National Institute on Aging

National Institutes of Health

U.S. Department of Health and Human Services
Gl obal Heal t h and Agi ng
2 Global Health and Aging
Photo credits front cover, left to right (Dreamstime.com): Djembe; Sergey Galushko; Laurin Rinder; Indianeye;
Magomed Magomedagaev; and Antonella865.
3
Preface
Overview
Humanitys Aging
Living Longer
New Disease Patterns
Longer Lives and Disability
New Data on Aging and Health
Assessing the Cost of Aging and Health Care
Health and Work
Changing Role of the Family
Suggested Resources
Contents
Rose Maria Li
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4 Global Health and Aging
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Preface
Theworldisfacingasitnationwithontprecedent:Wesoonwillhaemoreolderpeoplethan
childrenandmorepeopleatetremeoldagethaneerIefore.AsIoththeproportionof older
peopleandthelengthof lifeincreasethronghonttheworld.Le,qnestionsarise.Willpopnlation
agingIeaccompaniedI,alongerperiodof goodhealth.asnstainedsenseof well-Ieing.and
etendedperiodsof socialengagementandprodnctiit,.orwillitIeassociatedwithmoreillness.
disaIilit,.anddependenc,?Howwillagingaffecthealthcareandsocialcosts?Arethesefntnres
ineitaIle.orcanweacttoestaIlishaph,sicalandsocialinfrastrnctnrethatmightfosterIetter
healthandwellIeinginolderage?Howwillpopnlationagingpla,ontdifferentl,forlow-income
conntriesthatwillagefasterthantheirconnterpartshae.IntIeforethe,Iecomeindnstrialized
andwealth,?
ThisIrief reportattemptstoaddresssomeof theseqnestions.AIoeall.itemphasizesthecentral
rolethathealthwillpla,moingforward.AIetternnderstandingof thechangingrelationship
Ietweenhealthwithageiscrncialif wearetocreateafntnrethattaLesfnlladantageof the
powerfnlresonrceinherentinolderpopnlations.Todoso.nationsmnstdeelopappropriate
datas,stemsandresearchcapacit,tomonitorand nnderstandthesepatternsandrelationships.
specincall, longitndinal stndies that incorporate measnres of health. economic statns. famil,. and
well-Ieing.AndresearchneedstoIeIettercoordinatedif wearetodiscoerthemostcost-effectie
wa,stomaintainhealthfnllifest,lesandeer,da,fnnctioninginconntriesatdifferentstagesof
economicdeelopmentandwithar,ingresonrces.CloIaleffortsarereqniredtonnderstandand
nnd cnres or wa,s to preent snch age-related diseases as Alzheimer`s and frailt, and to implement
eistingLnowledgeaIontthepreentionandtreatmentof heartdisease.stroLe.diaIetes.and
cancer.
HanagingpopnlationagingalsoreqniresInildingneededinfrastrnctnreandinstitntionsassoonas
possiIle.Thelongerwedela,.themorecostl,andlesseffectiethesolntionsareliLel,toIe.
Popnlationagingisapowerfnlandtransformingdemographicforce.Weareonl,jnstIeginning
tocomprehenditsimpactsatthenationalandgloIalleels.Asweprepareforanewdemographic
realit,.wehopethisreportraisesawarenessnotonl,aIontthecriticallinLIetweengloIalhealth
andaging.IntalsoaIonttheimportanceof rigoronsandcoordinatedresearchtoclosegapsinonr
LnowledgeandtheneedforactionIasedoneidence-Iasedpolicies.
JichardSnzman.PhD
Director, Division of Behavioral and Social Research
NationalJnstitnteonAging
NationalJnstitntesof Health
1
)ohnLeard.HLLS.PhD
Director, Department of Ageing and Life Course
WorldHealthOrganization
Preface
2 Global Health and Aging
Figure 1.
Young Children and Older People as a Percentage of Global
Population: 1950-2050
Source: United Nations. World Population Prospects: The 2010 Revision.
Available at: http://esa.un.org/unpd/wpp.
Overview
TheworldisontheIrinLof ademographic
milestone.SincetheIeginningof recorded
histor,.,onngchildrenhaeontnnmIered
their elders. Jn aIont ne ,ears` time. howeer.
thennmIerof peopleaged6orolderwill
ontnnmIerchildrennnderage.DrienI,
fallingfertilit,ratesandremarLaIleincreasesin
lifeepectanc,.popnlationagingwillcontinne.
eenaccelerate(Figure 1).ThennmIerof
peopleaged6orolderisprojectedtogrow
fromanestimated21millionin2010tonearl,
1.Iillionin200.withmostof theincreasein
deelopingconntries.
TheremarLaIleimproementsinlife
epectanc,oerthepastcentnr,werepart
of ashiftintheleadingcansesof disease
anddeath.Atthedawnof the20thcentnr,.
themajorhealththreatswereinfectionsand
parasiticdiseasesthatmostoftenclaimed
theliesof infantsandchildren.tnrrentl,.
noncommnnicaIlediseasesthatmorecommonl,
affectadnltsandolderpeopleimposethe
greatestInrdenongloIalhealth.

Jn toda,`s deeloping conntries. the rise of

chronicnoncommnnicaIlediseasessnchas
heart disease. cancer. and diaIetes renects
changesinlifest,leanddiet.aswellasaging.
Thepotentialeconomicandsocietalcostsof
noncommnnicaIlediseasesof thist,perise
sharpl,withageandhaetheaIilit,toaffect
economicgrowth.AWorldHealthOrganization
anal,sisin28low-andmiddle-incomeconntries
estimatedtheeconomiclossesfromthree
noncommnnicaIlediseases(heartdisease.
3
stroLe.anddiaIetes)intheseconntrieswonld
totalJS888IillionIetween2006and201.
JedncingseeredisaIilit,fromdisease
andhealthconditionsisoneLe,toholding
downhealthandsocialcosts.Thehealth
andeconomicInrdenof disaIilit,alsocan
IereinforcedoralleiatedI,enironmental
characteristicsthatcandeterminewhether
anolderpersoncanremainindependent
despiteph,sicallimitations.Thelongerpeople
canremainmoIileandcareforthemseles.
thelowerarethecostsforlong-termcareto
familiesandsociet,.
Lecanseman,adnltandolder-agehealth
proIlemswererootedinearl,lifeeperiences
andliingconditions.ensnringgoodchild
health can ,ield Ienents for older people.
Jnthemeantime.generationsof children
and,onngadnltswhogrewnpinpoert,
andillhealthindeelopingconntrieswillIe
enteringoldageincomingdecades.potentiall,
increasingthehealthInrdenof older
popnlationsinthoseconntries.
Withcontinningdeclinesindeathratesamong
olderpeople.theproportionaged80orolder
isrisingqnicLl,.andmorepeopleareliing
past100.Thelimitstolifeepectanc,and
lifespanarenotasoIionsasoncethonght.
Andthereismonntingeidencefromcross-
nationaldatathatwithappropriatepolicies
andprogramspeoplecanremainhealth,
andindependentwellintooldageandcan
continnetocontriIntetotheircommnnities
andfamilies.
Thepotentialforanactie.health,oldage
istemperedI,oneof themostdanntingand
potentiall,costl,conseqnencesof eer-longer
lifeepectancies:theincreaseinpeoplewith
dementia. especiall, Alzheimer`s disease. Host
dementiapatientseentnall,needconstant
careandhelpwiththemostIasicactiities
of dail,liing.creatingahea,economicand
socialInrden.Prealenceof dementiarises
sharpl,withage.Anestimated2-80percent
of peopleaged8orolderhaedementia.
Jnlessnewandmoreeffectieinterentions
are fonnd to treat or preent Alzheimer`s
disease.prealenceisepectedtorise
dramaticall,withtheagingof thepopnlation
intheJnitedStatesandworldwide.
