THEORIES IN MORTALITY

Prof. Maria Theresa M. Verian

SS101 Society and Culture with Family Planning
Summer AY 2012-2013
 OUTLINE

PART ONE:
1. Omran, 1971 . The Epidemiological Transition: A Theory of the
Epidemiology of Population Change.
2. Mosley and Chen, 1984. An Analytical Framework for the Study
of Child Survival in Developing Countries.
3. Olshansky and Ault, 1986. The Fourth Stage of the Age of
Degenerative Diseases.
PART T WO:
1. Horiuchi, 1998. Deceleration in the Age Pattern of Mortality at
Older Age.
2. Horiuchi, 1999. Epidemiological Transition in Human History.
3. Fries, 2005. The Compression of Morbidity.
4. Jagger, 2006. In Longer Life and Healthy Aging.
PART ONE
1. 1. Omran, 1971. The Epidemiological
Transition: A Theory of the Epidemiology
of Population Change.

2. 2. Mosley and Chen, 1984. An Analytical

Framework for the Study of Child
Survival in Developing Countries.

3. 3. Olshansky and Ault, 1986. The Fourth

Stage of the Age of Degenerative
Diseases.
THE EPIDEMIOLOGICAL
TRANSITION:
A THEORY OF THE EPIDEMIOLOGY OF By Abdel
Omran: 1971
POPULATION CHANGE
THE THEORY OF EPIDEMIOLOGIC TRANSITION

This describes the complex change in

patterns of health and disease and on the
interactions between these patterns and their
demographic, economic and sociological
determinants and consequences.

Data used from UN Model Life Tables

THREE (3) MAJOR
SUCCESSIVE STAGES OF
EPIDEMIOLOGIC
TRANSITION
1. The Age of Pestilence and
Famine
2. The Age of Receding Pandemics
3. The Age of Degenerative and
Man-Made Diseases
1. THE AGE OF PESTILENCE AND FAMINE

When mortality is HIGH and FLUCTUATING,

thus precluding sustained population
growth.

In this stage, the average life expectancy

at birth is LOW and VIABLE, vacillating
between 20 and 40 years.
 1. THE AGE OF PESTILENCE AND FAMINE

 It also represents for all practical purposes an

extension of the pre-modern pattern of health and
disease.

 The major determinants of deaths are the Malthusian

“positive checks” i.e. epidemics, famines and wars.

 Graunt’s Bill of Mortality – nearly ¾ or 75% of all

deaths were attributed to infectious diseases,
malnutrition and maternity complications;
cardiovascular disease and cancer were responsible
for <6%.
 2. THE AGE OF RECEDING PANDEMICS

When mortality DECLINES progressively; and

the rate of decline accelerates as epidemic
peaks become less frequent or disappear.

The average life expectancy at birth increases

steadily from about 30 to 50 years.

Population growth is sustained and begins to

describe an exponential curve.
 3. THE AGE OF DEGENERATIVE AND MAN-
MADE DISEASES

When mortality CONTINUES TO DECLINE and

eventually approaches STABILITY at a relatively
LOW LEVEL.

The average life expectancy at birth RISES

gradually until it exceeds 50 years.

It is during this stage that fertility becomes the

crucial factor in population growth.
 FIGURE 1. DEMOGRAPHIC TRENDS IN
SELECTED COUNTRIES (1750-1970)

Comparing the growth curves of the four countries.

Chile and Ceylon: Death rate has declined rapidly in recent years especially
since WWII, and the birth rate has remained high with minor fluctuations.
F I G URE 2 . PAT TERN OF M ORTA LI T Y T RE N DS ( STA NDARDIZE D
M ORTA LIT Y) BY CAUSE -OF -DEATH GROUPS FOR E X PE C TATI ON
OF LI F E AT BI RT H F ROM 4 0 TO 76 Y E A RS.

