MANY THANKS for your INVITATION

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


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


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


Population in DevelopED and developING countries by age and gender

1960



2000



2040


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


2005 – LIFE EXPECTANCY (LE)

0

10

20

30

40

50

60

70

80

90LE of Men at birth LE of women at birth


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%


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%


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


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 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


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


«LOW RISK» group




«HIGH RISK» group


«LOW RISK» group




«HIGH RISK» group


«LOW RISK» group


Which

are the main causes


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)




Modifiable risk factors: Malnutrition, low exercise level, slow gait and

depression ! SARKISIAN CA et al J Am Geriatr Soc 2000; 48: 170-8

FRAILTY



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


Which

are the main causes


Life styles ?YES

Age by itself ? YES Diseases ?

DISEASES INCREASING AGE

(dysfunctions in activities of daily living)




Modifiable risk factors: Malnutrition, low exercise level, slow gait and

depression ! SARKISIAN CA et al J Am Geriatr Soc 2000; 48: 170-8

FRAILTY



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


Which

are the main causes


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


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


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


0102030405060708090

Pandemy ofMorbidity

Balance


0102030405060708090

Pandemy ofMorbidity

Balance Compression ofMorbidity


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


Pandemics Compression Pandemics Compression Balance Balance Balance

Belgium 1995

Belgium 2005

Sweden 1990

Sweden 2004

Sweden 1980

UK 1980UK 2000

UK 2005

Time


China 1980

China 2000

France 1980

France 1990

France 2000

New Zealand 1980

New Zealand 1990

Pandemics Balance Compression Balance

Time


80s 90s 00s 2005

- Belgium - Belgium

China - China ?

France France France ?

New Zealand New Zealand - ?

Sweden Sweden Sweden Sweden

UK UK UK UK




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 ?


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



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


QUALITY of LIFE1.Own concept of living

NEEDED ANTICIPATION

2. Love of your family’s members and friends


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


NEEDED ANTICIPATION

2. Love of your family’s members and friendsPRESERVATION OF YOUR AFFECTIVE

LIFE



2. Love of your family’s members and friends


COMMUNITY LIFE ?Leisures

LEISURES with FRIENDS


NEEDED ANTICIPATION


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



PHYSICAL EXERCISES

BALANCED DIET

Preventable infectious diseases

vaccines

Optimizing yourbrain reserve



For a great part, each of us is responsible of

the quality of our ageing process



QUALITY of LIFE


NEEDED ANTICIPATION


LIFE

3. Social integrationCOMMUNITY LIFE INVOLVEMENT


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.)

Documents

MANY THANKS for your INVITATION