AgingistaLingplacealongsideotherIroad
socialtrendsthatwillaffecttheliesof older
people.JconomiesaregloIalizing.peopleare
moreliLel,tolieincities.andtechnolog,
iseolingrapidl,.Demographicandfamil,
changesmeantherewillIefewerolderpeople
withfamiliestocareforthem.Peopletoda,
haefewerchildren.arelessliLel,toIe
married.andarelessliLel,toliewitholder
generations.Withdecliningsnpportfrom
families.societ,willneedIetterinformation
andtoolstoensnrethewell-Ieingof the
world`s growing nnmIer of older citizens.
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Overview
4 Global Health and Aging
Humanitys Aging
Jn2010.anestimated21millionpeoplewere
aged 6 or older-8 percent of the world`s
popnlation.L,200.thisnnmIerisepectedto
nearl,tripletoaIont1.Iillion.representing
16 percent of the world`s popnlation. Althongh
moredeelopedconntrieshaetheoldest
popnlation pronles. the ast majorit, of
olderpeopleandthemostrapidl,aging
popnlationsareinlessdeelopedconntries.
Letween2010and200.thennmIerof older
peopleinlessdeelopedconntriesisprojectedto
increasemorethan20percent.comparedwith
a1percentincreaseindeelopedconntries.
ThisremarLaIlephenomenonisIeingdrien
I,declinesinfertilit,andimproementsin
longeit,.Withfewerchildrenenteringthe
popnlationandpeopleliinglonger.older
peoplearemaLingnpanincreasingshareof the
totalpopnlation.Jnmoredeelopedconntries.
fertilit,fellIelowthereplacementrateof two
lieIirthsperwomanI,the190s.downfrom
nearl,threechildrenperwomanaronnd190.
Jenmorecrncialforpopnlationaging.fertilit,
fellwithsnrprisingspeedinman,lessdeeloped
conntriesfromanaerageof sichildrenin
190toanaerageof twoorthreechildren
in200.Jn2006.fertilit,wasatorIelowthe
two-childreplacementleelin11lessdeeloped
conntries.
Hostdeelopednationshaehaddecadesto
adjnsttotheirchangingagestrnctnres.JttooL
more than 100 ,ears for the share of Jrance`s
popnlationaged6oroldertorisefrom
percentto11percent.Jncontrast.man,less
deelopedconntriesareeperiencingarapid
increaseinthennmIerandpercentageof older
people.oftenwithinasinglegeneration(Figure
2).Joreample.thesamedemographicaging
thatnnfoldedoermorethanacentnr,in
JrancewilloccnrinjnsttwodecadesinLrazil.
DeelopingconntrieswillneedtoadaptqnicLl,
tothisnewrealit,.Han,lessdeelopednations
Figure 2.
The Speed of Population Aging
Time required or expected for percentage of population aged 65 and over to
rise from 7 percent to 14 percent
Source: Kinsella K, He W. An Aging World: 2008. Washington, DC: National Institute on Aging
and U.S. Census Bureau, 2009.
5
will need new policies that ensnre the nnancial
secnrit,of olderpeople.andthatproidethe
healthandsocialcarethe,need.withontthe
sameetendedperiodof economicgrowth
eperiencedI,agingsocietiesintheWest.
Jnotherwords.someconntriesma,growold
Ieforethe,growrich.
Jnsomeconntries.thesheernnmIerof
peopleenteringolderageswillchallenge
nationalinfrastrnctnres.particnlarl,health
s,stems.Thisnnmericsnrgeinolderpeopleis
dramaticall, illnstrated in the world`s two most
popnlonsconntries:thinaandJndia(Figure 3).
thina`s older popnlation - those oer age 6 -
willliLel,swellto880millionI,200from110
million toda,. Jndia`s cnrrent older popnlation
of 60millionisprojectedtoeceed22million
in200.anincreaseof nearl,280percentfrom
toda,.L,themiddleof thiscentnr,.there
conldIe100millionthineseoertheageof 80.
Thisisanamazingachieementconsidering
thattherewerefewerthan11millionpeople
thisageontheentireplanetjnstacentnr,ago.
Figure 3.
Growth of the Population Aged 65 and Older in India and China:
2010-2050
Source: United Nations. World Population Prospects: The 2010 Revision.
Available at: http://esa.un.org/unpd/wpp.
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Humanitys Aging
6 Global Health and Aging
Living Longer
Thedramaticincreaseinaeragelifeepectanc,
dnringthe20thcentnr,ranLsasoneof
societ,`s greatest achieements. Althongh most
IaIiesIornin1900didnotliepastage0.life
epectanc,atIirthnoweceeds88,earsin
)apanthecnrrentleaderandisatleast81
,earsinseeralotherconntries.Lessdeeloped
regionsof theworldhaeeperiencedastead,
increaseinlifeepectanc,sinceWorldWar
JJ.althonghnotallregionshaesharedin
theseimproements.(OnenotaIleeception
isthefallinlifeepectanc,inman,partsof
AfricaIecanseof deathscansedI,theHJV/
AJDSepidemic.)Themostdramaticandrapid
gainshaeoccnrredinJastAsia.wherelife
epectanc,atIirthincreasedfromlessthan1
,earsin190tomorethan1,earstoda,.
Theseimproementsarepartof amajor
transitioninhnmanhealthspreadingaronnd
thegloIeatdifferentratesandalongdifferent
pathwa,s.Thistransitionencompassesa
Iroadsetof changesthatinclndeadecline
fromhightolowfertilit,:astead,increase
inlifeepectanc,atIirthandatolderages:
andashiftintheleadingcansesof deathand
illnessfrominfectionsandparasiticdiseases
tononcommnnicaIlediseasesandchronic
conditions.Jnearl,nonindnstrialsocieties.the
risLof deathwashighateer,age.andonl,a
smallproportionof peoplereachedoldage.Jn
modernsocieties.mostpeopleliepastmiddle
age.anddeathsarehighl,concentratedatolder
ages.
Theictoriesagainstinfectionsandparasitic
diseasesareatrinmphforpnIlichealth
projectsof the20thcentnr,.whichimmnnized
millionsof peopleagainstsmallpo.polio.
andmajorchildhoodLillersliLemeasles.Jen
earlier.Ietterliingstandards.especiall,
morenntritionsdietsandcleanerdrinLing
water.Iegantorednceserionsinfectionsand
preentdeathsamongchildren.Horechildren
weresnriingtheirnlneraIleearl,,ears
andreachingadnlthood.Jnfact.morethan
60percentof theimproementinfemalelife
epectanc,atIirthindeelopedconntries
Ietween180and1900occnrredIecansemore
childrenwereliingtoage1.notIecansemore
adnlts were reaching old age. Jt wasn`t nntil
the20thcentnr,thatmortalit,ratesIegan
todeclinewithintheolderages.Jesearchfor
morerecentperiodsshowsasnrprisingand
continningimproementinlifeepectanc,
amongthoseaged80oraIoe.
Theprogressieincreaseinsnrialinthese
oldestagegronpswasnotanticipatedI,
demographers.anditraisesqnestionsaIonthow
hightheaeragelifeepectanc,canrealisticall,
riseandaIontthepotentiallengthof thehnman
lifespan.Whilesomeepertsassnmethatlife
epectanc,mnstIeapproachingannpperlimit.
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Figure 4.
Female Life Expectancy in Developed Countries: 1840-2009
Source: Highest reported life expectancy for the years 1840 to 2000 from online supplementary
material to Oeppen J, Vaupel JW. Broken limits to life expectancy. Science 2002; 296:1029-
1031. All other data points from the Human Mortality Database (http://www.mortality.org)
provided by Roland Rau (University of Rostock). Additional discussion can be found in
Christensen K, Doblhammer G, Rau R, Vaupel JW. Aging populations: The challenges ahead.
The Lancet 2009; 374/9696:1196-1208.