Source: Department of Economic and Social Affairs. 1962. Population Bulletin of the United Nations 6, 110-
12
 AN ANALYTICAL
FRAMEWORK FOR
THE STUDY OF CHILD By W.H.
Mosley and
SURVIVAL Lincoln C.
Chen: 1984
IN DEVELOPING
COUNTRIES
 “This is an essay whose approach incorporates
both social and biological variables and
integrates research methods employed
by social and medical scientists.
1.
It provides measurement of morbidity and mortality in
a single variable.
2.
The framework is based on the premise that
all social and economic determinants of child mortality
necessarily operate through common set of biological
mechanisms, or determinants, to exert an impact on
mortality.”
 PREMISE OF
PROXIMATE DETERMINANTS
(1) An optimal setting over 97 percent of newborn infants can be
expected to survive through the first five years of life;
(2) Reduction in this survival probability in any society is due to
the operation of social, economic, biological, and
environmental forces;
(3) Socioeconomic determinants (independent variables) must
operate through more basic proximate determinants that in
turn influence the risk o disease and the outcome of disease
processes;
(4) Specific diseases and nutrient deficiencies observed in a
surviving population may be viewed as biological indicators
of the operations of the proximate determinants;
(5) Growth faltering and ultimately mortality in children (the
dependent variable) are the cumulative consequences of
multiple disease processes (including their biosocial
interactions).
 FIVE (5) CATEGORIES OF
RISK OF MORBIDIT Y AND MORTALIT Y
(1) Maternal factors i.e. age, parity, birth
interval;
(2) Environmental contamination i.e. air,
food/water/fingers, skin/soil/inanimate
objects, insects vectors;
(3) Nutrient deficiency i.e. calories, protein,
micronutrients (vitamins and minerals);
(4) Injury i.e. accidental or intentional; and
(5) Personal illness control i.e. personal
preventive measures and medical
treatment.
FIGURE 1 . OPERATION OF THE FIVE GROUPS OF
PROXIMATE DETERMINANTS ON THE HEALTH
DYNAMICS OF A POPULATION

Socioeconomic
determinants

Environmental
Maternal factors Nutrient deficiency Injury
contamination

Healthy Sick

Prevention

Personal illness control Growth faltering Mortality

Treatment
 PROXIMATE DETERMINANTS:

1 . Maternal factors
 measurement can be done directly through an interview i.e.
age, parity, and birth interval (since last birth and to the next
birth where appropriate).

2. Environmental contamination
 may be measured directly by carrying out microbiological
examination of samples of air, water, food, skin washing, or
vectors e.g. e. coli bacteria.
 Another measurement is the number of recent episodes
(incidence) of a group of acute infectious diseases in the
cohort of children under study.
 PROXIMATE DETERMINANTS:

3. Nutrient deficiency
 nutrient availability to the infant or to the mother during
pregnancy and lactation can be measured directly by
weighing of all foods before consumption, accompanied by
physical or biochemical analysis of food samples.
 Biochemical measures eg. Low serum albumin levels for
protein deficiency, signs of xerophthalmia for vitamin A
deficiency, and anemia for iron deficiency

4. Injury
 incidence of recent injuries, or the cumulative prevalence of
injury -related disabilities e.g. scarring from burns
 PROXIMATE DETERMINANTS:

5. Personal illness control

 Preventive measures include services i.e. immunizations,
malaria prophylaxis, or antenatal care
 Curative measures i.e. provider of care and therapy
 SOCIO-ECONOMIC
DETERMINANTS
(INDEPENDENT VARIABLES)
The three (3) broad categories:
1. Individual-levels variables
2. Household-levels variables
3. Community -levels variables
 1. INDIVIDUAL-LEVEL VARIABLES

A. Individual productivity (fathers, mothers);

Three elements:
 Skills
 Health
 Time
 1. INDIVIDUAL-LEVEL VARIABLES

Father’s education is strongly determinant of

the household’s assets and the marketable
commodities the household consumes.
It may also influence attitudes and thus
preferences in choice of consumption goods,
including child care services.
This effect is likely to be most significant for
child survival when more educated fathers are
married to less educated mothers.
 1. INDIVIDUAL-LEVEL VARIABLES

 Mother’s skills, time and health operated directly on

the proximate determinants.
 There is a biological link between the mother and
infant during pregnancy and lactation, the mother’s
health and nutritional status as well as her
reproductive pattern influences the health survival of
the child.
 The educational level can affect child survival by
influencing her choices and increasing her skills in
health care practices related to contraception,
nutrition, hygiene, preventive care, and disease
treatment- this process is called Social synergy.
 1. INDIVIDUAL-LEVEL VARIABLES

Child care time often competes with time

needed for income-generating work.

