the limitations associated with illness 2.​ sustain mental sharpness and physicial abilities  3.​ actively engage in social actieis successful aging is characterized by more than the typical aging process and includes proactive lifestyle oriented factors Foster, L. and Walker, A. (2015) "Active and Successful Aging: A European Policy Perspective." The Gerontologist 55: 83 90 active aging has emerged in europe as the policy respons to challenges. -> article examines active aging and how it differs from successful aging. active aging= more holistic life course oriented approach than successful aging -​ there has been a shift in european policy towards promoting active and successful aging active aging= emphasizes participation in social, economic, cultural and civic activities not just workforce involvement successful-aging= involves maintaining physical mental and social well being throughout older age framework for active aging; the WHO’s active aging policy framework serves as a guideline focusin on health participation for elderly policy objectives: extending working lives, promoting health and preventing care and fostering social inclusion for older adults barriers: challenges include ageism, lack of awareness ino funding and the need to intergenerational solidarity ageism= districimination, prejudice against someone based on their age -​ social networks and support systems are crucial for active and successful aging; need for personal lifestyle adjustments and choices and supportive public polities week 1 lecture 1 MIPAA = UN recognized this population issue in Madrid international plan of action on ageing MIPAA. -​ political response to ageing challenges- not binding but commitment to create age friendly societies with older adults as valued and productive members main three priorities 1.​ older persons and development 2.​ advancing health and well-being into old age 3.​ ensuring enabling and supportive environments reviews every 5 years priorities older persons and development 1.​ active participation in society and development 2.​ work in ageing labor force 3.​ rural development, migration and urbanization 4.​ access to knowledge, education and training 5.​ intergenerational solidarity 6.​ eradication of poverty 7.​ income, social protection and povert advancing health and wellbeing into old age 1.​ health pormotion wellbeing throughout life 2.​ universal and equal access to health care services 3.​ older personsn and hiv/ aids 4.​ mental health needs of older ersons 5.​ older persons and disability ensuring enabling and supportive environments 1.​ housing and living environment 2.​ care and support for care givers 3.​ neglect, abuse and bviolence 4.​ images of ageing population ageing= humans around the world getting older, life expectancies are rising in most parts of the world around 15 years increase -> threat to health care system; how to pay for it all -> threat to the economic system; aging workforce bad for productivity concerns -​ more elderly people is more medical condition -​ relative imbalance between younger and older age groups -​ mobility of elderly, urban planning motivation for healthy ageing macro level= motivation to cope with population ageing -> delaying disease and disability, longer productivity and work live, lower societal costs. micro level= concerns individual behavior and outcomes healthy aging and the life course -​ healthy ageing determined by our behaviours over the life course -> course is the comprehensive view on the progression of life over age -​ smoking, nutrition and physician exercise over the life course are core components of health at older ages  -​ also: social and physicial environment play central role in healthy ageing, intergenerational support and mobility morbidity= presence of illness, disease of health condition within the population, measure of how widespread or sever certain health problems are lecture 2 week 1 definitions of health -​ presence or absence of disease as diagnosed by a professionall -​ critique: depends on medical diagnosis; person may feel ill or healthy but may not be diagnosed as such old definition of the WHO health= a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity critique: healthy state can hardly be reached health = ability of an individual to function effectively and participate within society functional perspective -​ activities of daily living ADL -​ instrumental activities of daily living IADL -​ ADL and IADL are measures to evaluate need of care and support critique: not all people with illnesses picked up by this definition: neglect of people’s perspective wellbeing -​ good or satisfactory condition of existence -​ state of being comfortable healthy or happy -​ more holistic way 2 approaches to wellbeing 1.​ objective; ascribed 2.​ subjective wellbeing: self-assesed, individual judgememts critique on wellbeing: current aspects of wellbeing may decrease health and wellbeing in the future (smoking) there are different approaches to define well being depending ioon perspective healthy aging = theoretical definitions vary and depends on the discipline biomedical perspective (most udes) -​ emphasizes absence of physical and cognitive disabilities -​ reduction of the amount ot unhealthy life years o -​ prioritiezes achievement of medically inspired criteria: life expectancy, morbidity -​ pessimistic view of healthy ageing: focus on decline critique 1.​ disease-free older age is unrealistic for most people 2.​ doctors’ opinions are crucial- older people’s perspective often neglected 3.​ rather negative, discriminating perspective there is more ageing (discrimination against older people) accroding to who Psychosocial perspective healthy aging= active ageing, promoted by WHO and EU in early 2000s active ageing includes -​ extende participation of older workers in the labour market -​ continued participation of seniors in social, economic, cultura, spiritual and civic affairs, not just their ability to remain physically active or participate in the workforce (baltes and baltes 1990): healthy ageing= successful aging : the resilience of people who succeed in achieving a positive balance between gains and losses during the life span resilience: the ability to bounce back, to change and to adapts to new situation. Psychological resources are seen as important for healthy ageing individual psychological resources as jey to ageing successfully 1.​ positive outlook, optimist 2.​ self esteem 3.​ confidence 4.​ autonomy: abilityfor older people to make their own decisions about life 5.​ independence: living on one’s own care for oneself 6.​ resilience psychosocial and biomedical perspective compared -​ prioritizing psycho-social criteria -​ allows for non-normative, individual trajectories of healthy ageing, no role model for health ageing but more individually -​ dynamic, continuous process -​ optimistic definition of health ageing -​ focus on pshycological resources healthy ageing- psychosocial perspective -​ focus on active contribution of older adults to society instead of looking at deficiencies -​ emphasizes competence and knowledge, more positive view critique -​ over-idealization of active ageing -​ deterministic (passive lifestyle= bad) healthy ageing; lay based perspective -​ healthy ageing= subjective -​ non professional/ scientist determine what is health but individuals themselves (lay= non professional)  -​ from the views and perceptions of older adults themselves -​ researcher define healthy agein differently -​ mcontext is important additional priorities and aspected that are important by individuals are social relationship, environmental quality, physicial apperacen, financial security, spiritualituy So: healthy ageing concept comprises a variety of aspects 1.​ biomedical focus -> absence of disease 2.