Living Longer
8 Global Health and Aging
dataonlifeepectanciesIetween1810and200
showastead,increaseaeragingaIontthree
monthsof lifeper,ear.Theconntr,withthe
highestaeragelifeepectanc,hasariedoer
time(Figure 4).Jn1810itwasSwedenand
toda,itis)apanIntthepatternisstriLingl,
similar.Sofarthereislittleeidencethatlife
epectanc,hasstoppedrisingeenin)apan.
Therisinglifeepectanc,withintheolder
popnlationitself isincreasingthennmIerand
proportionof peopleater,oldages.The
oldestold(peopleaged8orolder)constitnte
8 percent of the world`s 6-and-oer popnlation:
12percentinmoredeelopedconntriesand6
percentinlessdeelopedconntries.Jnman,
conntries.theoldestoldarenowthefastest
growingpartof thetotalpopnlation.Ona
Figure 5.
Percentage Change in the Worlds Population by Age: 2010-2050
Source: United Nations, World Population Prospects: The 2010 Revision.
Available at: http://esa.un.org/unpd/wpp.
gloIalleel.the8-and-oerpopnlationis
projectedtoincrease81percentIetween2010
and200.comparedtoa188percentincreasefor
thepopnlationaged6orolderanda22percent
increaseforthepopnlationnnderage6(Figure 5).
ThegloIalnnmIerof centenariansisprojected
toincrease10-foldIetween2010and200.Jn
themid-1990s.someresearchersestimatedthat.
oertheconrseof hnmanhistor,.theoddsof
liingfromIirthtoage100ma,haerisenfrom
1in20.000.000to1in0forfemalesinlow-
mortalit,nationssnchas)apanandSweden.
This gronp`s longeit, ma, increase een faster
thancnrrentprojectionsassnmepreions
popnlationprojectionsoftennnderestimated
decreasesinmortalit,ratesamongtheoldest
old.
9
Thetransitionfromhightolowmortalit,
andfertilit,thataccompaniedsocioeconomic
deelopmenthasalsomeantashiftin
theleadingcansesof diseaseanddeath.
DemographersandepidemiologistsdescriIethis
shiftaspartof anepidemiologictransition
characterizedI,thewaningof infectionsand
acntediseasesandtheemergingimportanceof
chronicanddegeneratiediseases.Highdeath
ratesfrominfectionsdiseasesarecommonl,
associatedwiththepoert,.poordiets.and
limitedinfrastrnctnrefonndindeeloping
conntries.Althonghman,deelopingconntries
stilleperiencehighchildmortalit,from
infectionsandparasiticdiseases.oneof the
majorepidemiologictrendsof thecnrrent
centnr,istheriseof chronicanddegeneratie
diseasesinconntriesthronghonttheworld
regardlessof incomeleel.
Jidencefromthemnlticonntr,CloIalLnrden
of Diseaseprojectandotherinternational
epidemiologicresearchshowsthathealth
proIlemsassociatedwithwealth,andaged
popnlationsaffectawideandepanding
swathof worldpopnlation.Oerthenet
10to1,ears.peopleineer,worldregion
willsnffermoredeathanddisaIilit,from
snchnoncommnnicaIlediseasesasheart
disease.cancer.anddiaIetesthanfrom
Figure 6.
The Increasing Burden of Chronic Noncommunicable Diseases:
2008 and 2030
Source: World Health Organization, Projections of Mortality and Burden of Disease, 2004-2030.
Available at: http://www.who.int/healthinfo/global_burden_disease/projections/en/index.html.
New Disease Patterns
New Disease Patterns
10 Global Health and Aging
A growing Iod, of research nnds that man,
healthproIlemsinadnlthoodandoldagestem
frominfectionsandhealthconditionsearl,inlife.
Someresearchersargnethatimportantaspectsof
adnlthealtharedeterminedIeforeIirth.andthat
nonrishmentinnteroanddnringinfanc,hasa
directIearingonthedeelopmentof risLfactorsfor
adnltdiseasesespeciall,cardioascnlardiseases.
Jarl,malnntritioninLatinAmericaishighl,
correlatedwithself-reporteddiaIetes.foreample.
andchildhoodrhenmaticfeerisafreqnentcanseof
adnltheartdiseaseindeelopingconntries.
Jesearchalsoshowsthatdela,edph,sicalgrowthin
childhoodredncesph,sicalandcognitiefnnctioning
in later ,ears. Data on thina`s oldest old show that
rarel,orneersnfferingfromserionsillnessesor
receiingadeqnatemedicalcarednringchildhood
resnltsinamnchlowerrisLof snfferingcognitie
impairmentsorph,sicallimitationsatages80or
older.
ProinglinLsIetweenchildhoodhealthconditions
andadnltdeelopmentandhealthisacomplicated
researchchallenge.Jesearchersrarel,haethedata
necessar,toseparatethehealtheffectsof changes
inliingstandardsorenironmentalconditions
dnring a person`s life from health effects related
tohisorherIirthorchildhooddiseases.Howeer.
aSwedishstnd,withecellenthistoricaldata
conclndedthatredncedearl,eposnretoinfections
diseaseswasrelatedtoincreasesinlifeepectanc,.
Across-nationalinestigationof datafromtwo
snre,sof olderpopnlationsinLatinAmerica
andthetariIIeanalsofonndlinLsIetweenearl,
conditionsandlaterdisaIilit,.Theolderpeoplein
thestndieswereIornandgrewnpdnringtimes
of generall,poornntritionandhigherrisLof
eposnretoinfectionsdiseases.JnthePnertoJican
snre,.theproIaIilit,of IeingdisaIledwasmore
than61percenthigherforpeoplegrowingnpin
Lasting Importance of Child
infectionsandparasiticdiseases.Them,th
thatnoncommnnicaIlediseasesaffectmainl,
afnnent and aged popnlations was dispelled I,
theproject.whichcomIinesinformationaIont
mortalit,andmorIidit,fromeer,worldregion
to assess the total health Inrden from specinc
diseases.TheInrdenismeasnredI,estimatingthe
loss of health, ,ears of life dne to a specinc canse
Iasedondetailedepidemiologicalinformation.Jn
2008.noncommnnicaIlediseasesacconntedforan
estimated86percentof theInrdenof diseasein
high-incomeconntries.6percentinmiddle-income
conntries.andasnrprising8percentinlow-income
conntries.
L,2080.noncommnnicaIlediseasesareprojected
toacconntformorethanone-half of thedisease
Inrdeninlow-incomeconntriesandmorethan
three-fonrthsinmiddle-incomeconntries.
Jnfectionsandparasiticdiseaseswillacconntfor
80percentand10percent.respectiel,.inlow-and
middle-incomeconntries(Figure 6).Amongthe
60-and-oerpopnlation.noncommnnicaIlediseases
alread,acconntformorethan8percentof the
Inrdeninlow-.middle-.andhigh-incomeconntries.
Lntthecontinninghealththreatsfrom
commnnicaIlediseasesforolderpeoplecannot
Iedismissed.either.Olderpeopleacconntfora
growingshareof theinfectionsdiseaseInrdenin
low-incomeconntries.Jnfectionsdiseaseprograms.
inclndingthoseforHJV/AJDS.oftenneglect
olderpeopleandignorethepotentialeffectsof
popnlationaging.Yet.antiretroiraltherap,is
enaIlingmorepeoplewithHJV/AJDStosnrie
toolderages.And.thereisgrowingeidence
thatolderpeopleareparticnlarl,snsceptiIle
toinfectionsdiseasesforaariet,of reasons.
inclndingimmnnosenescence(theprogressie
deteriorationof immnnefnnctionwithage)
andfrailt,.Olderpeoplealread,snfferingfrom
onechronicorinfectionsdiseaseareespeciall,
nlneraIletoadditionalinfectionsdiseases.Jor
eample.t,pe2diaIetesandtnIercnlosisarewell-
LnowncomorIidrisLfactorsthathaeserions
healthconseqnencesforolderpeople.