E.g. For poor families, a mother’s outside work

may result in child neglect or care by a less
skilled sibling,
while a wealthy family may hire a skilled and
attentive nursemaid.
 1. INDIVIDUAL-LEVEL VARIABLES

B. Traditions/norms/attitudes

Cultural determinants:
Power relationships within the household
Beliefs about health causation
Food preferences
 B.1. POWER RELATIONSHIPS WITHIN THE
HOUSEHOLD

In traditional societies, the mother has full

responsibility for child care; she may have
little control over allocation of resources
(food) to herself or her child or over critical
child care practices (diet, sickness care).
Often decisions in these areas are reserved
for the elders, particularly the mother-in-law
or the husband, and the latter may rigidly
adhere to useless or harmful traditional
practices.
B.2. BELIEFS ABOUT HEALTH CAUSATION

 Disease causation shape behaviors range from

ritualistic disease prevention practices, to choice of
therapies and practitioners for sickness care, to
sexual taboos and abstinence to prevent illness in
the suckling child- “underutilization” of modern
health facilities.

 Formal education when exposed to mothers can

transform their preferences for health care practices
so as to significantly improve child survival, often
without investment of additional economic
resources.
 B.3. FOOD PREFERENCES

Patterns of dietary intake and food

choice are probably among the
strongest “culturally conditioned”
tastes across all societies, as
confirmed by the dietary
heterogeneity even in developed
countries.
 2. HOUSEHOLD-LEVEL VARIABLES

Income/wealth
A variety of goods, services, and assets
at the household level operate on child
health and mortality through the proximate
determinants.
i.e. food, water, clothing/bedding,
housing, fuel/energy, transportation,
hygienic/preventive care, sickness care
and information
 3. COMMUNIT Y-LEVEL VARIABLES

a. Ecological setting
b. Political economy
c. Health system
d. Public
information/education/motivation
e. The role of Technology
 3.A. ECOLOGICAL SETTING

i.e. climate, soil, rainfall, temperature,

altitude, and seasonality.
These affect the quantity and variety of
food crops produced the availability and
quality of water, vector-borne disease
transmission, the rate of proliferation of
bacteria in stored foods, the survival or
parasite larvae and eggs in soil, and the
drainage of sewage.
 3.B. POLITICAL ECONOMY

Political factors that can operate

to influence child survival -
Organization of production,
physical infrastructure and
political institutions.
 3.C. HEALTH SYSTEM

The formal health system is viewed

as operating in the following ways:
Institutionalized (imposed)
actions – mandated by law
Cost Subsidies – health related
goods and services
 3.D. PUBLIC
INFORMATION/EDUCATION/MOTIVATION

Public
information/education/motivation –
have greater influence for
policy formulation,
modification of development
strategies, etc.
 3.E. THE ROLE OF TECHNOLOGY

 The role of Technology – increases efficiency and

effectiveness of the health system i.e. Vaccines and
antibiotics.
 Issues:
(1) what is the potential contribution of the
intervention toward improving child survival
when analyzed in the proximate determinants
model, taking into account biological
synergy?
(2) to what portion of the population will the
technology be available?
(3) will it be used and used effectively?
 GROWTH FALTERING
THE DEPENDENT VARIABLE
Social scientists examine mortality as a
dependent variable. They pay scant attention
to the health status of survivors while
medical scientists focus on the diseases or
nutritional status of survivors.
Malnutrition – growth faltering in a cohort of
children as the consequence of dietary
deficiency.
To assess the validity of integrating the level
of growth faltering and mortality
 GROWTH FALTERING
THE DEPENDENT VARIABLE

Examine the current procedure for scaling

“malnutrition” in children
 Actual Weight-for-age vs Expected (Median) Weight-
for-age
 There is an increase of death risk with lower weight-
for-age
 The probability of dying at a given level of growth
faltering varies greatly between population according
to the prevalence of certain diseases and the
availability of medical services.
 THE FOURTH STAGE OF THE By S. Jay
Olshansky
EPIDEMIOLOGIC TRANSITION : and Brian
Ault: 1986
THE AGE OF
DEGENERATIVE DISEASES
 INTRODUCTION