​ psychosocial focus -> focus on staying active and involved 3.​ individual preferences for not directly health related priorities (financiel security etc) defining healthy, succesful active ageing depends on chosen perspective biological theories of healthy ageing Galen (A.D 129-199) -​ thought that agin was due to changes in body ‘humors’ that began in early life -​ these changes caused a slow increase in dryness and coldness of the body roger bacon (1220-1292) -​ one of the first to suggest a ‘wear and tear’ theory -​ aging is the result of abuses and insults to the body system -​ good hygiene might slow the aging process charles darwin 91809-1892) -​ attributed aging to the loss of irritability in the nervous and muscular tissue biological theories of healthy ageing -​ explain why health deteriorates with age, difference between ageing and senescence -​ senescene (carnes and oshansky 1992)= time-dependent acculuation of damage at the molecual level which starts at fertilization and ultimately death 3 main broad theories of biological theoruies of ageing, focus on different levels of ageing studies -> can be groupes in 3 broad types of theories: 1. genetic theory, 2. molecular/celular theory 3. system level theory 1.​ genetic theory = complex genetic interactions regulate ageing process and death ageing and disease explained by a malfunctiong or deviation of certain genes turned off genes fail to produce necessary substances or resources (apoptosis) -​ studies show that number of cells replications declines over age-> this suggests that our length of life depends on how often our cells can replicate  -​ different theories about the finite number of cell replications -​ genertic regulation are effected by environmental factors (pollutions etc) -​ DNA can be repaired 2.​ molecular theories = free radicals theory most prominent in explaining ageing and emergence of diseases -​ oxidation in cells (conversion from nutrients to energy) sets molecules free that affect the normal functioning of other molecules including NDA -​ malfunctioning of molecules causes diseases -> related theory suggest that older cells lose the ability to get rid of oxidaditive was matter; can lead to alzheimer’s disease 3.​ molecular theories = like in genetic theories, assumption about existence of protective molecules that main health, help to reduce impact of stress, infections etc 4.​ system level theories -​ organisms need certain stability of environmental and intracellular conditions (homeostatis), blood pressure, temperature etc -​ after episodes of instability organism returns to stability -​ over age ability to stability (adapt to environmental challenges) declines -​ wear-and-tear theory postulates that using certain organs over a long time leads to deterioration and malfunctioning -​ exposure to stress and ability to cope with stress are also seen as determinants for maintainging health and postpone emergence of diseases DUS -> agein chronological process not necessarily implying bad health -> senescence as a biological process suggesting deterioration with age -> different theories on the genetic, molecular and system level why senescence occurs pace of decay strongly influenced by individual and societal factos social and psychological theories 1.​ life course theory -​ health and ageing outcomes determined by individual life course -​ life course means developmental transitions and periods from childhood over adulthood to old age -​ individual development affected by social context. own choices and preferences and previous episode -​ studies how that economic conditions at childhood affect health and cognitive outcomes in later life 2.​ goal-oritented models -​ described the development into adulthood and olf age as a balance of gains and losses  -​ early adulthood relatively successful in acquiring positive resources/ characteristics -> later life characterized by losing resources and attempt to conserve therse resources -​ successful ageing by selection, optimization and compensation of certainresources -> ageing as adaptation process example of piano player: with age reduction of pieces that he played and optimization of those pieces resilience and ageing = resilience as a capability to withstand adversity (WHO 2002): The process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age -​ specific resources to withstand stress or other harmful external influences -​ individual resources (financial situation) -​ contextual resources (social support) -​ sociocultural resources (access to health care etc) -​ week 2 literature Rowe, J. and Kahn, R. (1997)"Successful aging." The Gerontologist 37: 433-440 -​ reviews recent research on and puts a conceptual framework for routes to successful ageing. -​ successful ageing exists of: avoidance of disease and disability, high cognitive and physicial functional capacity and active engagement with life. -​ propose a new category of altered within individual variabiiity in physiologic functions which should be included in studies of ageing which typically concentrate on absolute levels of variables. -​ characteristics that are associated with high levels of cognitive ability are length of educationand physician activity which has many different positive effects. -> another componen in successful ageing: maintenance of interpersonal relations and productive activies, isolation is a big risk for health authors propose that people move in and out of succes -> concepts of resilience which describes how people recover from such episodes want a more robust and multidimensional picture of successful aging -> but are moostly rooted in bio-social perspective of ageing studies. -​ what is moore important is also a more extensive understanding of the reasons why people do not adopt the criteria of succes (postmodernist approach) dus: main concept of successful ageing defined bu 1.​ avoidance of disease and disability 2.​ maximing functional abilities: keeping cognitive and physical capabilities strong 3.​ active engagement in life -> critique on the way successful aging is commonly framed, should be less focus on universal criteria because it can unfairly blame individuals especially erdlerly for failing to meet these standards. -> instead: should be emphasizing under personal and societal factors that influence choices and behaiors by questioning established assumptions and listening to experiences. -> there is no one-size-fits all definitions of healthy ageing Foster, L. andWalker A. (2015)"Active and Successful Aging: A European Policy Perspective."The Gerontologist 55: 8390 discusses strategies and policuy frameworks aimed at promoting active aging and successful aging in europe active aging= refers to older individuals being able to maintain engagement in social, economic and cultural activities, ensuring they live full and healthy lives. this approach emphasizes not just the avoidance of disease but also maintaingin independence and social participation policy perspective: european policies on aging are become more and more focused on enabling older adults to lead more active live thhorugh supportive environments successful againg: avoiinding disease, maintaining functional capacities gender and socioeconomic factors; highlights that age related challenges can be influenced by gender and socioeconomic status authors suggest that policies should focus on reducing inequalities, providing access to health and wellness services and fostering environments that encourage older adults to stay socially connected and active. these policies should also include opportunitites for older individuals to continue contributing to society in various roles such as through volunteer workd Week 2 LECTURE 2 monday 18/11/2024 universal aspects of mortality (graph) senesecnce= increase of mortality