11
poorconditionsthanforpeoplegrowingnpingood
conditions.Asnre,of seennrIancentersinLatin
AmericaandthetariIIeanfonndtheproIaIilit,
of disaIilit,was18percenthigherforthosefrom
disadantagedIacLgronndsthanforthosefrommore
faoraIleones(Figure 7).
Jf theselinLsIetweenearl,lifeandhealthatolder
agescanIeestaIlishedmoredirectl,.the,ma,hae
especiall, signincant implications for less deeloped
conntries.Peoplenowgrowingoldinlow-andmiddle-
incomeconntriesareliLel,tohaeeperiencedmore
hood Health
Figure 7.
Probability of Being Disabled among Elderly in Seven Cities of Latin
America and the Caribbean (2000) and Puerto Rico (2002-2003) by Early Life
Conditions
Source: Monteverde M, Norohna K, Palloni A. 2009. Effect of early conditions on disability among the
elderly in Latin-America and the Caribbean. Population Studies 2009;63/1: 21-35.
distressanddisadantageaschildrenthantheir
connterpartsinthedeelopedworld.andstndies
snchasthosedescriIedaIoesnggestthatthe,are
atmnchgreaterrisLof healthproIlemsinolderage.
oftenfrommnltiplenoncommnnicaIlediseases.
LehaiorandeposnretohealthrisLsdnringa
person`s adnlt life also innnence health in older age.
JposnretotoicsnIstancesatworLorathome.
ardnonsph,sicalworL.smoLing.alcoholconsnmption.
diet.andph,sicalactiit,ma,haelong-termhealth
implications.
New Disease Patterns
12 Global Health and Aging
Areweliinghealthieraswellaslongerlies.or
areonradditional,earsspentinpoorhealth?
ThereisconsideraIledeIateaIontthisqnestion
amongresearchers.andtheanswershaeIroad
implicationsforthegrowingnnmIerof older
peoplearonndtheworld.Onewa,toeamine
theqnestionistolooLatchangesinratesof
disaIilit,.onemeasnreof healthandfnnction.
SomeresearchersthinLtherewillIeadecrease
intheprealenceof disaIilit,aslifeepectanc,
increases.termedacompressionof morIidit,.
Othersseeanepansionof morIidit,an
increaseintheprealenceof disaIilit,aslife
epectanc,increases.Yetothersargnethat.as
adancesinmedicineslowtheprogressionfrom
chronicdiseasetodisaIilit,.seeredisaIilit,
willlessen.Intmilderchronicdiseaseswill
increase.JntheJnitedStates.Ietween1982
and2001seeredisaIilit,fellaIont2percent
amongthoseaged6oroldereenaslife
epectanc,increased.Thiser,positietrend
snggeststhatwecanaffectnotonl,howlong
welie.Intalsohowwellwecanfnnctionwith
adancingage.Jnfortnnatel,.thistrendma,
notcontinneinpartIecanseof risingoIesit,
amongthosenowenteringolderages.
WehaelessinformationaIontdisaIilit,in
middle-andlower-incomeconntries.Withthe
rapidgrowthof olderpopnlationsthronghont
theworldandthehighcostsof managing
peoplewithdisaIilitiescontinningandIetter
assessmentof trendsindisaIilit,indifferent
conntrieswillhelpresearchersdiscoermore
aIontwh,therearesnchdifferencesacross
conntries.
Somenewinternational.longitndinalresearch
designedtocomparehealthacrossconntries
promisestoproidenewinsights.moing
forward.A2006anal,sissponsoredI,theJ.S.
NationalJnstitnteonAging(NJA).partof
theJ.S.NationalJnstitntesof Health.fonnd
snrprisinghealthdifferences.foreample.
Ietweennon-Hispanicwhitesagedto61
intheJnitedStatesandJngland.Jngeneral.
peopleinhighersocioeconomicleelshaeIetter
health.Intthestnd,fonndthatolderadnltsin
theJnitedStateswerelesshealth,thantheir
Lritishconnterpartsatallsocioeconomicleels.
Thehealthdifferencesamongthese,onng
olderpeopleweremnchgreaterthanthegaps
inlifeepectanc,Ietweenthetwoconntries.
Lecansetheanal,siswaslimitedtonon-
Hispanic whites. the differences did not renect
thegenerall,lowerhealthstatnsof IlacLsor
Latinos.Theanal,sisalsofonndthatdifferences
inedncationandIehaioralrisLfactors(snchas
smoLing.oIesit,.andalcoholnse)eplainedfew
of thehealthdifferences.
Thisanal,sissnIseqnentl,inclndedcomparaIle
NJA-fnndedsnre,sin10otherJnropean
conntriesandwasepandedtoadnltsaged0to
1. The nndings were similar: American adnlts
reportedworsehealththandidJnropeanadnlts
asindicatedI,thepresenceof chronicdiseases
andI,measnresof disaIilit,(Figure 8).Atall
leelsof wealth.Americanswerelesshealth,
thantheirJnropeanconnterparts.Anal,sesof
thesamedatasonrcesalsoshowedthatcognitie
fnnctioningdeclinedfnrtherIetweenagesand
6inconntrieswhereworLersleftthelaIorforce
atearl,ages.snggestingthatengagementin
worLmighthelppreserecognitiefnnctioning.
SnIseqnentanal,sesof theseandotherstndies
shonldshedmorelightonthesenational
differencesandsimilaritiesandshonldhelpgnide
policies to address the proIlems identined.
Longer Lives and Disability
13
Source: Adapted from Avendano M, Glymour MM, Banks J, Mackenbach JP. Health disadvan-
tage in US adults aged 50 to 74 years: A comparison of the health of rich and poor Americans
with that of Europeans. American Journal of Public Health 2009; 99/3:540-548, using data from
the Health and Retirement Study, the English Longitudinal Study of Ageing, and the Survey of
Health, Ageing and Retirement in Europe. Please see original source for additional information.
Figure 8.
Prevalence of Chronic Disease and Disability among Men and
Women Aged 50-74 Years in the United States, England, and Europe:
2004
Longer Lives and Disability
14 Global Health and Aging
The Burden of Dementia
Thecanseof mostdementiaisnnLnown.Intthe
nnal stages of this disease nsnall, means a loss of
memor,.reasoning.speech.andothercognitie
fnnctions.TherisLof dementiaincreasessharpl,
withageand.nnlessnewstrategiesforpreention
andmanagementaredeeloped.thiss,ndrome
isepectedtoplacegrowingdemandsonhealth
and long-term care proiders as the world`s
popnlationages.Dementiaprealenceestimates
ar,consideraIl,internationall,.inpart
Iecansediagnosesandreportings,stemsarenot
standardized.Thediseaseisnoteas,todiagnose.
especiall,initsearl,stages.Thememor,
proIlems.misnnderstandings.andIehaior
commonintheearl,andintermediatestages
areoftenattriIntedtonormaleffectsof aging.
acceptedaspersonalit,traits.orsimpl,ignored.
Han,casesremainnndiagnosedeeninthe
intermediate.moreserionsstages.Across-national
assessmentcondnctedI,theOrganizationfor
JconomictooperationandDeelopment(OJtD)
estimatedthatdementiaaffectedaIont10million
peopleinOJtDmemIerconntriesaronnd2000.
jnstnnderpercentof peopleaged6orolder.
Alzheimer`s disease (AD) is the most common
formof dementiaandacconntedforIetween
two-nfths and fonr-nfths of all dementia cases
citedintheOJtDreport.Horerecentanal,ses
haeestimatedtheworldwidennmIerof people
liingwithAD/dementiaatIetween2million
and86million.Theprealenceof ADandother
dementiasiser,lowat,onngerages.thennearl,
donIles with eer, ne ,ears of age after age
6.JntheOJtDreiew.foreample.dementia
affectedfewerthan8percentof thoseaged6to
69.Intalmost80percentof thoseaged8to89.