US life expectancy at birth (1980) from 47.0 to

73.6

The cause of the rapid increase in life

expectancy was a substitution of
degenerative causes of death
such as heart disease and cancer for deaths
(caused by infectious and parasitic diseases).
TA BLE 1 : LI F E E X P E C TANCY AT SE LE C TED E X AC T AG E S I N T H E
UN I T ED STATES, BY SE X
OBSE RVE D ( 1 9 0 0 - 1 9 8 0)
 LIFE EXPECTANCY

1. From 1900 to 1920 females gained 7.3

years (14.8%) at birth and only 13 years
(3.3%) at age 85.
2. Sex differences in life expectancy at birth
have increased steadily from 1900 until the
decade of the 1970s (except for a brief time
period during the influenza epidemic in
1918).
They are then projected to decrease by 1990 and then
increase to the dif ference that was observed in 1970.
SHIFTS IN THE AGE DISTRIBUTION OF DEATH

The 4 th stage: characterized by a

SUBSTITUTION of the ages at which
degenerative diseases tend to kill.

In effect, this means that while it is likely that

degenerative diseases will remain with us as
the major causes of death, the risk of dying
from those diseases during this stage in our
transition is thought to be progressively
redistributed from younger to older ages.
EVIDENCE OF REDISTRIBUTION PROCESS

e.g. US distribution of age at death from 1962

to 1979

Mean age at death had increased by 3.2 years

for males and 5.8 years for females

Standard deviations of ages at death had also

increased during this time period for the
population aged 60 and over.
 IMPLICATIONS:
T WO (2) MAJOR DEMOGRAPHIC VARIABLES

1. Size and relative proportions of the

population; e.g. Siegel, 1979 Projected
that by the year 2020, the population
aged 65 and over in the US will double
from 23M in 1976 to about 45M.

2. Health and vitality of the elderly .

 IMPLICATIONS

 Future mortality declines will result in a simultaneous

compression of mortality and morbidity into advanced
ages.

 Improved survival may lead to an increase in the

proportions of the population with a short duration of
functional impairment, and an increase in the proportion
of the population with a longer duration of functional
impairment

(i.e. survivors to advanced ages in the future may

experience the extremes of frailty depending upon what
causes the mortality declines)
 CONCLUSION

 Based upon the analysis of mortality:

“Life expectancy, and sur vival data for the US from the turn of
the centur y to 1980, and projections to the year 2020, the US
appears to have recently entered a 4 th stage in the
epidemiologic transition.”

 The Age of Delayed Degenerative Diseases: a stage

characterized distinctly by RAPID mortality declines in
advanced ages that are caused by a postponement of the ages
at which degenerative diseases tend to kill.

 The use of alternative mortality projection models has

demonstrated that EVEN SMALL CHANGES in assumptions can
produce RELATIVELY LARGE DIFFERENCES in projections of life
expectancy.
 CONCLUSION

 The inevitability of the growth of the elderly population,

whether it is caused by larger cohorts moving into advanced
ages and/or greater proportions of these cohorts surviving to
advanced ages as mortality continues to decline, is certain to
have a profound influence on the health care industry and
social service programs for the elderly in the coming decades.

 The Age of Delayed Degenerative Diseases

 represents an unexpected and perhaps welcome era in

our epidemiologic history, an era that requires new ways
of thinking about aging, disease, morbidity, mortality, and
certainly how life will be lived in advanced ages in the
very near future.
PART TWO
1. 1. Horiuchi, 1998. Deceleration in the
Age Pattern of Mortality at Older Age.

2. 2. Horiuchi, 1999. Epidemiological

Transition in Human History.

3. 3. Fries, 2005. The Compression of

Morbidity.

4. 4. Jagger, 2006. In Longer Life and

Healthy Aging.
DECELERATION IN THE AGE By Shiro
PATTERN OF MORTALITY AT Horiuchi:
1998
OLDER AGES
 THE PREMISE

The rate of mortality increase

slows at older ages.
This observation has led some researchers to switch
from exponential (e.g., Gompertz)
to logistic or power functions.
T WO (2) EXPLANATIONS FOR THE SLOWING
OF MORTALIT Y INCREASES AT OLDER AGES

1. the Heterogeneity hypothesis;

2. the Individual-risk hypothesis.

