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MANY THANKS for your INVITATION. The tomorrow old people are already born. The tomorrow old people are already born. From quantity of life to active ageing and quality of life. NUMBER of YEARS of LIFE. ALIVE (healthy or not) Dead. Years. SURVIVAL CURVE Middle ages. Survival. Years. - PowerPoint PPT Presentation
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MANY THANKS for your INVITATION
The tomorrow old people
arealready born
The tomorrow old people are
already bornFrom
quantity of life to
active ageing and
quality of life
NUMBER of YEARS of LIFE
ALIVE (healthy or not)
Dead
0
10
20
30
40
50
60
70
80
Life Expectancy
Years
SURVIVAL CURVEMiddle ages
0
100
200
300
400
500
600
700
800
900
1000
0 10 20 30 40 50 60 70 80 90 100 110
Survivals
Years
Survival
SURVIVAL CURVEXVIIth century
0
100
200
300
400
500
600
700
800
900
1000
0 10 20 30 40 50 60 70 80 90 100 110
XVIIth centuryMiddle ages
Years
Survival
HUMAN LONGEVITY
0
20
40
60
80
100
120
140
Number of years of life
SURVIVAL CURVEXIXth century
0
100
200
300
400
500
600
700
800
900
1000
0 10 20 30 40 50 60 70 80 90 100 110
XIXthMiddle ages
Survival
Years
HUMAN LONGEVITY
0
20
40
60
80
100
120
140
PUBLIC HYGIENE: water separation
Number of years of life
SURVIVAL CURVEXXth century
0
100
200
300
400
500
600
700
800
900
1000
0 10 20 30 40 50 60 70 80 90 100 110
XXthXIXthMiddle ages
Survival
Years
HUMAN LONGEVITY
0
20
40
60
80
100
120
140
PUBLIC HYGIENE: water separation
Number of years of life
CARE OF MOTHER AND CHILD
SURVIVAL CURVEXXIst century
0
100
200
300
400
500
600
700
800
900
1000
0 10 20 30 40 50 60 70 80 90 100 110
XXIstXXthXIXthMiddle ages
Survival
Years
The tomorrow old are already born
Percent POPULATION aged 65 and over: 2008
An Ageing World 2008, International population Reports, US department of Health and Human Services, June 2009
Percent POPULATION aged 65 and over: 2040
An Ageing World 2008, International population Reports, US department of Health and Human Services, June 2009
Population in DevelopED and developING countries by age and gender
1960
An Ageing World 2008, International population Reports, US department of Health and Human Services, June 2009
Population in DevelopED and developING countries by age and gender
2000
An Ageing World 2008, International population Reports, US department of Health and Human Services, June 2009
Population in DevelopED and developING countries by age and gender
2040
An Ageing World 2008, International population Reports, US department of Health and Human Services, June 2009
AGEING PROCESSVERY OLDOLD OLD
OLDYOUNG OLDFUTURE OLD
AGEING PERSONCulture, Socio-economic conditions, Anticipation
2005 – LIFE EXPECTANCY (LE)
0
10
20
30
40
50
60
70
80
90LE of Men at birth LE of women at birth
An Ageing World 2008, International population Reports, US department of Health and Human Services, June 2009
2005 – LIFE EXPECTANCY (LE)
0
10
20
30
40
50
60
70
80
90LE of Men at birth LE of women at birth
An Ageing World 2008, International population Reports, US department of Health and Human Services, June 2009
Switzerland2.5 million inhabitants
1860
85+80-8475-7970-7465-6960-6455-5950-5445-4940-4435-3930-3425-2920-2415-1910-145-90-4
Hommes
050100150200250300350
Femmes
0 50 100 150 200 250 300 350
1860
5.1%
0.2%
Switzerland5.4 million inhabitants
1960
85+80-8475-7970-7465-6960-6455-5950-5445-4940-4435-3930-3425-2920-2415-1910-14
5-90-4
Hommes
050100150200250300350
Femmes
0 50 100 150 200 250 300 350
1960 1%
10%
Switzerland7.2 million inhabitants
2000
85+80-8475-7970-7465-6960-6455-5950-5445-4940-4435-3930-3425-2920-2415-1910-145-90-4
Hommes
050100150200250300350
Femmes
0 50 100 150 200 250 300 350
2000
15.4%
4.0%
SWITZERLAND 2000 and 2025
2000 2025
SWITZERLAND 2000, 2025 and 2050
2000 2025
2050
SWITZERLAND 2000, 2025 and 2050
2000 2025
2050
The tomorrow old are already born
We are
preparin
g our
own futu
re old age
AGEING:Life course perspective
VERY OLDOLD OLD
OLDYOUNG OLDFUTURE OLD
AGEING PERSONAdult
AdolescentChild
Socio-economics Culture
AGEING EVIDENCE !