Horethanone-half of womenaged90orolder
haddementiainJranceandCerman,.asdid
aIont10percentintheJnitedStates.andjnst
nnder80percentinSpain.
Theprojectedcostsof caringforthegrowing
nnmIersof peoplewithdementiaaredannting.
The 2010 World Alzheimer Jeport I, Alzheimer`s
DiseaseJnternationalestimatesthatthetotal
worldwidecostof dementiaeceededJS8600
Iillionin2010.inclndinginformalcareproided
I,famil,andothers.socialcareproidedI,
commnnit,careprofessionals.anddirectcostsof
medicalcare.Jamil,memIersoftenpla,aLe,
caregiingrole.especiall,intheinitialstagesof
whatist,picall,aslowdecline.Ten,earsago.
J.S.researchersestimatedthattheannnalcost
of informalcaregiingfordementiaintheJnited
StateswasJS818Iillion.
Thecompleit,of thediseaseandthewide
ariet, of liing arrangements can Ie difncnlt for
peopleandfamiliesdealingwithdementia.and
conntries mnst cope with the monnting nnancial
andsocialimpact.Thechallengeiseengreater
inthelessdeelopedworld.whereanestimated
two-thirdsormoreof dementiasnffererslie
IntwherefewcopingresonrcesareaailaIle.
Projections I, Alzheimer`s Disease Jnternational
snggestthat11millionpeopleworldwidewill
IeliingwithAD/dementiain200.witha
marLedl,increasingproportionof thistotalin
lessdeelopedconntries (Figure 9).CloIalefforts
are nnderwa, to nnderstand and nnd cnres or
wa,sof preentingsnchage-relateddiseasesas
Alzheimer`s.
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Source: Alzheimers Disease International, World Alzheimer Report, 2010. Available at:
KWWSZZZDO]FRXNUHVHDUFKOHV:RUOG$O]KHLPHU5HSRUWSGI
Figure 9.
The Growth of Numbers of People with Dementia in High- income
Countries and Low- and Middle-income Countries: 2010-2050
Longer Lives and Disability
16 Global Health and Aging
Thetransitionfromhightolowmortalit,and
fertilit,andtheshiftfromcommnnicaIleto
noncommnnicaIlediseasesoccnrredfairl,
recentl,inmnchof theworld.Still.according
totheWorldHealthOrganization(WHO).most
conntrieshaeIeenslowtogenerateandnse
eidencetodeelopaneffectiehealthresponse
tonewdiseasepatternsandagingpopnlations.
Jnlightof this.theorganizationmonnteda
mnlticonntr,longitndinalstnd,designedto
simnltaneonsl,generatedata.raiseawarenessof
thehealthissnesof olderpeople.andinformpnIlic
policies.
TheWHOStnd,onCloIalAgeingandAdnlt
Health(SACJ)inolesnationall,representatie
cohortsof respondentsaged0andoerinsi
conntries(thina.Chana.Jndia.Heico.Jnssia.
andSonthAfrica).whowillIefollowedasthe,age.
Acohortof respondentsaged18to19alsowillIe
followedoertimeineachconntr,forcomparison.
The nrst wae of SACJ data collection (200-2010)
hasIeencompleted.withfntnrewaesplannedfor
2012and2011.
Jnadditiontom,riaddemographicand
socioeconomiccharacteristics.thestnd,collects
dataonrisLfactors.healtheams.andIiomarLers.
LiomarLerssnchasIloodpressnreandpnlserate.
heightandweight.hipandwaistcircnmference.
and Ilood spots from nnger pricLs. are alnaIle
andoIjectiemeasnresthatimproetheprecision
of self-reportedhealthinthesnre,.SACJalso
collectsdataongripstrengthandlnngcapacit,
New Data on Aging and Health
Figure 10.
Overall Health Status Score in Six Countries for Males and Females:
Circa 2009
Notes: Health score ranges from 0 (worst health) to 100 (best health) and is a composite measure
derived from 16 functioning questions using item response theory. National data collections con-
ducted during the period 2007-2010.
Source: Tabulations provided by the World Health Organization Multi-Country Studies Unit,
Geneva, based on data from the Study on global AGEing and adult health (SAGE).
17
Figure 11.
Percentage of Adults with Three or More Major Risk Factors: Circa 2009
Notes: Major risk factors include physical inactivity, current tobacco use, heavy alcohol consump-
tion, a high-risk waist-hip ratio, hypertension, and obesity. National data collections conducted
during the period 2007-2010.
Source: Tabulations provided by the World Health Organization Multi-Country Studies Unit,
Geneva, based on data from the Study on global AGEing and adult health (SAGE).
60%
50%
40%
30%
20%
10%
0%
18-49 50-59 60-69 70-79 80+
Age Group
andadministerstestsof cognition.ision.and
moIilit,toprodnceoIjectieindicatorsof
respondents` health and aIilit, to carr, ont Iasic
actiitiesof dail,liing.Asadditionalwaes
of data are collected dnring these respondents`
later,ears.thestnd,willseeLtomonitorhealth
interentions and address changes in respondents`
well-Ieing.
Aprimar,oIjectieof SACJistooItainreliaIle
andaliddatathatallowforinternational
comparisons.Jesearchersderieacomposite
measnrefromresponsesto16qnestionsaIont
healthandph,sicallimitations.Thishealthscore
rangesfrom0(worsthealth)to100(Iesthealth)
andisshownformenandwomenineachof thesi
SACJconntriesin Figure 10.Jneachconntr,.the
healthstatnsscoredeclineswithage.asepected.
Andateachageineachconntr,.thescoreformales
ishigherthanforfemales.Womenlielongerthan
menonaerage.Inthaepoorerhealthstatns.
ThennmIerof disaIledpeopleinmostdeeloping
conntriesseemscertaintoincreaseasthennmIer
of olderpeoplecontinnestorise.Healths,stems
needIetterdatatonnderstandthehealthrisLs
facedI,olderpeopleandtotargetappropriate
preentionandinterentionserices.The
SACJdatashowthatthepercentageof people
withatleastthreeof sihealthrisLfactors
(ph,sicalinactiit,.cnrrenttoIacconse.hea,
alcoholconsnmption.ahigh-risLwaist-hip
ratio.h,pertension.oroIesit,)riseswith
age.Intthepatternsandthepercentages
ar,I,conntr,(Figure 11). One of SACJ`s
importantcontriIntionswillIetoassess
how these risL-factor pronles affect cnrrent
andfntnredisaIilit,.Smallerfamil,sizeand
decliningprealenceof co-residenceI,mnltiple
generationsliLel,willintrodncefnrther
challengesforfamiliesindeelopingconntriesin
caringforolderrelaties.
New Data on Aging and Health
18 Global Health and Aging
Popnlation aging is liLel, to innnence patterns
of healthcarespendinginIothdeelopedand
deelopingconntriesinthedecadestocome.
Jndeelopedconntries.whereacntecareand
institntionallong-termcaresericesarewidel,
aailaIle.thenseof medicalcaresericesI,
adnltsriseswithage.andpercapitaependitnres
onhealthcarearerelatiel,highamongolderage
gronps.Accordingl,.therisingproportionof older
peopleisplacingnpwardpressnreonoerallhealth
carespendinginthedeelopedworld.althongh
otherfactorssnchasincomegrowthandadances
inthetechnologicalcapaIilitiesof medicine
generall,pla,amnchlargerrole.