 1. HETEROGENEIT Y HYPOTHESIS

"the deceleration is a statistical effect of

selection through the attrition of mortality”

Because the more frail tend to die at younger

ages, survivors to older ages tend to have
favorable health endowments and/or healthy
lifestyles" (p. 391).
 2. INDIVIDUAL RISK HYPOTHESIS

“Mortality increases may slow down

at later ages.”

Because organisms often perform key

processes more slowly at later ages
 FIGURE 1 . AGE -SPECIFIC DEATH RATES FOR
SWEDISH FEMALE COHORTS BORN BET WEEN 1871
AND 1875

The rate of
mortality
increase slows
at older ages
 T YPES OF ADULT MORTALIT Y

Senescent Mortality Background Mortality

 (age-related  independent of
deterioration of senescent processes
physiological function) (as risks of some
contagious diseases
and external injuries
may be).
 EPIDEMIOLOGICAL By Shiro
TRANSITIONS IN HUMAN Horiuchi:
1999
HISTORY
 INTRODUCTION

Objective of the study

To know the transitions that significantly alter
the distribution of deaths by cause and/or or
by age.

Epidemiological Transition
A long-term change in the overall distribution
of diseases, injuries, and their risk factors.
 MAJOR CAUSE-OF-DEATH CATEGORIES

Infectious diseases
Degenerative diseases
1. Cardiovascular diseases
2. Cancers
External injuries
 GLOBAL BURDEN OF DISEASES (GBD)
CATEGORIES

Group 1 (includes infectious and parasitic

diseases, maternal and perinatal disorders)

Group 2 (comprises non-communicable

diseases)

Group 3 (consists of injuries, poisoning, toxic

effects, and other external causes, whether
intentional or accidental)
 FIGURE 1.
E P I DE M IOLOG ICAL T R A N SITI ON I N H U M A N H I S TORY

 Note: the “major cause of

death” does not
necessarily mean the
most frequent cause of
death in the population,
but rather indicates a
cause of death that is
considerably more
prevalent in the era than
in the other eras.

 Thus, the cause of death

characterizes the
mortality pattern of the
society.
 A. EPIDEMIOLOGICAL TRANSITIONS

First Transition: External injuries to infectious

diseases
Second Transition: Infectious diseases to
degenerative diseases
Third Transition: Decline of cardiovascular
disease mortality
Fourth Transition: Decline of cancer mortality
Fifth Transition: Slowing of senescence
 FIRST TRANSITION:
EXTERNAL INJURIES TO INFECTIOUS
DISEASES
 A number of communicable diseases were endemic or
occasionally became epidemic in pre -industrial agricultural
societies. Thus, many cases were rare or less serious in small,
isolated tribes of early humans, who engaged mainly in hunting
and gathering.

 Causes of death that are rare now but probably were not
uncommon in those days includes:
 Attacks by carnivores
 Drowning
 Intertribal war and
 Infanticide

 Considered prevalent causes -of-death were:

 Natural disasters,
 Starvation and
 Complications of pregnancy and childbirth
 FIRST TRANSITION:
EXTERNAL INJURIES TO INFECTIOUS
DISEASES
Cohen, 1995. Agriculture started some
10,000 to 12,000 years ago (8,000 BC and
4,000 BC).

Various changes in human life, including diet,

dwelling and habitat, social structures, and
social size.
Shift pattern in health and mortality (Austad,
1997).
 FIRST TRANSITION:
EXTERNAL INJURIES TO INFECTIOUS
DISEASES
 Various pathogens in agricultural societies :

Greater population size of communities,

Higher population density in broad geographical
areas that have multiple communities, longer
periods of residence at the same locations (often
with domesticated animals),
Storage of foods,
Domestication of some animals, and
Extended contacts with other communities.
 FIRST TRANSITION:
EXTERNAL INJURIES TO INFECTIOUS
DISEASES
Emergence of urban communities;
Nutritional deficiencies due to decreased
dietary diversity in agricultural societies;
Infectious and parasitic diseases had become
the dominant cause of human mortality.
 SECOND TRANSITION:
INFECTIOUS DISEASES TO
DEGENERATIVE DISEASES
18 th century – life expectancy at birth in
European countries ranges from 25-40
years with substantial regional
variations;
Mid-20 th century, life expectancy for all
European countries combined reached
the neighborhood of 65 years;
 SECOND TRANSITION:
INFECTIOUS DISEASES TO
DEGENERATIVE DISEASES
 Two phases:
1. The reduction of crisis mortality
 E.g. Spanish influenza epidemic of 1918 may be the last
episode o the traditional type of mortality crisis in European
countries.

