Ageing Populations: The Challenges Ahead

Danish Ageing Research Centre, University of Southern Denmark, Odense, Denmark.
The Lancet (Impact Factor: 45.22). 10/2009; 374(9696):1196-208. DOI: 10.1016/S0140-6736(09)61460-4
Source: PubMed


If the pace of increase in life expectancy in developed countries over the past two centuries continues through the 21st century, most babies born since 2000 in France, Germany, Italy, the UK, the USA, Canada, Japan, and other countries with long life expectancies will celebrate their 100th birthdays. Although trends differ between countries, populations of nearly all such countries are ageing as a result of low fertility, low immigration, and long lives. A key question is: are increases in life expectancy accompanied by a concurrent postponement of functional limitations and disability? The answer is still open, but research suggests that ageing processes are modifiable and that people are living longer without severe disability. This finding, together with technological and medical development and redistribution of work, will be important for our chances to meet the challenges of ageing populations.

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    • "The rising number of frail older adults is a major challenge for health care systems in aging societies [1] [2]. Many frail older adults have complex care needs because of the presence of multiple chronic diseases and/or functional disabilities [3]. "
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    ABSTRACT: Background: Primary care-based comprehensive care programs have the potential to improve outcomes in frail older adults. We evaluated the impact of the Geriatric Care Model (GCM) on the quality of life of community-dwelling frail older adults. Methods: A 24-month stepped wedge cluster randomized controlled trial was conducted between May 2010 and March 2013 in 35 primary care practices in the Netherlands, and included 1147 frail older adults. The intervention consisted of a geriatric in-home assessment by a practice nurse, followed by a tailored care plan. Reassessment occurred every six months. Nurses worked together with primary care physicians and were supervised and trained by geriatric expert teams. Complex patients were reviewed in multidisciplinary consultations. The primary outcome was quality of life (SF-12). Secondary outcomes were health-related quality of life, functional limitations, self-rated health, psychological wellbeing, social functioning and hospitalizations. Results: Intention-to-treat analyses based on multilevel modeling showed no significant differences between the intervention group and usual care regarding SF-12 and most secondary outcomes. Only for IADL limitations we found a small intervention effect in patients who received the intervention for 18months (B=-0.25, 95%CI=-0.43 to -0.06, p=0.007), but this effect was not statistically significant after correction for multiple comparisons. Conclusion: The GCM did not show beneficial effects on quality of life in frail older adults in primary care, compared to usual care. This study strengthens the idea that comprehensive care programs add very little to usual primary care for this population. Trial registration: The Netherlands National Trial Register NTR2160.
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    • "Depression, a prevalent and extremely disabling psychiatric condition in later life (Beekman et al., 1999; Blazer, 2003), has not been studied sufficiently in low and middle income countries (LMIC) where a demographic transition, with an increasing number of older people is rapidly occurring (Christensen et al., 2009). "
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    • "Olshansky et al. (2009) and Coles (2004) argued in favor of diminishing gains and an ultimate statistical limit due to the need to reduce all-cause mortality by ever-greater amounts in order to keep increasing longevity—and, in fact, many past efforts to forecast longevity built in diminishing rates of progress against mortality at older ages (Wachter, 2003). On the other side of the debate, Oeppen and Vaupel (2002), Christensen et al. (2009), Howse (2009) and Vallin and Meslé (2010), among others, found little evidence for a limit to life expectancy, given that, over time, the greatest declines in mortality have occurred in older and older age groups, and also that the rate of mortality decline has been accelerating for the oldest old as well (Caselli and Vallin, 2001; Strulik and Vollmer, 2013; Willets et al., 2004). Indeed, more recent forecasting efforts, including that of the United Nations Population "
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