Life course perspective
NUMBER of YEARS of LIFE
NUMBER of YEARS of LIFEwithout disability
0
10
20
30
40
50
60
70
80
Life Expectancy
Years
ALIVE
DEADICIDH 1, WHO Geneva 1980 et 1993
PATHOLOGICAL PROCESS
DEATH
IMPAIRMENT
DISABILITY
HANDICAP
DEATH
ICIDH 1, WHO Geneva 1980 et 1993
ORGAN
INDIVIDUAL
SOCIETY
Activities of Daily Living
Social identity
Social identity
Coping ability
Coping ability
Situational condition
Situational condition
PATHOLOGICAL PROCESS
DEATH
0
10
20
30
40
50
60
70
80
Disability Free Life Expectancy Life WITH Disability
Aging successfully until deathStudy of predictors of dying without disability
in 1’097 US citizens who died in late old age with known disability
LEVEILLE SG et al Am J Epidemiol 1999; 149: 654-64
For a NON-disabled 65 y.o. Man Woman
the probability of surviving to age of 80 y.o. 85 y.o.
and being NON-disabled before death was 26% 18%
CAUSES of DISABILITY ?
Which
are the main causes
ofthe inability of accomplishing alonethe Activities of Daily Living (ADL)
Life styles ?Age by itself ? Diseases ?
32 year-follow-up (1962-1994)of 1741 students born between 1913 and 1925
3 “modifiable” risk factors
PHYSICAL EXERCICES WEIGHT SMOKING
.
VITA AJ et al New Engl J Med 1998; 338: 1035-41
LIFE STYLES and ADL functioning
High risk group Low risk group
32 year-follow-up (1962-1994)of 1741 university alumni born between 1913 and 1925
3 “modifiable” risk factors
PHYSICAL EXERCICES WEIGHT SMOKING
DISABILITY was
postponed by 10 y.
VITA AJ et al New Engl J Med 1998; 338: 1035-41
LIFE STYLES and ADL functioning
High risk group Low risk group
Longitudinal 32-years survey (1962-1994)
1,741 university alumni
(cumulative disability)
Bias of the study cohort ???White men
Highly educated
Good socioeconomic status
GENERALIZABILITY of the FINDINGS ?
CAMPION EW New Engl J Med 1998;338: 1064-6
12 year-longitudinal study of a 65+ community dwelling population 418 death registered between 1986 and 1998
ADL were analyzed considering 3 « modifiable» risk factors: physical exercices, weight and smoking habit
HB HUBERT et al J Gerontol A Biol Sci Med Sci 2002; 57: M347-51
«HIGH RISK» group
LIFE STYLES and ADL functioning
«LOW RISK» group
12 year-longitudinal study of a 65+ community dwelling population 418 death registered between 1986 and 1998
ADL were analyzed considering 3 « modifiable» risk factors: physical exercices, weight and smoking habit
HB HUBERT et al J Gerontol A Biol Sci Med Sci 2002; 57: M347-51
«HIGH RISK» group
LIFE STYLES and ADL functioning
«LOW RISK» group
12 year-longitudinal study of a 65+ community dwelling population 418 death registered between 1986 and 1998
ADL were analyzed considering 3 « modifiable» risk factors: physical exercices, weight and smoking habit
HB HUBERT et al J Gerontol A Biol Sci Med Sci 2002; 57: M347-51
«HIGH RISK» group
LIFE STYLES and ADL functioning
«LOW RISK» group
CAUSES of DISABILITY ?