2. The mortality level of regular years showed a gradual

decline.
 Occurred mainly the second half of the 19 th century and the
first half of 20 th century, multifactorial reasons: improved
standard of living i.e. nutrition, importance of public health
measures and personal hygiene (Morel, et. al. 1991)
 SECOND TRANSITION:
INFECTIOUS DISEASES TO
DEGENERATIVE DISEASES
 Reduction of infectious disease mortality shifted major
causes of death from infectious to degenerative diseases
including:
Heart diseases
Strokes
Cancers
Diabetes mellitus
Chronic liver diseases,
Chronic kidney diseases
 In France (1925 and 1955), combined decline in age -
standardized death rate due to all cardiovascular diseases -
27% for males and 34% for females.
 THIRD TRANSITION:
DECLINE OF CARDIOVASCULAR DISEASE
MORTALIT Y
The decline of cardiovascular disease
mortality was generally slow in the 1950s and
1960s, but accelerated in the 1970s.
Health improvements are not limited to
technological advancements in curative
medicine. Publicly supported health care
systems have been developed.
 FOURTH TRANSITION:
DECLINE OF CANCER MORTALIT Y

In contrast to the decline in mortality due to

cardiovascular disease, mortality due to
cancers did not show a substantial reduction
in DCs during the last few decades.
The trend varies considerably by the site of
cancer, among countries, and between sexes.
In general, downward trends seem dominant
for cancers of the colon, rectum, bone, cervix
uteri, testis, bladder, and thyroid, as well as
Hodgkin’s disease.
 FIFTH TRANSITION:
SLOWING OF SENESCENCE

It has been observed that cancers are

quite rare among centenarians.
More than 40% of deaths in the 80s and
90s are attributed to cardiovascular
diseases.
THE COMPRESSION OF By James
Fries: 2005
MORBIDITY (1982)
 INTRODUCTION

“A reduction in mortality from

diseases of over 99% has led
to the present era, where the
major burdens of illness of
the US are the chronic
diseases”
 CHRONIC DISEASES

1. Atherosclerosis and its complications

2. Neoplasia
3. Emphysema
4. Diabetes
5. Cirrhosis
6. Osteoarchritis

have increased in prevalence even as

infectious illnesses which preceded them
declined.
 THE THESIS

“This chronic disease era in its turn will

slowly decline in significance,
leaving a third era
in which the major health problems of the
US will be directly related to the process of
senescence, and where the aging process
itself,
independent of specific disease,
will constitute a major burden of illness for
US.
 DEFINITION OF TERMS

Maximum Life Potential – is

approximated by the oldest age achieved
by any human being

e.g. US – 113 years, 214 days

(represents a point far out on the “tail” of
a distribution of different individuals)
 DEFINITION OF TERMS

Life Expectancy – is the average length of life

which we may expect, given current age-
specific death rates, for an infant born today

e.g. 1980s – 73 (approx. 70 for men and 77 for

women)

Note: Life expectancy can rise toward, but

cannot exceed, the Life span.
 DEFINITION OF TERMS

Life Span – represents the average longevity

in a society without disease or accident

e.g. to be approx. 85 years,

with a broad distribution in which natural
longevity for individuals falls nearly entirely
within the range of from 70 to 100 years.
 THE COMPRESSION OF MORBIDIT Y

Occurs if the age at first appearance of aging

manifestations and chronic disease symptoms
can increase more rapidly than life expectancy
Marker of morbidity:
First heart attack
First dyspnea from emphysema
First disability from osteoarthritis
First memory loss of a certain
magnitude
 PERIOD BET WEEN THAT MARKER AND THE
END OF LIFE

Absolute compression of Relative compression of

morbidity morbidity

 Occurs if age-specific  Occurs if the amount of

morbidity rates life after first chronic
decrease more rapidly morbidity decreases as
than age-specific rates a percentage of life
expectancy
CHARACTERISTICS OF CHRONIC DISEASE

 The acute infectious diseases have ceased to be statistically

major causes of mortality in the US.