Jelatiel,littleisLnownaIontagingand
healthcarecostsinthedeelopingworld.Han,
deelopingnationsarejnstnowestaIlishing
Iaselineestimatesof theprealenceandincidence
of arionsdiseasesandconditions. Jnitial nndings
fromtheWHOSACJproject.whichproidesdata
onIloodpressnreamongwomeninsideeloping
conntries.showannpwardtrendI,ageinthe
percentageof womenwithmoderateorseere
h,pertension(seeFigure 12).althonghthepatterns
and age-specinc leels of h,pertension ar, among
theconntries.Jf risingh,pertensionratesin
thosepopnlationsarenotadeqnatel,addressed.
theresnltinghighratesof cereIroascnlarand
Assessing the Costs of Aging
and Health Care
Figure 12.
Percentage of Women with Moderate or Severe Hypertension in Six
Countries: Circa 2009
Note: National data collections conducted during the period 2007-2010.
Source: Tabulations provided by the World Health Organization Multi-Country Studies Unit,
Geneva, based on data from the Study on global AGEing and adult health (SAGE).
50%
40%
30%
20%
10%
0%
18-49 50-59 60-69 70-79 80+
Age Group
19
cardioascnlardiseaseareliLel,toreqnirecostl,
medicaltreatmentsthatmighthaeIeenaoided
withantih,pertensietherapiescostingjnsta
fewcentsperda,perpatient.Jarl,detection
andeffectiemanagementof risLfactorssnchas
h,pertensionandotherimportantconditions
snchasdiaIetes.whichcangreatl,complicatethe
treatmentof cardioascnlardiseaseindeeloping
conntriescanIeinepensieandeffectiewa,sof
controllingfntnrehealthcarecosts.Animportant
fntnrepa,off fordatacollectionprojectssnchas
SACJwillIetheaIilit,tolinLchangesinhealth
statnswithhealthependitnresandotherreleant
ariaIlesforindiidnalsandhonseholds.Thiswill
proidecrncialeidenceforpolic,maLersdesigning
healthinterentions.
Alargeproportionof healthcarecostsassociated
withadancingageareincnrredinthe,earorso
Ieforedeath.Asmorepeoplesnrietoincreasingl,
olderages.thehighcostof prolonginglifeisshifted
toeer-olderages.Jnman,societies.thenatnre
andetentof medicaltreatmentater,oldages
isacontentionsissne.Howeer.datafromthe
JnitedStatessnggestthathealthcarespendingat
theendof lifeisnotincreasingan,morerapidl,
thanhealthcarespendingingeneral.Atthesame
time.goernmentsandinternationalorganizations
arestressingtheneedforcost-of-illnessstndieson
age-relateddiseases.inparttoanticipatetheliLel,
Inrdenof increasingl,prealentandepensie
chronic conditions-Alzheimer`s disease in
particnlar.Alsoneededarestndiesof comparatie
performanceorcomparatieeffectienessin
low-incomeconntriesof arionstreatmentsand
interentions.
The Costs of Cardiovascular Disease and Cancer
Jnhigh-incomeconntries.heartdisease.stroLe.
andcancerhaelongIeentheleadingcontriIntors
totheoeralldiseaseInrden.TheInrdenfrom
theseandotherchronicandnoncommnnicaIle
diseasesisincreasinginmiddle-andlow-income
conntriesaswell(Jignre6).
Togangetheeconomicimpactof shiftingdisease
pronles in deeloping conntries. the World Health
Organization(WHO)estimatedthelossof
economicontpntassociatedwithchronicdiseasein
28low-andmiddle-incomenations.whichtogether
acconntforaIont80percentof thetotalchronic
diseasemortalit,inthedeelopingworld.
TheWHOanal,sisfocnsedonasnIsetof leading
chronicdiseases:heartdisease.stroLe.and
diaIetes.Jn2006.thissnIsetof diseasesincnrred
estimatedeconomiclossesrangingfromJS820
milliontoJS880millioninVietnamandJthiopia.
andnptonearl,JS81IillioninthinaandJndia.
Short-termprojections(to201)indicatethat
losseswillnearl,donIleinmostof theconntries
if nopreentieactionsaretaLen.Thepotential
estimatedlossineconomicontpntforthe28
nationsasawholeIetween2006and201totaled
JS881Iillion.
Arecentanal,sisof gloIalcancertrendsI,the
JconomistJntelligenceJnit(JJJ)estimatedthat
therewere18millionnewcancercasesin2009.The
costassociatedwiththesenewcaseswasatleast
JS8286Iillion.ThesecostsconldescalateIecanse
of thesilentepidemicof cancerinlesswell-off.
resonrce-scarceregionsaspeoplelielongerand
adoptWesterndietsandlifest,les.TheJJJ
anal,sisestimatedthatlessdeelopedconntries
acconntedfor61percentof thenewcasesin2009.
Largel,Iecanseof gloIalaging.theincidence
of cancerisepectedtoaccelerateincoming
decades.TheannnalnnmIerof newcancercases
isprojectedtoriseto1millionI,2020.andreach
2millionI,2080.Agrowingproportionof the
gloIaltotalwillIefonndinthelessdeeloped
world. and I, 2020. almost half of the world`s new
caseswilloccnrinAsia.
Assessing the Costs of Aging and Health Care
20 Global Health and Aging
Health and Work
Jnthedeelopedworld.olderpeopleoften
leaetheformalworLforceintheirlater,ears.
althonghthe,ma,continnetocontriInteto
societ,inman,wa,s.inclndingparticipating
intheinformalworLforce.olnnteering.or
proidingcrncialhelpfortheirfamilies.There
isnoph,siologicreasonthatman,olderpeople
cannotparticipateintheformalworLforce.Int
theepectationthatpeoplewillceaseworLing
whenthe,reachacertainagehasgained
credenceoerthepastcentnr,.Jisingincomes.
alongwithpnIlicandpriatepensions,stems.
haeallowedpeopletoretireIasedontheirage
ratherthanan,health-relatedproIlem.
Jtisironicthattheageatretirementfromthe
worLforcehasIeendroppingatthesametime
thatlifeepectanc,hasIeenincreasing.Older
peopletoda,spendman,,earsinretirement.
JnOJtDconntries.in200.theaerageman
leftthelaIorforceIeforeage61andconld
epect18,earsof retirement(Figure 13).The
aeragewomanstoppedworLingatage68
andlooLedforwardtomorethan22,earsof
retirementif the,adoptsimilarconceptsof
retirement.
Han,high-incomeconntriesnowwantpeople
toworLformore,earstoslowescalating
costsof pensionsandhealthcareforretirees.
especiall,giensmallercohortsenteringthe
laIorforce.Hostmiddle-andlow-income
conntrieswillfacesimilarchallenges.
Otherthantheeconomicincentiesof
pensions.whatwonldmaLepeoplesta,inthe
worLforcelonger?Tostart.misconceptions
aIontolderworLersaIonndandperceptions
ma,needtochange.Jnadditiontohaing
acqniredmoreLnowledgeandjoIsLills
throngheperiencethan,onngerworLers.
mostolderadnltsshowintactlearningand
thinLing.althonghtherearesomedeclinesin
cognitiefnnction.mostnotaIl,inthespeed
of informationprocessing.Horeoer.thereis
someeidencethatsta,inginthelaIorforce
afterageisassociatedwithslowerlossof
cognitiefnnction.perhapsIecanseof the
stimnlationof theworLplaceandrelatedsocial
engagement.
Jenph,sicalaIilitiesma,notdeteriorate
asqnicLl,ascommonl,assnmed.Althongh
relatiel,littleisLnownaIonttherelationship
Ietweenageandprodnctiit,(whichtaLes
wagesintoacconnt).onestnd,of Cerman
assemIl,lineworLersinanantomotieplant
fonnd that the aerage age-prodnctiit, pronle
of worLersincreasednntilage6.
Whetherolderpeoplespendmore,earsin
thelaIormarLetalsowilldependonthe
t,pesof joIsaailaIletothem.Han,joIsin
indnstrializedconntriesdonotreqnireph,sical
eertion that might Ie difncnlt for an older
worLer.Intthe,ma,necessitateacqniring
newsLillsandretrainingtoadjnsttochanging
worLenironments.Jidenceisneededonthe
capacit,of olderworLers.especiall,thosewith
low edncation leels. to pront from retraining.