Which
are the main causes
ofthe inability of accomplishing alonethe Activities of Daily Living (ADL)
Life styles ? YESAge by itself ? Diseases ?
PHYSICAL EXERCISES
BALANCED DIET
PHYSICAL EXERCISES
BALANCED DIET
Preventable infectious diseases
vaccines
Optimizing yourbrain reserve
INCREASING AGE(dysfunctions in
activities of daily living)
Significant explanatory variables for functional disabilities
Major causes of DISABILITY
HOGAN DB et al J Gerontol A Biol Sci Med Sci 1999; 54: M77-82
FRAILTY
2 x functional disabilities in 85+ than in the youngest
In the 85+ In the 65-84 y.o.
« A transitional state »
ROBUSTNESS
FRAILTY
ADLDEPENDENCE
FRAILTY life long processtime
DEATHPhysiological reserves
Total
Used
AVAILABLE
Age, Gender, Lifestyle, Socio-economic status,
Co-morbidities, Affective, Cognitive and Sensory
Impairments (…)
« FRAILTY »A stage of age-related
PHYSIOLOGIC VULNERABILITY
resulting from
IMPAIRED HOMEOSTATIC RESERVE and
REDUCED CAPACITY of the ORGANISM
TO WITHSTAND ANY STRESS
FRIED L et al In: HAZZARD W New York 1998: 1387-1402
ROBUSTNESS
FRAILTY
DEPENDENCEin Activities of Daily
Living (ADL)
FRAILTY life long processtime
DEATH
Functional Decline
The disablement process is secondary to any stress,
trauma, or disease
Latent Phase
The frailty process occurs during the life course and corresponds to a precise biological change:
decline of physiological reserves
JP MICHEL et JM ROBINE 2009
Repeated falls Multiple and various trauma
Functional declineDisability
HospitalisationsNosocomial inf.
DependenceInstitution
Death
Consequences of «FRAILTY»
Adapted from RAPHAEL D et al Can Public Health 1995; 86: 224-7
Personalsuffering
Caregiver burden
INCREASING AGE(dysfunctions in
activities of daily living)
Significant explanatory variables for functional disabilities
Major causes of DISABILITY
HOGAN DB et al J Gerontol A Biol Sci Med Sci 1999; 54: M77-82
Modifiable risk factors: Malnutrition, low exercise level, slow gait and
depression ! SARKISIAN CA et al J Am Geriatr Soc 2000; 48: 170-8
FRAILTY
2 x functional disabilities in 85+ than in the youngest
In the 85+ In the 65-84 y.o.
VANITALLIE TB Metabolism 2003; 52(10 Suppl 2): 22-6
AGEING and/or FRAILTY ?
One characteristic
of the FRAILTY SYNDROME
that distinguishes it from the effects of ageing per se
is the
POTENTIAL REVERSIBILITY
of many of its features
CAUSES of DISABILITY ?
Which
are the main causes
ofthe inability of accomplishing alonethe Activities of Daily Living (ADL)
Life styles ?YES
Age by itself ? YES Diseases ?
DISEASES INCREASING AGE
(dysfunctions in activities of daily living)
Significant explanatory variables for functional disabilities
Major causes of DISABILITY
HOGAN DB et al J Gerontol A Biol Sci Med Sci 1999; 54: M77-82
Modifiable risk factors: Malnutrition, low exercise level, slow gait and
depression ! SARKISIAN CA et al J Am Geriatr Soc 2000; 48: 170-8
FRAILTY
2 x functional disabilities in 85+ than in the youngest
In the 85+ In the 65-84 y.o.