follows the gompertz law of aging (formula in the graph) beta=0.1 so each year risk of dying increases with 10 % alpha= is going done, reducing overall level of mortality rage of aging is not changing. general shape of mortality is basically still here nowadays, first decrease in the risk of dying until 10 years old and then an increase of about 10 % each year immigrants usually have higher life expectancy because you must be healthy to move abroad, so countries with more immigrants have a higher life expectancy rate what’s new now!!!: -​ decrease in infant mortality (1st year of life), back in the days 25/30% mortality rate -​ really about epidemics. -​ lot of regional differences -​ longer breastfeeding period= less mortality at enfants, but also can’t get pregnant again -> lower fertility rates long term evolution (how to capture whole age patterns) -​ usually central measures of central tendencies (average) -​ 3 measures of central tendency= mean (average), mode (most frequent) median (middle) life expectancy= mean, sensitive to extremes is an average doesn’t necessarily reflect the distribution it is reflecting, hides peak of mortality life expectancy graph r2= >0.99 so almost perfect representation, almost a straight line, not seeing any decrease of relection points. slope= 0.25 with every year, life expectancy in the world increases with a quarter of the year. how to explain life expectancy -> epidemiological transition theory -​ there are different stages in the increase of life expectancy (stage= age) 1.​ the age of pestilence and famine 2.​ the age of receding pandemics 3.​ the age of degenerative and man-made disease 4.​ the age of declining CVD mortality, aging and emergin diseases (1960s) 5.​ the age of aspired quality of life with persistent inequalities (where we are now) stalling= stagnation for example US had a high life exptentency but now in some regions almost the lowest, lots of drug related mortality but what makes the big difference is the cardiovascular diseases -> lifestyle, obesity food. but also poverty and public policies that are behind this, inequalities debate (since 1980s from pessimistic to optimistic but currently a bit back -​ pessimistics -​ examples; fries, olshankuy, carnes -​ fixed limit 85/90 in the 1990s knot less clear -​ dominant until the 1980s -​ assumed a fixed limit in life expectancy! optimistics -​ examples; vaupel and his team -​ no observable fixed limit/ ‘immortality -​ but still ongoing debate life expectancy= average number of years a person of a certain age can expect to live lifespan = age of death, length of a human. maximum of a lifespan =is maximum someone can be centenarian= someone who is 100 years old supercentenarians= more than 110 two levels of analysis types of graphs -​ flows (mortality, fertility and migration); life expectancy and mortality -​ structures -> population aging. population dynamics -​ different regions are more dependent on different aspect of the equation than others formula: net change + net migration -> zie pp voor hele formule -​ mortality, fertility and migration influence population ageing, these components have different influence in different countries, not 1 story fits all. But also about the history of your population!! -​ in every country there is path dependency because of cohorts effects (groupiing people based on the moment you were born see example Japan powerpoint. population life expectancy is also based on history ( if you had a baby boom, there are now more older people) how to measure population aging -​ median age: the age at which 50% of population is older and 50% younger, split in half dependency ratio= a measure used in demophrapics to show the proportion of people who are considered dependent (usally not working like elderly and children) to those who are ecopnomically productive (of working age) often expressed as percentage dependency ratio= number of dependence/ number of working age people *100% You can divide this by child dependency, old age dependency ratio and total dependency ratio. summary; -​ ever increasing life expectancy around the world with no clear sign of stopping, maximum lifespan is still difficult to judge -​ population ageing is by far not linked to longer lives. the role of fertility and migations and history is essential too -​ measures of population ageing are sometimes misleading or debatable because they are often arbitrary and do not take into account changes in old people’s heath and capabilities -​ population ageing will continue in the future with implications for societies as a whole week 2 lecture 2 living longer and healthier in most countries we see an increasing life expectancy morbidity= the condition of suffering from a disease or medial condition graph: life expectancy jumped after WO2 than almost stagnates for about 10 years, switch from infectious diseases only until 1940s antibiotics were used. 1960s plateau before the cardiovascular revolution -> diseases thought they had raised a limit? pessimistic team 3 theories -​ in the 1970s it becomes clear that life expectancy is not stopping -​ older adults are now mostly contributing (not infants) -> does saving old people mean keeping themin longer bad health? 3 theories/ predictions on the relationship between mortality and health (morbidity) how do we measure it? 1.​ expansion of morbiditiy 2.​ compression of morbidity 3.​ dynamic equilibrium graphs: triangle is morbidity if it is high you are very sick morbidity onset= point where people get sick morbidity expansion (gruenbuerg 1977)  -​ ‘failure of succes theory’; when we save peoples life we might not be able to restore them to their initial state -​ longer lifespan more year spent in poor health -​ reduction in the fatality rate of (chronic) disease -​ we can postpone the moment when people die but we cant make the period that they are sick shorter. morbidity compression (Fries 1980) (more pessimistic) -​ shift in onset of morbidity to higher ages -​ fixed life expectancy 9original limit of 85 year assumed) -​ we can postpone the limit when people get sick, but not when they die -​ life expectancy was increasing slower than the first sign of of morbidityu dynamic equilibrium (Manton, 1982) -​ somewhere in the middle -​ same mechanisms drive mortality rates; expected a shift from severe to moderate disability -​ healthy life expectancy remains the same -​ increase of life expectancy but also decrease in incidence of disability so unclear increase of years with disability until 1990 there were no population surveys on health so very little data! operationalizations what is health? -​ ‘a state of complete of physicial, mental and social well being and not merely the absence of disease or infirmity (WHO consitution 1948), but often measured as absence of disease disease= medical (definition) conception of pathological abnormality which is indicated by a set of signs and symptoms -> implies biomedical cause and often already known treatment. ICD 11 is international classifications of diseases illness= individual’s experience of ill-health indicated by the person’s feelings of pain, discomfort and the like (field 1976) -> wide concept that may refer to temporary mild problems to long lasting severy problems sickness= social consequences/ role attached to the health problem by society at large (hardon 1994) -> sick leave etc. whole dimension of disability. acute diseases vs chronic acutre: short, relative rapid onset, relivtely direct ausation chronic: slow onset, progression, long lasting, life lond, relatively complex (more interesting for population studies) self reported health (very vague) -​ self rated/ self assessed and perceived -​ on purpose vague to let people define themselves what means to be in food health -​ ICD 11 is your guide for diseases -> subjective (but more comparable?) -> valid -> reliable - average numbers of years in health a newborn can expect to live based on current rates of health and mortality - companion to life expectancy -> age standardized - question like ‘in general’ would you say that you rhealth is excellant’ answers like ‘very good’ 1 good 2 ‘moderate 3 bad very bad it is reliable because it is measures with mortality graph 1 scenario ; morbidity compression, years of bad health go from 5 to 3 gray is healthy life expectancy black is unhealthy morbidity graph 2 scenario: morbidity expansion -​ healthy life expectancy the same -​ but life span is longer -​ perspective relative or absolute makes it different graph 3 scenario; absolute equilibirum/ relative compression -​ time spent in bad health is stagnating ;( -​ proportion of life in good health is increasing HLE in the world study 2012 (Salmon et al) -​ 187 countries looked at life expectancy -​ y-axis healthy years lost to disability, if 1 extra year of life would mean 1 year of suffering that means slope of 1. -​ x- life expectancy at birth; if all years would be good than it would be a flat line from absolute perspectve -​ each line is 1 country, comparing 1990 with 2010 general slope of each country not interested in the level but in the slope. -​ bad news: there is a morbidity expansion -​ good news 83% of the additional years are disability free social inequalities -​ swiss case 1990-2014 -​ 3 levels of education: mandatory, secondary, tertiary  -​ LE and HLE at age 20 using SRH -​ convergence in LE and divergence in HLE main message of the paper; you might see a global picture and see for 1 country 1 direction but within the same country there can be different groups that are experiencing morbidity compression. equilibrium or expansion -> literature does not differentiate between health and mortality differentials by education swiss health care system -​ similar to dutch system (mandatory and private) -​ high out of pocket payments (personal contribution -​ very dense nework of hospitals and specialist doctos literature week 3 Oeppen, J., and Vaupel, J.(2002)"Broken limits to life expectancy."Science296: 10291031 -​ the mortality research has explodes the empirical misconceptinos and specious theories that underlie the belied that the expectation of life cannot rise much furthered -​ faith in proximate longevity limits endures This means that the slowing down of life expectancy growth in some countries happens because: 1.​ Laggards catching up: Countries with lower life expectancy have improved significantly, closing the gap with higher-performing countries. 2.​ Leapers falling behind: Countries that used to lead in life expectancy are no longer improving as quickly or are facing setbacks. -​ -​ the apparent leveling off of life expectancy in various countries is an artifact of laggards catching up and leapers falling behind -​ if life expectancy were close to a maximum then the increase in the record expectation of life should be slowing Literature lecture 4; healthy life expectancy; theory and patterns Huber, Machteld, et al.(2011)"How should we define health?"BMJ343: d4163 WHO definition of health is no longer fit due to an increase of chronic diseases.- > new proposal changing the emphasis towards ability to adapt and self manage with new challenges definition now is ‘ a state of complete physical, mental and social well- meing an dnot merely the absence of disease or infirmity’ -> criticism is increasing because of new illnesses paper summarises the limitations of the WHO definition and describes the proposal for making it more useful -​ criticism on the word ‘complete’ in relation to welbeinn -? unintentionally contributed to medicalisation of society -​ emphasis on complete physical wellbeing can result that large groups become eligible for screening or for expensivbe interventions even when only one person might benefit and highler level of medial dependency -​ also demography of populations and nature of diseases have changes a lot; chronic diseases are increasing ant put more pressure on healthcare need for reformulation -​ limitations of the current definition are affecting health poluicy because in prevention progrmmes the definition of health determines the outcome measures -​ aspects to be considered when redefining are : stakeholders, cultures, furure scientific and technological advances -​ more towards ‘the ability to adapt and to self manage’ -​ considere dif definition shouldnt be a concept or conceptual framework of health physical health: ‘allostasis’ = the maintenance of physiological homeostasis through changing circumstances mental health: ‘sense of coherence’= enhancinng comprehensibillity, manageability and meaningfulness of a difficult situation social health: capacity to fulfil their poteinoal and obligations, ability to participate in social activities measuring health -​ general concept of health is useufl fo rmanagement and policies and can support doctors in their communicaiton with patients becuaese more focus on empowerment of the patient. Robine, JM, and Jagger C.(2005)"The relationship between increasing life expectancy andhealthy lifeexpectancy."Ageing Horizons3: 14- 21 explores how current knowledge of mortality rates in the oldest people, trends in oldest people and healthy life expectancy, gap between gender. dynamic equilibrium scenario: points much more clearly to whether the extra years of life are good quality years and the need to introduce a notion of severity. -​ possible to have a number of indicators that might measure healthy life including: 1 life expectancy ‘in good perceived health’, 2 disease free life expectancy and 3 active life expectancy without loss in the performance for daily living activities and 4 ‘life expectancy without significant risk factor damage -​ more focus on quality of life than previous the length of life -​ compression of morbidity: the survival curves without disease and without disability have to move uch closer to the toal survival curve. -​ LE is increasing less rapidly than DFLE expansion of morbidity = survival curve move to the righ when the disability and morbidity curves move little, thus LE increases more rapidly than DisFLE and DFLE. limits to life expectancy -still much debate if there is a limit to life expectancy -> traditional view= mortality increases exponentially with age, mortality rates doublic around every 8 years - current dataL no exponential increase of mortality rates but slows down and tends to have a ceiling so ;> no limits to life duration in terms of age for individuals very unlikely that health behviours or socio demographic factors might singly be responsible for similar develariots in life expectancy data -​ comparative data on disability prevalence ahs improved by differing gloabl definitions; but can also make it challenging -​ more focus into disability-free life expectancy -​ dynamic equilibrium: evidence supports a balance where severe disability trends align with LE increases -​ compression of morbidity: more likely in countries with initially high disability level and or lslower increases in LE -​ countries with low initial disability levels face more challenges in reducing disability rtes; aries mostly from chronic diseases -​ gender gap -​ women live around 7 yars longer but experience 50% higher prevalence of disability than men causes longer life span 1.​ biological factors; chromosomal, hormonal  2.​ social and hevioral factors: less risky behavior and healthy behavior 3.​ but higher rates of disability health transition theory -> as life expectancy increases - initially, more sick people survive into older ages leading to increased disability health improvement reduce years lived with disability -​ health improvements reduce years lived with disability -​ at very advanced ages, years lived with disability rise again due to multiple chronic disease and fraily lecture 5 literature Richards, M. and Deary, I.