OlderpeoplewithlimitedmoIilit,orother
health proIlems ma, reqnire more neiIle
schednlesoradaptedworLenironments.
tonsiderationsma,needtoIegientothe
alneof InildingnewapproachesatworLor
institntionsthatwillincreasetheeasewith
whicholderpeoplecancontriInteontsideof
theirfamilies. J
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Figure 13.
Expected Years of Retirement for Men in Selected OECD Countries: 2007
Note: OECD average is for 30 OECD member nations.
Source: Organization for Economic Cooperation and Development. OECD Society at a Glance
2009. Available at: http://public.tableausoftware.com/views/Retirement/LFEA.
Health and Work
22 Global Health and Aging
Jamilialsnpportandcaregiingamong
generationst,picall,rnninIothdirections.
Olderpeopleoftenproidecareforaariet,
of others(sponses.olderparents.children.
grandchildren.andnonfamil,memIers).while
families.andespeciall,adnltchildren.arethe
primar,sonrceof snpportandcarefortheir
olderrelaties.Hostolderpeopletoda,hae
children.andman,haegrandchildrenand
liingsiIlings.Howeer.inconntrieswither,
lowIirthrates.fntnregenerationswillhaefew
if an,siIlings.ThegloIaltrendtowardhaing
fewerchildrenassnresthattherewillIeless
potentialcareandsnpportforolderpeoplefrom
theirfamiliesinthefntnre.
Aslifeepectanc,increasesinmostnations.so
dotheoddsthatseeralgenerationsarealieat
thesametime.Jnmoredeelopedconntries.this
ismanifestedasaIeanpolefamil,.aertical
etensionof famil,strnctnrecharacterized
I,moreIntsmallergenerations.Asmortalit,
ratescontinnetoimproe.morepeopleintheir
0sand60sareliLel,tohaesnriingparents.
annts.andnncles.tonseqnentl,.morechildren
willLnowtheirgrandparentsandeentheir
great-grandparents.especiall,theirgreat-
grandmothers.Thereisnohistoricalprecedent
foramajorit,of middle-agedandolderadnlts
haingliingparents.
Howeer.whilethennmIerof snriing
generationsinafamil,ma,haeincreased.
toda,thesegenerationsaremoreliLel,tolie
separatel,.Jnman,conntries.theshapeof
the famil, nnit renects changing social norms:
economicsecnrit,:risingratesof migration.
diorce.andremarriage:andIlendedand
stepfamil,relations.Jnaddition.moreadnlts
arechoosingnottomarr,orhaechildrenat
all.Jnpartsof snI-SaharanAfrica.thesLipped-
generationfamil,honseholdinwhichan
olderpersonorconpleresideswithatleastone
grandchildIntnomiddle-generationfamil,
memIershasIecomeincreasingl,common
Iecanseof highmortalit,fromHJV/AJDS.
JnZamIia.foreample.80percentof older
womenheadsnchhonseholds.Jndeeloped
conntries.conplesandsinglemothersoften
dela,childIearingnntiltheir80sand10s.
honseholdsincreasingl,haeIothadnlts
worLing.andmorechildrenareIeingraisedin
single-parenthonseholds.
ThennmIer.andoftenthepercentage.of older
peopleliingaloneisrisinginmostconntries.
JnsomeJnropeanconntries.morethan10
percentof womenaged6orolderliealone.
Jeninsocietieswithstrongtraditionsof older
parentsliingwithchildren.snchasin)apan.
traditionalliingarrangementsareIecoming
lesscommon(Figure 14).
Jnthepast.liingaloneinolderageoften
waseqnatedwithsocialisolationorfamil,
aIandonment.Howeer.researchinman,
cnltnralsettingsshowsthatolderpeopleprefer
toIeintheirownhomesandcommnnities.
eenif thatmeansliingalone.Thispreference
isreinforcedI,greaterlongeit,.epanded
social Ienents. increased home ownership. elder-
friendl,honsing.andanemphasisinman,
nationsoncommnnit,care.
Thenltimateimpactof thesechangingfamil,
patternsonhealthisnnLnown.Olderpeople
who lie alone are less liLel, to Ienent from
sharinggoodsthatmightIeaailaIleinalarger
famil,.andtherisLof fallingintopoert,in
olderagema,increaseasfamil,sizefalls.On
theotherhand.olderpeoplearealsoaresonrce
for,onngergenerations.andtheiraIsencema,
createanadditionalInrdenfor,onngerfamil,
memIers.
Changing Role of the Family
23
Long-Term Care

Han,of theoldest-oldlosetheiraIilit,tolie
independentl,Iecanseof limitedmoIilit,.
frailt,.orotherdeclinesinph,sicalorcognitie
fnnctioning.Han,reqniresomeformof long-
termcare.whichcaninclndehomennrsing.
commnnit,careandassistedliing.residential
care. and long-sta, hospitals. The signincant
costsassociatedwithproidingthissnpport
ma,needtoIeIorneI,familiesandsociet,.
Jnlessdeelopedconntriesthatdonothae
anestaIlishedandaffordaIlelong-termcare
infrastrnctnre.thiscostma,taLetheform
of otherfamil,memIerswithdrawingfrom
emplo,mentorschooltocareforolderrelaties.
And.asmoredeelopingconntr,residentsseeL
joIsincitiesorotherareas.theirolderrelaties
IacLhomewillhaelessaccesstoinformal
famil,care.
Thefntnreneedforlong-termcareserices
(Iothformalandinformal)willlargel,Ie
determinedI,changesintheaIsolntennmIer
of peopleintheoldestagegronpsconpledwith
trendsindisaIilit,rates.Cientheincreasesin
lifeepectanc,andthesheernnmericgrowth
of olderpopnlations.demographicmomentnm
willliLel,raisethedemandforcare.This
growthconld.howeer.IealleiatedI,declines
indisaIilit,amongolderpeople.Jnrther.the
narrowinggapIetweenfemaleandmalelife
epectanc,rednceswidowhoodandconldmean
ahigherpotentialsnppl,of informalcareI,
oldersponses.Thegreatopportnnit,forpnIlic
health programs in the nrst half of the 21st
centnr,istoLeepolderpeoplehealth,longer.
dela,ingoraoidingdisaIilit,anddependence.
Figure 14.
Living Arrangements of People Aged 65 and Over in Japan: 1960 to 2005
1RWH3HUFHQWDJHVOLYLQJZLWKFKLOGUHQLQFOXGHVPDOOQXPEHUVRISHRSOHOLYLQJLQXQVSHFLHG
arrangements.
Sources: Japan National Institute of Population and Social Security Research. Population
Statistics of Japan 2008.
Available at: http://www.ipss.go.jp/p-info/e/psj2008/PSJ2008-07.xls.
Changing Role of the Family
24 Global Health and Aging
The nndings highlighted thronghont this
IooLletnnderscorethealneof cross-national
dataforresearchandpolic,.Jnternational
andmnlti-conntr,datahelpgoernmentsand
polic,maLersIetternnderstandtheIroader
implicationsandconseqnencesof aging.
learnfromtheeperiencesinotherconntries.
inclndingthosewithdifferenthealthcare
s,stemsandatadifferentpointalongtheaging
anddeelopmentcontinnnm.andfacilitatethe
craftingof appropriatepolicies.especiall,inthe
deelopingworld.
ValnaIlenewinformationiscomingfrom
nationall,representatiesnre,s.oftenpanel
stndiesthatfollowthesamegronpof people
asthe,age.TheJ.S.HealthandJetirement
Stnd,(HJS).Iegnnin1990.haspainteda
detailed pictnre of older adnlts` health. worL.
retirement.incomeandwealth.andfamil,
characteristicsandintergenerationaltransfers.
