Health, well-being of aging population 'at risk' if interventions are overlooked

Currently, there are 841 million people over the age of 60 across the world. This number is expected to rise to 2 billion by 2050. In a new series of studies published in The Lancet, authors warn that the aging population is at risk of chronic illness and poor well-being, and call for effective strategies to reduce this risk.

Researchers say the aging population may be at risk of poor health and well-being in the future.

In the next 6 years - for the first time in history - there will be more people over the age of 60 than children under the age of 5 years.

According to the series authors, the growing aging population is largely due to reductions in infant and child mortality. The World Health Organization (WHO) state that the under-5 global mortality rate has reduced from 90 deaths per 1,000 live births in 1990 to 46 deaths per 1,000 live births last year.

Furthermore, a reduction in deaths from stroke and heart disease over the years - as a result of improved health care and strategies to lower tobacco use and incidence of hypertension - has contributed to an aging population.

But the series authors note that although people are living longer, this does not mean they are healthier.

The burden of long-term illness in the older population

Approximately 23% of the total global burden of disease is accounted for by conditions in individuals aged 60 years and older, with most of these occurring in low- and middle-income countries.

Furthermore, most of these conditions are long-term illnesses - such as cancer, musculoskeletal diseases (including osteoporosis and arthritis), cardiovascular disease, diabetes and dementia. The authors believe this poses a serious problem.

Incidence rates of many of these illnesses are expected to rise in the future. The number of people with dementia worldwide currently stands at 44 million but is expected to reach 135 million by 2050. And figures from a National Health and Nutrition Examination Survey (NHANES) estimated that between 2004 and 2030, diabetes incidence among older people would increase by 96%.

The series authors claim that this increase in long-term illness among the older population will not only put a strain on the patients themselves, but also on their families, health systems and economies.

The authors note:

"Older people have greater health and long-term care needs than younger people, leading to increased expenditure. They are also less likely to work if they are unhealthy, and could impose an economic burden on families and society.

Like everyone else, older people need both physical and economic security, but the burden of providing these securities will be falling on a smaller portion of the population."

What can be done to reduce the burden of an aging population?

In order to reduce the burden of the aging population, researchers at the Department of Aging and Life Course at WHO, say there needs to be "deep and fundamental reforms of health and social care systems."

When it comes to health care, the authors say that in order to combat agism, unaffordable user fees and poor access to appropriate care among older populations, primary care services need to be reorganized and trained to meet the needs of senior patients.

Reforms should include a commitment to provide continuing care, capacity for outreach including home-based assessments, and holistic integrated care for patients with multimorbidities.

"Simple, structured assessment and attention to underlying frailties (little mobility, undernutrition, pain, incontinence, and cognitive and sensory impairment) might promote increased attention to the needs of older people and limit disability and dependence."

Furthermore, the authors say that family carers may also benefit from better advice and support. "The development and evaluation of such models of care is urgently needed, particularly for their cost-effectiveness," the authors add.

But another team of researchers at the Department of Health Statistics at WHO, says "we must be careful that these reforms do not reinforce the inequities that drive much of the poor health and functional limitation we see in older age." 

"While some interventions will be universally applicable, it will be important that countries monitor the health and functioning of their aging populations to understand health trends and design programs that meet the specific needs identified.

Cross-national surveys - such as the WHO Study on Global Aging and Adult Health (SAGE), the Gallup World Poll, and other longitudinal cohorts studies of aging in Brazil, China, India, and South Korea - are beginning to redress the balance and provide the evidence for policy, but much more remains to be done."

The authors say that it is important reforms are also made within social care systems. For example, they say affordable health care should be extended to cover all older adults.

In addition, the authors believe that changes to policies are needed to encourage people to work for longer, and there should be more focus on low-cost disease prevention and early detection of disease, rather than treatment.

"New technologies also offer many ways of bringing health care to underserved older populations more efficiently, especially in rural areas," they add, noting that use of mobile clinics could be optimized, which offer an array of services usually found in hospitals.

Overall, the research team from the Department of Health Statistics at WHO, says that "we need to look beyond the costs commonly associated with aging to think about the benefits that an older, healthier, happier, and more productive older population can bring to society as a whole."

In a recent feature,researchers investigated how overpopulation is likely to affect public health, after recent research estimated that there is likely to be up to 12.3 billion people living on the planet by 2100.

References:

1. Series on aging, John Beard, Ties Boerma, Somnath Chatterji, et al., The Lancet, published online 6 November 2014.
2. The Lancet news release, accessed 4 November 2014.