(2014) “A life course approach to cognitive capability.”In A lifecourse approach to healthy ageing,pp. 32-45. Oxford University Press, Oxford cognitive capability= encompasses mental funcitons like memore and reasoing and problem-solving that influence health, well-being and aging outcomes life course perspective -​ cognitive capability is shaped throughout life by genetic, environmental and social factors -​ critical periods like early childhood are particularly infleuncital key influences on cognitive development early life: -​ prenatal and childhood nutrition, exposure to toxins and maternal health -​ early education and socio-economic status also influences adulthood: -​ lifestyle factors; chronic stress, poor health negatively impact cognitive capabilities old age: -​ cognitive decline is common but varies on lifestyle, health habits and social interactions policies -​ interventions should target early childhoord and promote lifelong learning, health m aintenance and social support -​ strategies include improving education access, reducing socio economic disparities and encouraging healthy behaviors Cognitive capability is shaped by genetic, environmental, and social factors throughout life, with critical influences at different stages. Promoting healthy behaviors, education, and social equity across the life course can improve cognitive health and enhance quality of life in aging week 3 lecture 1 25/11/2024 cognitive functioning = cognitive function is the mental ability to process and interpret information of daily life not emotions why are they important it includes domains as -​ memory -​ attention -​ reasoning -​ planning of tasks -​ language -​ information processing speed neuropsychological testing -​ mini mental state exam MMSE -​ rey-osterrieth complex figure -​ trail making test -​ verbal fluency -​ verbal memory test rey osterrieth complex figure -​ 1st step copying freehand to test recognition functioning -​ second step; drawing from memory to test recall functioning -​ scored by time and the presence and right location of each line what is measures -​ visuospatial abilities -​ memory -​ attention -​ planning -​ working memory trail making test measures: primarily cognitive processing speeds primarily executive functioning also: visual attention and task switchies cognitive decline over age -​ decline in cognitive test scores over 10 yar -​ all cognitive scores( except vocabulary) declines in all 5 categories -​ P-value: whether there is a significant difference across age categories vocab gets better over time diagnosis of mild cognitive impairment (not hard to diagnose) modest cognitive decline from a previous level of performance -> one or more cognitive demain how to test 1.​ concern of the individual, a knowledgeable informant or the clinician that there ahs been a mild decline in cognitive function and 2.​ a modest impairment in cognitive performance, preferable documented by standardized neuropsychological testing or in its absence another quantified clinical assessment. B cognitive deficits do not interfere with capacity for independence in everyday activities like paying bills (greater effort may be required) Cthe cognitive deficits do not occur exclusively in the context of a delirium Dthe cognitive deficits are not better explained by another mental disorder (e.g. schizophrenia) dementia diagnosis -​ comparable but different of MCI -​ differences: 1.​ impairments in cognitive performance are severe instead of modest 2.​ cognitive deficits do interfere with independence in everyday activities dementia majority of cases -​ alzheimers 70% three stages of alzheimer’s disease stage 1. forgetfulness -​ disorientation -​ change of personality -​ reduced creativity stage 2 -​ problems in activities in daily living  -​ problems with short term memory while memories from the remote past are clear -​ reduced control over emotions -​ difficult recognizing friends and family -​ possibly apathy stage 3 -​ total dependence -​ need for 24h care progression from MCI to AD -​ most of the subjects with MCI will progress to AD at a rate of 10% to 15% -​ for comparison: healthy control subjects progress convert at a rate of 1% to 2% per year important to detect in an early stage; most likely you will have AD after MCI so good to prepare -> its normal to use cognitive function but MCI is more severe but does not directly influence your life global dementia mortality lower risks in countires llike Russia; people dont reach that age -​ more dementia in developing countries because the population is way bigger. consequences of cognitive decline burden on: -​ patient -​ family -​ informal caregiver -​ society as a whole burden on the society -​ in the netherlands 96% of the total costs of dementia cna be attributed to costs for care in nursing homes and homes for the elderly -​ increased demand for prolonged independent living and informal caregiving\long term care expenditure amount to 4.3% of GDP onsert -> if we would have the opportunity to post pone this would delas change in world wilde prevalence (how many times alzheimers is occuring) risk factors of cognitive decline -​ pharmaceutical treatment of dementia can only modestly improve symptoms  -​ new introduced drug lequembi (2024) promising in slowing the progression of alzheimer’s disease ; major focuse on prevention risk factors -> Account for half the dementia cases like, diabetes, hypertension, obsesity, smoking, depression risk factors of cognitive decline -​ remaining socially active may help built cognitive reserve -​ cognitive reserve: enables individuals to better compensate for changes in the brain that could result in symptoms of: -> increase in connections in the brain -> using alternative routes of communication in the brain risk factors of cognitive decline -​ cognitive stimulation -​ stress reduction (stress-buffering hypothesis -​ health behavior enhancement to summarize -​ cognitive decline a major threat to healthy ageing -​ alzheimer’s disease as a prime cause for future long term care demands -> burden for individuals and society at large -​ prevention is key to maintain cognitive functioning to older ages -> health behaviors and education over the life course are crucial. week 4 literature Zweifel, P., Felder, S., & Meiers, M. „Ageing of population and health care expenditure:redherring?Health economics, 8(1999):485 496 the study challenges the assumption that population aging directly drives increasing health care expenditure key finding: population aging’s limited impact on costs: while the aging population is foten blamed for rising healthcare costs, the study finds that other factors like technological advancements play a larger role -​ health care expenditures are more affected by technological progress: new medical technologies and treatments increase health care costs more than the demographic shift alon -​ income growth correlation: rising income levels lead to increased demand for healthcare services which may outpace the effects of aging -​ health care costs ar more heavily influenced by the individual’s age and their need for care, but costs rise more sharply due to advancements in treatment not simpluy age policy immplications -​ policymakers should focus on controlling technological growth and improving health care system efficiency rather than attributing rising consist solely to aging -​ financial burden of aging cn be mitigated by focusing on cost management strategies unrelated to demographic shjifts so: population aging is not the primary cause of rising helathfare expenditure, other factors like medical technoloyg and income growht are more significant contributers Lecture week 4 kijk dit college even terug want heel veel moeilijke graphs! lecture 7 Health care expenditures (HCE) how much does increased lifespan contribute to health care expenditure? main question -​ GDP is increasing -​ Nl is slightly above average recents trends (before covid-19) -​ slight decrease of Nl after 2013 of health expenditure as a share of GDP, renewed attempt with higher share out of pocket payments -> people have later diagnostics; greater reliance at home care -​ the way we deal with healthcare expenditure is more a political choice. are we doomed? -​ long term increae in long term health expenditure but also increase in lifespan; you quickly get the idea that we are doomed and that our health care system will collapse.  -​ if we have more older people, health care expenditure inceases, however 1. it might not be the only contributor to more expenditure and might not be the biggest contributor and 2. is age the end of the story? or is it linked to other variables that are driving themselves? (->we can also look at education levels is explains about 20% of increased life expectancy, or urban vs rural) -​ trends in HCE characteristics of NL system -​ stagnating share of GDP (higher deductible, sectoral agreements, generics hoomecare etc) -​ low out of pocket payments -​ long term care sector very expensive what drives changes in HCE? -> there are more factors!! 1.​ population composition : age and education 2.​ longevity; (healthy) life expectancy 3.​ practices: demand, supply, knowledge, technology and policies; ‘cost per case’ for the same diagnostic, how much will it cost to treat someone. you can also see this from a demand perspective (how much tdoes the patient need?) or demand perspective (hoe much technologiy and care do we need to provide. France (2006) average individual health expenditures by age group 1992 versus 2000, increase for each age group about 10/20 %. -​ in total about a 50% increase in expenditure; how much is this due to population ageing/ practices( =how much does it cost to teat)/ morbidity (= healthy life expectancy)? -​ overall result of this study: population ageing +3.4%, morbidity -9.7% people are more healthy on average at the same age, less likely to be diagnosed with condition, practices +12.9% Costs per case mostly driven by medication costs china (2017): empirical evidence suggests that the age structure of thep population has only a modest impact on the growth of health expenditure -​ only about 11 % of the growth in health care expenditure is due to population ageing. has a modest impact; dark green -​ cost per case blue has a very large increase. 14% of costs for cardiovascular disease. -​ small increase in time that group is healthy SO: more health care expenditure and increased life span? there can be relationship between these factors; but biggest contributor is how much we pay per person. domont et al 2006 study france: for any developed country, an increase in the proportion of the elderly entails an increase in per capita health care expenditure. This is undoubtly true, given that individual health care expenditure is an increasing funciotn of age (Dormont et al, 2006) -> does increased longevity push costs? is age an absolute concept? mediator/ control variable: it is possible that A is related to B but C can also be in the middle and be related. is life more like tennis or football? tennis: -​ match ends when score is reached -​ time is relative to each match -​ critical periods = ends of games -​ outcome depends on coming events with some conditionality football -​ match ends when time is over -​ time is absolute -​ no clear critical period -​ outcome depends gradually on past events relative age = idea: define old people not by their age but by their remaining life expectancy advantage= takes improvements in health and life expectancy into account example= prospective old age dependency ratio numbers of persons with remaining life expectancy < 15 years/ number of persons between age 20 and age with remaining life expectancy= 15 -​ fixed starting age not necessary: could also be less than 15 years of life expectancy vs more than 15 years of life expectancy age vs time to death (graphs) -​ back pain: depends on chronological age because caused by wear and tear -​ mental health & SRH; depends on lhow long remains to live because, either people feel they approaching death (mental health) or their body generally shuts down -​ smoking: determines how old you will live (lifespan) not remaining time to live because people start smoking around the same age -​ blood pressure: if you are young with high bp it is a bad sign and youll die soon if you are olf with a high bp it is not going to kill you soon Conclusion -​ morbidity varies across all demographic time dimensions and chronological age is only one of them -​ because the other dimensions overlap with chronological age and are rarely measured we tend to take for granted that old people are more unhealthy and generate more health care expenditures -​ because of methodological challenges, theses conclusions are still strongly debated -​ we tend to think of demographic time in absolute terms (like football) but age is relative (tennis -​ population ageing brigs challenges that can be used as scarecrow such as healthcare expenditure -​ HCE are more affected by increasing demand and supply of health care (practices) and costs per case than population ageing (age structure and population) -​ the link between age and healthcare expenditure (through morbidity is not as obvious as it seems -​ costs are only slightly affected by population ageing and possibly not all by increasing life expectancy. Week 4 lecture 9 municipality of groningen Week 5 literature Kuh,D., Richards, M., Cooper, R., Hardy, R. and Ben-Shlomo,Y.(2014)“Lifecourse epidemiology, ageing research and maturing cohort studies: a dynamic combination for understanding healthy ageing.”In A life course approach to healthy ageing, pp.3-15. OxfordUniversity Press, Oxford Increased life expectancy requires big changes in out attitudes to ageing to make it a success. -> debate mostly focuses on the expected increase in health and welfare expenditure required to for the post war baby boom generations. - implication of population ageing could be viewed more positively if disability free life yars was increasing faster than life expencating disease trends: -​ US and Europe rise in chronic diseases aomnd elderly -​ Us shows a decline in late life disability since 1980s due to better health care -​ new data shows decline in personal care activities -​ more social inequalities for disability Need for interdisciplinary and life course approach to healthy ageing  -​ geowing consencsus between international health organization, national policymakers, research funders and scientisit that aging itself needs to be studied from an interdisciplinary and life course perspective key elements of this approach 1.​ research priority is to understand better the underlying biological processes of aging and the body system; mechanistic and population science need to work more closely together 2.​ we need to understand social inequalities in health better 3.​ more interest in studying the whole spectrum of health and ageing from best to worst health 4.​ growing interest in life course approach to ageing; more attention to social and psychological pathways 5.