Jnrecent,ears.othernationshaensedthe
HJS - a Iiennial snre, of more than 20.000
Americans oer age 0 - as a model for planning
similarlarge-scale.longitndinalstndies
of theirownpopnlations.Seeralparallel
stndieshaeIeenestaIlishedthronghontthe
world.inclndinginthina.Jngland.Jndia.
Jreland.)apan.Korea.andHeico.withmore
plannedinotherconntriessnchasThailand
andLrazil.Jnaddition.coordinatedmnlti-
conntr,panelstndiesareeffectiel,Inilding
aninfrastrnctnreof comprehensieand
comparaIledataonhonseholdsandindiidnals
tonnderstandindiidnalandsocietalaging.
TheSnre,of Health.AgeingandJetirement
in Jnrope (SHAJJ) - inoling 1 conntries
asof 2010(Anstria.Lelginm.tzechJepnIlic.
DenmarL.Jrance.Cerman,.Creece.Jreland.
Jsrael.Jtal,.theNetherlands.Poland.Spain.
Sweden. Switzerland) - and the World Health
Organization(WHO)Stnd,ongloIalACJing
andadnlthealth(SACJ)insiconntries
(thina.Chana.Jndia.Heico.Jnssian
Jederation.andSonthAfrica)greatl,epand
thennmIerof conntriesI,whichinformatie
comparisonscanIemadeof theimpactof
policiesandinterentionsontrendsinaging.
health.andretirement.ALe,aspectof this
newinternationalcommnnit,of researchersis
thatdataareshareder,soonaftercollected
withallresearchersinallconntries.
Han,othercross-nationalaging-related
datasetsandinitiatiesoffercomparaIle
demographicindicatorsthatreealhistorical
trendsandofferprojectionstohelp
internationalorganizationsandgoernments.
planners.andInsinessesmaLeinformed
decisions.Thesesonrcesinclnde.foreample.
theJnternationalDataIaseonAging.inoling
22conntries:theJnternationalNetworLfor
theDemographicJalnationof Popnlations
andTheirHealth(JNDJPTH).inoling19
deelopingnations:theHnmanHortalit,
DataIase.inoling28conntries:andthe
2006CloIalLnrdenof DiseaseandJisL
Jactorsinitiatie.whichisstrengthening
themethodologicalandempiricalIasisfor
nndertaLingcomparatieassessmentsof
healthproIlemsandtheirdeterminantsand
conseqnencesinagingpopnlationworldwide.
A Note About the Data Behind This Report
25
Suggested Resources
Readings
AIegnndeDO.HatherstD.AdamT.OrtegonH.StrongK.TheInrdenandcostsof chronic
diseasesinlow-incomeandmiddle-incomeconntries.The Lancet200(DecemIer8):80:1929-1988.
AendanoH.Cl,monrHH.LanLs).HacLenIach)P.HealthdisadantageinJSadnltsaged0to
1,ears:Acomparisonof thehealthof richandpoorAmericanswiththatof Jnropeans.American
Journal of Public Health2009:99/8:10-18.
LanLs ). Harmot H. Oldneld Z. Smith )P. Disease and disadantage in the Jnited States and in
Jngland.JAMA2006(Ha,8):29/1:208-201.
thatterjiS.KowalP.Hatherst.NaidooN.VerdesJ.Smith)P.SnzmanJ.Thehealthof aging
popnlationsinthinaandJndia.Health Affairs2008:2/1:102-1068.
thristensenK.DoIlhammerC.JanJ.Vanpel)W.Ageingpopnlations:Thechallengesahead.
The Lancet2009:81/9696:1196-1208.
trimminsJH.PrestonSH.tohenL..eds.International Differences in Mortality at Older Ages.
Dimensions and Sources.Washington.Dt:TheNationalAcademiesPress.2010.
Jnropeantommission.2009 Ageing Report: Economic and Budgetary Projections for the
EU-27 Member States (2008-2060).Lrnssels:Jnropeantommnnities.2009.
AailaIleat:http://www.da.dL/Iilag/pnIlication11992_ageing_report.pdf.
KinsellaK.HeW.An Aging World: 2008. Washington.Dt:NationalJnstitnteonAgingandJ.S.
tensnsLnrean.2009.
LafortnneC.LalestatC.Trends in Severe Disability Among Elderly People. Assessing the Evidence
in 12 OECD Countries and the Future Implications.OJtDHealthWorLingPapers26.Paris:
OrganizationforJconomictooperationandDeelopment.200.
LopezAD.HatherstD.JzzatiH.)amisonDT.Hnrra,t)L.eds.Global Burden of Disease and Risk
Factors. Washington.Dt:TheWorldLanLCronp.2006.
NationalJnstitnteonAging.Growing Older in America: The Health and Retirement Study.
Washington.Dt:J.S.Departmentof HealthandHnmanSerices.200.
Ole,.H.Policies for Healthy Ageing: An. Overview.OJtDHealthWorLingPapers12.Paris:
OrganizationforJconomictooperationandDeelopment.2009.
PlassmanLL.LangaKH.JisherCC.HeeringaSC.WeirDJ.OfstedalHL.LnrLe)J.HnrdHD.
PotterCC.JodgersWL.SteffensDt.WillisJ).andWallaceJL.Prealenceof dementiainthe
JnitedStates:Theaging.demographics.andmemor,stnd,.Neuroepidemiology200:29:12-182.
JohwedderS.WillisJ).Hentalretirement.Journal of Economic Perspectives2010Winter:21/1:
119-188.
ZengY.CDanan.LandKt.Theassociationof childhoodsocioeconomicconditionswithhealth,
longeit,attheoldestoldagesinthina.Demography, 2007:11/8:19-18.
Suggested Resources
26 Global Health and Aging
Web Resources
JnglishLongitndinalStnd,of Ageing
http://www.ifs.org.nL/elsa/
JnropeanStatisticalS,stem(JJJOSTAT)
http://epp.enrostat.ec.enropa.en
HealthandJetirementStnd,
http://hrsonline.isr.nmich.edn/
HnmanHortalit,DataIase
http://www.mortalit,.org/
JnternationalNetworLonHealthJpectanc,andtheDisaIilit,Process
http://rees.site.ined.fr/en
OrganizationforJconomictooperationandDeelopmentHealthData2010:StatisticsandJndicators
http://www.oecd.org/health/healthdata(ma,reqnireafee)
Snre,of Health.AgeingandJetirementinJnrope
http://www.share-project.org/
JnitedNations.World Population Prospects: The 2010 Revision.
http://esa.nn.org/nnpd/wpp
J.S.tensnsLnreanJnternationalDataLase
http://www.censns.go/ipc/www/idI/
J.S.NationalJnstitnteonAging
http://www.nia.nih.go/
World Alzheimer`s Jeport
http://www.alz.co.nL/research/worldreport/
WorldHealthOrganization.Projections of Mortality and Burden of Disease, 2004-2030.
http://www.who.int/healthinfo/gloIal_Inrden_disease/projections/en/inde.html.
WorldHealthOrganizationStnd,ongloIalACJingandadnlthealth(SACJ)
http://www.who.int/healthinfo/s,stems/sage/en/
27
Funding for the development of this publication was provided by the National Institute on Aging (NIA), National
Institutes of Health (NIH) (HHSN263200700991P). Participation by the NIA in support of this publication does not
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The designations employed and the presentation of the material in this publication do not imply the expression of any
opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city
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approximate border lines for which there may not yet be full agreement.
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recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.
Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
All reasonable precautions have been taken by the World Health Organization to verify the information contained in
this publication. However, the published material is being distributed without warranty of any kind, either expressed or
implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World
Health Organization be liable for damages arising from its use.
National Institute on Aging
National Institutes of Health
NIH Publication no. 11-7737
October 2011