ICD 10
ICFICF = International Classification of Functions
DISEASES and DISABILITIES
MORTALITY DISABILITY DISEASES
Infectious
(Cancer)
Neuro-/Cardio-
vascular
Mental
Locomotor
Sensory i
ADULT DISEASES
Mortality or Disability
• Diabetes
• Stroke
• Cardio-Vx disease
• Respiratory diseases
• (…)
0
100
200
300
400
500
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
Years
s
10000
15000
20000
25000
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
Years
Death
s
Men Women
CVD mortality rates Disability linked to CVD
MEDICAL PROGRESS:The “paradox” of
Cardio Vascular Diseases (CVD)
Villar , Banegas, Donado, Rodríguez Artalejo. SEA Report 2003
GERIATRIC DISEASES
Mortality Disability
• Sensory impairments
• Locomotor disorders
• Dementias
ADULT DISEASES
Mortality or Disability
• Diabetes
• Stroke
• Cardio-Vx disease
• Respiratory diseases
• (…)
Dementia and
Physical dependence
Dementia increases by 14
inabilities in activities of daily living
Dementia is a
strong predictor of disability !
SAUVAGET C et al Gerontol 2002; 48: 226-33
CAUSES of DISABILITY ?
Which
are the main causes
ofthe inability of accomplishing alonethe Activities of Daily Living (ADL)
Life styles ?YES
Age by itself ? YES Diseases ? YES
0
10
20
30
40
50
60
70
80
Life Expectancy
Years
Healthy Ageing ?
OBVIOUSQUESTION ?
Courtesy from H BERGMAN
0
10
20
30
40
50
60
70
80
90
Healthy Life Expectancy Life WITH Disability
Health
y Life E
xpectan
cy
Ageing without Disability?
OBVIOUSQUESTION ?
Courtesy from H BERGMAN
0
10
20
30
40
50
60
70
80
Disability Free Life Expectancy Life WITH Disability
Dis
ability
Fre
e Life
Ex
pe
cta
nc
y
LE and HLE at birth
0
10
20
30
40
50
60
70
80
90LE both gender HLE both gender
An Ageing World 2008, International population Reports, US department of Health and Human Services, June 2009
2005
Percentage of life time spent in
disability - 2005
0
5
10
15
20
25
30
35
An Ageing World 2008, International population Reports US department of Health and Human Services, June 2009
%
Percentage of life time spent in
disability - 2005
0
5
10
15
20
25
30
35
An Ageing World 2008, International population Reports US department of Health and Human Services, June 2009
%
HEALTHY INFANCY ?
HEALTHY ADOLESCENCE ?
HEALTHY AGEING ?
0
10
20
30
40
50
60
70
80
Balance
Disability Free Life Expectancy Life WITH Disability
0102030405060708090
Pandemy ofMorbidity
Balance
Disability Free Life Expectancy Life WITH Disability
0102030405060708090
Pandemy ofMorbidity
Balance Compression ofMorbidity
Disability Free Life Expectancy Life WITH Disability
The VALUE of HEALTHY AGEING
Recent repeated cross sectional surveys of LE, HLE & DFLE
Austria 1978-1998 Netherlands 1989-2000
Belgium 1997-2004 New Zealand 1981-1991
Canada 1986-2003 Quebec 1985-1995
China 1987-2007 Spain 1986-2003
Denmark 1987-2005 Switzerland 1992-2002
France 1980-2000 Sweden 1980-2005
Germany 1984-2004 Thailand 1986-1995
Japan 1992-1998 UK 1980-2004
Lithuania 1997-2001 USA 1982-2004
Recent repeated cross sectional surveys of LE, HLE & DFLE
Austria 1978-1998 Netherlands 1989-2000
Belgium 1997-2004 New Zealand 1981-1991
Canada 1986-2003 Quebec 1985-1995
China 1987-2007 Spain 1986-2003
Denmark 1987-2005 Switzerland 1992-2002
France 1980-2000 Sweden 1980-2005
Germany 1984-2004 Thailand 1986-1995
Japan 1992-1998 UK 1980-2004
Lithuania 1997-2001 USA 1982-2004
Compression Balance Pandemic Changes of trends
80s 90s 00s 2005
- Belgium - Belgium
Sweden Sweden Sweden Sweden
UK UK UK UK
General theory of ageingRatio DFLE /LE
Compression Balance Pandemic Changes of trends
Pandemics Compression Pandemics Compression Balance Balance Balance
Belgium 1995
Belgium 2005
Sweden 1990
Sweden 2004
Sweden 1980
UK 1980UK 2000
UK 2005
Time
General theory of ageingRatio DFLE /LE
China 1980
China 2000
France 1980
France 1990
France 2000
New Zealand 1980
New Zealand 1990
Pandemics Balance Compression Balance
Time
General theory of ageingRatio DFLE /LE
80s 90s 00s 2005
- Belgium - Belgium
China - China ?