​ researchers examine several cohorts from ageing studies to increase power to detect associations and generalizations -> past research: emphasis on the distinctive features in each discipline related to studying ageing -> recent debate: emphasize what different approaches of studying have in common and how life course perspective can be used as common conceptual framework life course approach in epidemiology -​ investigates biological, beahvioural and social pathways that link physician and social exposures and experiences during life and across generations to changes in health and disease risk later in life. -​ has wineded its gaze from chronic disease to health and ageing seeing that health is multidimensional. week 6 lecture 1 9/12/2024 life course perspective WHO: emphasizes a temporal and social perspective, looking back across an individual’s or a cohort’s life experiences or across generations for clues to current patterns of health and disease, whilst recognizing that both past and present experiences are shaped by the wider, social economic and cultural context life course perspective in health research -​ study of long term effect on later health or disease risk based on physicial or social exposures during gestation, childhood, adolescence, young adulthood and later adult life (kuh et al.2003) -​ multidiscplinary approach to healthy ageing: folllowed by demographers, psychologist, anthropoligts, sociologists, biolofists, economicsts etc. to summarize -​ old age health is influenced by earlier life events for cohorts and individuals -​ life course as a theoretical approach that accounts for timing perspective, to understand changes over time and how ertain factors contribute to things happening in your life, doesn’t necessary involve old age can also be adolescent. -​ exposure to health risks/health prevention over phases of life course affects. life course approach to understand differences in an individuals life course the fetal origins hypothesis = an approach to show how later life health outcomes are already determined in uterno (maternal stress, nutrition etc9 Barker 1995), diabetes, hypertension, and chronic heartdisease is in response to undernutrition during pregnancy. in utero effects on long term health: pregnant during summer means more fresh food and better nutrition so less deviation to life expectancy ; thats why australia is otherway around from northern hemisphere. foetal origins and life course approach ; evidence -​ postulates negative early childhood effects prevail independent of later life health behaviors or environmental influences -> criticism: neglects that health at older ages is determined by various biological and social factors -​ over life course therse factors independently, cumulatively and interactively influence health and disease in adult life -​ less focus on early life but on all stages of the life course. -> life course approach puts ideas of detrimental health factors which puts you in a situation that you have accumulated so much of this that your body can not repare it anymore and that you gett diseases. life course effects on health graph; main q is ‘how do conditions during phases of life course accumulate?’ -​ how you can prevent negative effects, builds up the most during employment and work -​ how to avoid accumulation of risk factors. -​ healthy standards of living etc etc. pathways to (un) healthy ageing -​ accumulation of risks: negative effects gradually accumulate through episodes of illness and injury, adverse environmental conditions, and health damaging behavior -​ cumulative (so repetitive) damage to biological systems as numer, duration or severity of exposures increases -> body systems age and become less able to repair damage (see biological theories). life course approach models independent risk factors: exposure to risks could be independent (model a) or clustered model b clustered for example among families, neighbourhoods, or general socioeconomic position different factors can effect your health but are independent of eachother, for example smoking and malnutrition during pregnancy -> can also be related to eachother (model 2) risk chains= exposure increases risk of subsequent exposure and additional independent effect on disease risk irrespective of the later exposuer model c Negative effects add up cumulatively mode D chains of risk model ( not necesseralliy environmental but can also be social like growing up in a disadvantaged neighbourhood; which causes poorer eduction and worklife) -​ sequence of linked exposures that raise disease risk -​ different types of chains can lead to increased or decreased risk -​ social biological and psychological chains of risk are possible and involve -​ ‘mediating factors= positive or negative factors that explains the link between cause and consequence fo rexample low socioeconomic status, family characteristics and later health life -​ moderating factors= beneficial effects that lowers negative risk outcomes → links are probabilistic not necessarily deterministic; negative transitions are likely to occur but not unavoidable. physical capabilities at older ages physician capability= the capacity to undertake the physical tasks of dailing living, is a key component of healthy biological ageing and highly valued by older people -​ link to activities of daily living (ADL) and instrumental activities of daily living -​ physical capabilities important predictor for risk of death -​ immobility, risk of falls a central concern for older adults. -​ lots of elderly don’t leave the house out of fear of falling and not recovering etc. physical capabilities at older ages -​ difference in physicial capabilities at older ages result of changes across life course -> social, behavioral and biological processes from early life onwards -​ studies usually asses physicial capabilities by different measurements, grip strength, chair rise time, standing balance performance of walking speed -​ measurements of physical capabilities related to normal functioning of body system, especially the musculoskeletal, cardiovascular, respiratory and nervous system declining physical capabilities over age -​ overall decline of physician capabilities over age result of several factors related to ‘normal’ ageing processes -> reductions in muscle mass and quality other deteriorations in the musculoskeletal system -​ neurological hormonal and cardiovascular functional decline -​ detrimental (unfavourable) changes in weigh and health behaviors and the increasing risk of developing chronic conditions. -​ inter-individual variations in physical capabilities at older ages result of different effects over life courses: genetic factors: heritability of better physical functioning explains only 65% ariation life style factors -​ physical activity over the life course -> continuous exercise and training related to better physical functioning at old age -​ also sudden increase of exercise at older ages not necessarily beneficial -​ smoking behaviour: cumulative effect of smoking on respiratorty and cardiovascular -​ system decrease physician capabilities already at age 53 body size -​ high BMD related to worse physician capabilities at older ages- > longer phases of obesity over life course decrease physicial capabilities -​ also low birth weight or undernutirion at young ages related to lower grip strength at older ages. graph: different data set; 0 is no effect, on the left negative effect. nutrition over the life course -​ individual diet mayor modifiable factor with strong effects of healthy ageing -​ different nutition patterns over life course affect alter life cognitive and physical health outcomes -​ importance of nutrition for health reflected by publlic health guidelines, policy recommentdations. diet over the life course result of several factors -​ socioeconomic conditions affect availability and affordability of food -​ cultural or social norms affect food preferences or dietary rules ( you can also not afford food sometimes; take out food, fast food etc. -​ period of life when exposed to nutrition patterns or in need for certain nutrients are central -​ nutrition of mothers can