A major new Series on health and ageing, published in The Lancet, warns that unless health systems find effective strategies to address the problems faced by an ageing world population, the growing burden of chronic disease will greatly affect the quality of life of older people. As people across the world live longer, soaring levels of chronic illness and diminished wellbeing are poised to become a major global public health challenge.
Worldwide, life expectancy of older people continues to rise. By 2020, for the first time in history, the number of people aged 60 years and older will outnumber children younger than 5 years. By 2050, the world's population aged 60 years and older is expected to total 2 billion, up from 841 million today. 80% of these older people will be living in low-income and middle-income countries [Paper 1].
The increase in longevity, especially in high-income countries (HICs), has been largely due to the decline in deaths from cardiovascular disease (stroke and ischaemic heart disease), mainly because of simple, cost-effective strategies to reduce tobacco use and high blood pressure, and improved coverage and effectiveness of health interventions.
However, although people are living longer, they are not necessarily healthier than before-- nearly a quarter (23%) of the overall global burden of death and illness is in people aged over 60, and much of this burden is attributable to long-term illness caused by diseases such as cancer, chronic respiratory diseases, heart disease, musculoskeletal diseases (such as arthritis and osteoporosis), and mental and neurological disorders [Paper 2].
This long-term burden of illness and diminished wellbeing affects patients, their families, health systems, and economies, and is forecast to accelerate. For example, latest estimates indicate that the number of people with dementia is expected to rise from 44 million now, to 135 million by 2050.
"Deep and fundamental reforms of health and social care systems will be required,"* says Dr John Beard, Director of the Department of Ageing and Life Course at the World Health Organization (WHO), and co-leader of the Series with Dr Ties Boerma and Dr Somnath Chatterji, also from WHO. "But 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 ageing populations to understand health trends and design programmes that meet the specific needs identified"*, adds Dr Ties Boerma, Director of the Department of Health Statistics and Informatics at WHO. "Cross-national surveys such as the WHO Study on Global Ageing and Adult Health (SAGE), the Gallup World Poll, and other longitudinal cohorts studies of ageing 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."* [Paper 3 and Paper 4]
However, the responsibility for improving quality of life for the world's older people goes far beyond the health sector, say the Series authors. Strategies are needed that better prevent and manage chronic conditions by extending affordable health care to all older adults and take into consideration the physical and social environment. Examples include changing policies to encourage older adults to remain part of the workforce for longer (e.g., removing tax disincentives to work past retirement age), emphasising low-cost disease prevention and early detection rather than treatment (eg, reducing salt intake and increasing uptake of vaccines), making better use of technology (eg, mobile clinics for rural populations), and training health-care staff in the management of multiple chronic conditions [Paper 5].
According to Dr Chatterji, also from the Department of Health Statistics and Information Systems at WHO, "Collectively, we need to look beyond the costs commonly associated with ageing to think about the benefits that an older, healthier, happier, and more productive older population can bring to society as a whole."*