Tuberculosis
Small pox
Diphtheria
Tetanus
Polio
Typhoid fever, and others

Have declined by 99% to 100% in 20 th century.

FIGURE 1. AN INCREMENTAL MODEL OF
CHRONIC DISEASE

The model is
characterized
by early age
of onset,
progression
at various
rates, and
passage of a
symptomatic
threshold at
which time a
clinical
diagnosis
may be
made.

Source: J.F. Fries and L.M. Crapo, Vitality and Aging (1981)
 FIGURE 2. THE COMPRESSION OF
MORBIDIT Y

Two health-lives
are
diagrammed,
the upper with
poor health
habits and the
lower with
better health
habits.

The period of
adult vigor prior
to infirmity is Source: J.F. Fries and L.M. Crapo, Vitality and Aging (1981)
reduced in the
lower example.
 PLASTICIT Y OF MANY SENESCENT
PHENOMENA

Human optimal performance

e.g. World age-group for men in the marathon

World-class performance is optimal in the 20’s
and early 30’s and then shows a linear decline,
up to the point where sample size is inadequate
for estimation .
 ARE YOU AFRAID OF GETTING OLD?

Individuals over the age of 50 usually do not

cite fear of death instead they are more
significant concerns of:
1. chronic illness, pain, and inability to
physically get around;
2. fears of approaching senility and loss of
memory;
3. fear of total dependence upon others.
 PLASTICIT Y OF AGING
 Define as the modification by an individual at any age in:
Cardiac reserve,
Dental decay,
Glucose tolerance,
Intelligence test performance
and memory,
Osteoporosis,
Physical endurance,
Physical strength,
Pulmonary reserve,
Reaction time,
Social ability, and
Blood pressure
 FIGURE 3. THE PLASTICIT Y OF AGING

Within the
biological
potential of the
organism are
multiple possible
pathways to
improvement of
performance
with age
bounded by
present
performance
and maximum
potential
performance.
Source: Fries (1980)
IN LONGER LIFE AND By Carol
Jagger: 2006
HEALTHY AGING
 The increases in life expectancy that have occurred
thus far are a triumph for 20th Century PUBLIC
health in its widest sense though by many they are
still viewed negatively, especially in the light of
falling birth rates and the greater consumption of
health care in the final years of life.

 The future demand for care, both formal and

informal, will therefore greatly depend on the
health of the newer cohorts of older people.
 HOW WE CAN MONITOR OUR POTENTIAL FOR
HEALTHY AGEING AND HOW WE MIGHT LIVE
LONGER, HEALTHIER LIVES IN THE FUTURE?

 ’Healthy Ageing’ is now used freely in the

gerontology literature as a consequence of the
growing emphasis on the positive rather than the
negative aspects of an ageing population .
 ’Successful Ageing’ of Rowe and Kahn (1997) will
be explored as well as the, far from simple,
transition from conceptual definition to
measurement.
 Determinants of healthy ageing and the potential
for increasing both the numbers of older people
who age healthily and the length of time they do so.
From the bible, Psalm 90
“…the span of life as 70 years, or 80 if we are
strong, is on the generous side if we consider
the beginning of the last century.

e.g. UK – male life expectancy at birth

1900 (48 years) to 2006 (75 years)
- female life expectancy: 2006 (80
years)
Improvements in housing,
sanitation, and nutrition;
Control of infectious diseases
and maternal mortality
Advent of antibiotics (Cassel,
2001)
 In UK – around 1800 (first centenarians)
- 1900 from 100 to 6,000
- 2036 (39,000 estimates)

 In Japan – one of the earliest countries to have a truly

national registration system (so far a reliable data on age at
death
- Sept. 2000 (13,036 centenarians)
- 1966 *the first super-centenarians
(110 years) and
- 1980 their number has clearly increased.
THANK YOU! 