France France France ?
New Zealand New Zealand - ?
Sweden Sweden Sweden Sweden
UK UK UK UK
General theory of ageingRatio DFLE /LE
Compression Balance Pandemic Changes of trends
General theory of ageingRatio DFLE /LE
Pandemics Compression Pandemics Compression Balance Balance Balance
Belgium 1995
Belgium 2005
UK 1980UK 2000
Sweden 1990
Sweden 2004
China 1980
China 2000
France 1980
France 1990
France 2000
New Zealand 1980
New Zealand 1990
Sweden 1980
UK 2005
Pandemics Balance Compression Balance
Time
0
10
20
30
40
50
60
70
80
90
Balance
0
10
20
30
40
50
60
70
80
90
Compression
0
10
20
30
40
50
60
70
80
90
Expansion
0
10
20
30
40
50
60
70
80
90
Balance
GENERAL THEORY of AGEING
0
10
20
30
40
50
60
70
80
90
Balance
0
10
20
30
40
50
60
70
80
90
Compression
0
10
20
30
40
50
60
70
80
90
Expansion
0
10
20
30
40
50
60
70
80
90
Balance
Alternation of expansion and compression of
morbidity / disabilityVARIOUS SPEEDS
0
10
20
30
40
50
60
70
80
90
Balance
0
10
20
30
40
50
60
70
80
90
Compression
0
10
20
30
40
50
60
70
80
90
Expansion
0
10
20
30
40
50
60
70
80
90
Balance
More time of observation is needed to
valid this proposed theory
More time of observation is needed to
valid this proposed theory
HEALTHY AGEING ?
http://www.yannlayma.com
LIFE COURSE perspectives
AGEING
Ageing WITHOUT - Genes damage - Cells and tissues faults KiRKWOOD 2003
Ageing WITHOUT - Disease
Ageing WITHOUT - Disability ROBINE 1997
Ageing WITHOUT - Biological life events JOLLES 1995
Ageing WITHOUT - Bad perceived health
HEALTHY AGEING
HEALTHY AGEING ?AGEING SUCCESSFULLY ?
http://www.yannlayma.com
LIFE COURSE perspectives
AGEING SUCCESSFULLY
AGEING
Ageing WITHOUT - Genes damage - Cells and tissues faults KIRKWOOD 2003
Ageing WITHOUT - Disease
Ageing WITHOUT - Disability ROBINE 1997
Ageing WITHOUT - Biological life events JOLLES 1995
Ageing WITHOUT - Bad perceived health
Ageing WITH - a high degree of physical, mental and social functioning ROWE & KHANE 1997
Ageing WITH - the constant ability to adapt to changes BALTES 1990
Ageing WITH - an active engagement in life ROWE & KHANE 1997
Ageing WHILE - doing something meaningful BRYANT 2001
NUMBER of YEARS of LIFE
NUMBER of YEARS of LIFEwithout disability
QUALITY of LIFE
QUALITY of LIFE1. Own concept of living
2. Affection of family’s members and friends
3. Social integration
PROJET de
VIE
PROJECT for the
LAST PERIOD of LIFE
LIFE CYCLE
LIFE CHOICE ?