influence fetal growth -> fetal origins hypothesis -​ breastfeeding found to have positive effect on cognitive and health outcomes in childhood and inlater life. -> obesity and childhood overweight which has long term health outcomes like diabeters etc WHO. -​ major life events can influence nutrition patterns -> depressions can change food preferences or overall food intake -> ageing related factors like dental loss affect food preferences. residential environment -​ characteristics of the places people live in childhood and adult life can influence health at older age -​ higher vulnerability of individual during certain life stages (childhood or older ages) -​ area deprivation has a negative impact on later life health outcomes-> access to certain services, socioeconomic status week 6 literature Franke, T., Sims- Gould, J., Chaudhury, H., Winters, M., &Mckay, H. (2019). ‘It makes your life worthwhile. It gives you a purpose in living’: Mobility experiences among active older adults with low income.Ageing & Society, 39(8), 1639–1666 study purpose -​ to explore the mobility experiences of active older adults with low income and understand how mobility impacts their lives and well being -​ focuses on how mobility affects independence, social engagement and a sense of purpose among oldre adults -​ study with active older adults (65+), low income backgrounds and varying levels of physical ability key findings -​ mobility as key to independence: active mobility like walking was crucial for maintaining autonomy and performing daily activities -​ sense of purpose: mobility have older adults a sense of purpose and improved their quality of life -​ barriers: low income older adult faced challenges like costly transportation physical limitations and lack of accessible infrastructure -​ social and emotional benefits: mobility contributed to menatl well being and reduced loneliness -​ need for better infrastructure: study highlights the importance of improving transportation options and urban design to support the mobility needs of older adults especially with low income l - Meijering, L., & Weitkamp, G. (2024) I choose the quiet roads: Everyday mobility in later life on the rural-urban continuum of the Northern Netherlands.Journal of Transport Geography, 114: 10376 examines everyday mobility in later life specifically focusing on the rural urban continuum in northern nehterland key findings -​ older adulr tprefer quieter safer roads for daily mobility -​ mobility patterns vary across the rural urban spectrum with ruban areas proiding more public transport options with rural rely more on car use -​ highlights impact of accessibility and safety on older adults’ mobility choice, and quality of life emphasizing importance of tailored infrastructure lecture 2 week 5 guest lecture a ageing right care (fully): a snapshot of the housing and healthcare continuum for older adults. the housing continuum for older people. big focus in america; ageing in place, living and staying where you are. -​ doesnt include mobility, environment and social health. how to design for social sustainability better housing for economic people, not only economic -​ better policy, zoning and design guidelines -​ technology developments to link older adults with younger poulation -​ modular housing design and new layouts with open plans. week 6 lecture 1 mobility in later life conceptualising mobility= physical movement, representations and practices mobility in later life often: impairments that impact mobility mobility= the overcoming of any type of distance between a here and a there which can be situated in physical, electronic, social or other kinds of space caregiver mobility -​ capability to be mobile mobility is impacted by that of other people example: caring for someone with dementia -​ mobility restriction -​ mobility becomes local and oriented on career -​ mobility is more than moving from a to b -​ mobility impairments can be through -​ three research examples have shown that opportunities and barriers in everyday mobility depend on 1.​ other people, especially who you care for 2.​ your physical and social health 3.​ where you live so: -​ mobility as a central component of healthy ageing but heavily influenced by cognitive and physician decline over age -​ modern definitions of mobility going beyond movement from a to b  -​ mobility extends to other dimensions of human interactions such as digital or social mobility and contains different motives -​ week 6 lecture 2: population ageing in global perspective global population ageing -​ share of 60+ year old increases from 12-22% between 2015 and 2050 -​ already today more 60+ year olds than children below 5 -​ in 2050, 80% of older perons will live in low and middle income countries -​ despite overall ageing, different pace across and within regions achieving the MIPAA goals; 3 major obstacles​ main objectives mipaa; health, social inclusion, development 1.​ lack of data mainly in global south makes planning and revision very difficult 2.​ lacking political priority -> many populations in the global south still young -> focus on other challenges (demographic dividend, climate change, child and family health) 3.​ lacking resources -> related to previous point, no or little resource allocation for meeting MIIPA objectives ageing in sub-saharan africa -​ 2024, 4.8% of the population of SSA was older than 60 years -​ seemingly low share but in absolute numbers ageing is very sizeable by 2050. -​ rapidly growing older population puts economic growth at risk if no plans for aging are implemented -​ around on third of african countries had no strategies to implement the targets sen in MIPAA and strategies need to be aligned with the legal national frameworks -​ after 20 years since the adoption of MIPAA, older africans are typically not supported by social and development programs -​ also no adequate investments in efforts to support the rights and needs of older adults -​ special issue with collection of articles with examples of ageing situation in SSA -​ structure according to the MIPAA priority areas -​ studies from Nigeria, kenya etc -​ old age in SS accompanied by increasing health problems; study by Kohler et al; tanzania finds increasing prevalence of various helath problems  -​ men and women are suffering from multimorbidity and related behavioral health risks -​ increasing prevalence of multimorbidity may cause high demand of health and care services old age and health -​ reasons for adverse health at older ages is related to lifecourse adversity -​ study from jenning et al; find a number of risk factors for declining health in south africa -​ mixed results towards factors influencing later life health old age and multidimentional deprivation -​ older adults in SSA are at high risk to deprived of several resources -​ Moboloaji 2024 studied influences of suffering from deprivation in nigeria -​ deprivation is measured in terms of lack of nutrition, health care or daily finances old age and the living environment -​ unsatisfactory housing conditions and community level factors determine wellbeing of older adults -​ banda et al found in their study for zambia that factors such as poor access to clean water, basic building conditions and sanitary access determined wellbeing of older adults. older adults and HIV -​ HIV presents a significant health problem for older adults and their relatives -​ Mwangala et al studied perceived health threats for older adults in Kenya -​ older adults with HIV are confronted with multiple mental health threats, social and individual problems which limits coping abilities. -> workship in ageing in uganda 2024 - mostly qualitiative research often lack quantitative date insights on age discrimination, lacking support or housing arrangement, poor health etc