SPIRITUALITY
Participation in a community of thinking
HEALTH PRESERVATIONhttp://www.yannlayma.com
CHOICE of PLACE of LIVING
Localisation ? Accessibility ? Comfort ?Communication ?Security ?
TRADITIONAL LIFEvs.
HIGH TECH LIFE
http://www.yannlayma.com
QUALITY of LIFE1.Own concept of living
NEEDED ANTICIPATION
2. Love of your family’s members and friends
3. Social integration
SINGLE or COUPLE ?
SEXUALITY in AGEING/AGED ADULTS
Sexuality and ageing adults3005 US adults (1’550 Women and 1’455 Men)
aged from 57 to 85 years
0
20
40
60
80
100
57-64 years 65-74 years 75-85 years
Men Women
TESSLER LINDAU S et al New Engl J Med 2007; 357: 762-74
Sexual activity with a partner
Sexuality and ageing adults3005 US adults (1’550 Women and 1’455 Men)
aged from 57 to 85 years
TESSLER LINDAU S et al New Engl J Med 2007; 357: 762-74
Lack of interest !
0
20
40
60
80
100
57-64 years 65-74 years 75-85 years
Men Women
SEXUALITY in AGEING/AGED ADULTS
Different phases of the man sexual act: 1. Excitation
2. Plateau 3. Ejaculation
4. Detumescence 5. Refractory
1
2
3
4
5
1’
1
2
3
4
5
1’
Young Man Aged man
1
2
3
45
Different phases of the man sexual act: 1. Excitation
2. Plateau 3. Ejaculation
4. Detumescence 5. Refractory
Family life
QUALITY of LIFE1.Own concept of living
NEEDED ANTICIPATION
2. Love of your family’s members and friendsPRESERVATION OF YOUR AFFECTIVE
LIFE
3. Social integration
QUALITY of LIFE1.Own concept of living
2. Love of your family’s members and friends
3. Social integration
COMMUNITY LIFE ?Leisures
LEISURES with FRIENDS
QUALITY of LIFE1.Own concept of living
NEEDED ANTICIPATION
2. Love of your family’s members and friendsPRESERVATION OF YOUR AFFECTIVE
LIFE
3. Social integrationCOMMUNITY LIFE INVOLVEMENT
COMMUNITY LIFE ? COMMUNITY COMMUNITY
INVOLVEMENTINVOLVEMENT
BE OPENED
toTHE WORLD
Your appreciation of
VALUESmodifies
your appreciation of
AGEINGG MAC GILL, St Louis University, 1998
CONCLUSION
NUMBER of YEARS of LIFE
An Ageing World 2008, International population Reports, US department of Health and Human Services, June 2009
PHYSICAL EXERCISES
BALANCED DIET
Preventable infectious diseases
vaccines
Optimizing yourbrain reserve
NUMBER of YEARS of LIFE
NUMBER of YEARS of LIFEwithout disability
For a great part, each of us is responsible of
the quality of our ageing process
NUMBER of YEARS of LIFE
NUMBER of YEARS of LIFEwithout disability
QUALITY of LIFE
QUALITY of LIFE1.Own concept of living
NEEDED ANTICIPATION
2. Love of your family’s members and friendsPRESERVATION OF YOUR AFFECTIVE
LIFE
3. Social integrationCOMMUNITY LIFE INVOLVEMENT
The tomorrow old are already born
We are
preparin
g our
own futu
re old age
Your appreciation of VALUESmodifies
your appreciation ofAGEING
G MAC GILL, St Louis University, 1998
Is the “John GLENN Syndrome” a pure myth ?
I do thank you for your attention
Born in 19211rst to orbit the earth in 1962
2nd space flight in 1998 (77 y.o.)
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