Transcript Aging

Aging
"May you live a long, healthy life."
Sylvia Rozario
Epidemiology of Chronic Diseases
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Concept of aging
Overview
Prevalence of aging
Public health perspective
Diseases involved with aging
Prevention of diseases and disabilities
Current translational researches
Future areas of study
Financial burden
Conclusion
Concept of Aging
• Aging starts at birth.
• Aging is often equated with chronological age.
• Dependency ratio: "the ratio of those in the population considered to be
dependent (below 15 years and above 65 years), to those considered to be of
working age (15-64 years)" (Connell and Pringle, 2004).
• Characterizing the aging population in terms of "dependency ratios" reflects
negative image of ‘aging as dependency’ and hides the valuable contribution
older people make to society (NCAOP 2005).
• We need to distinguish chronological age as a statistical fact from the process
of aging as a complex phenomenon with physical, psychological, cultural
and social aspects.
Concept of Aging
• “Aging is a process, not an event" (Bigby; 2004).
• A life course approach: Analysis of the diversity of aging experiences
by examining the different paths of transition from adulthood to old age
for different social groups.
• Active Aging: Redefying aging in a positive way: "the process of
optimizing opportunities for health, participation and security in order to
embrace quality of life as people age" (WHO 2005).
• The key determinants of active aging are social, environmental,
behavioral, economic, personal and health/social service related.
• Successful Aging: the ability to maintain three key behaviors or
characteristics: low risk of disease and disability, high mental and physical
function and active engagement with life (Rowe & Kahn; 1998).
Global Health and Aging
The New Trend in Aging: 2010-2050
Percentage Change in the World’s Population
by Age: 2010-2050
Source: United Nations. World Population Prospects: The 2010. Available at: http://esa.un.org/unpd/wpp
Aging in USA
• In the US, the Healthy Aging Program of the Centers for Disease Control and Prevention defines
aging people as individuals of 50 years and above (Economist Intelligence Unit, 2012).
• The geriatric population in the United States is defined as individuals ≥65 years of age.
• Between 1989 and 2010, geriatric population rose from 25 to 40 million (US Census Bureau,
2010).
• Currently, about one in eight individuals in this country (13 percent) is an older American (U.S.
Census Bureau, 2011).
• The nation's 90-and-older population nearly tripled over the past three decades, reaching 1.9
million in 2010 (US Census Bureau, 2010).
• The U.S. population of older adults is predicted to grow rapidly as “baby boomers” (those born
between 1946 and 1964) begin to reach 65 years of age. As a result, population of Americans 65
years of age and older will rise from approximately 40 million in 2010 to 55 million in 2020, a
36% increase (AoA, 2010).
U.S. population, by age, selected years 1950–2080
Year
Population (thousands)
All ages
Under 20
20–64
65 or older
Percentage
65 or older
Historical
1950
160,118
54,466
92,841
812,811
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1970
214,765
80,684
113,158
20,923
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1990
260,458
75,060
153,368
32,029
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2005
302,323
83,963
181,457
36,902
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Projected
2020
339,269
87,547
198,213
53,510
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2040
376,856
92,268
207,416
77,172
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2060
402,079
96,760
218,777
86,543
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2080
428,214
101,159
230,137
96,918
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SOURCE: Board of Trustees (2006, Table V.A2)
U. S. Population by Age
Based on the RAND Corporation 2003 study, PBS.org.
Prevalence of Aging Population in USA
Percentage of the U.S. population over age 65, selected years: source, U.S. Census Bureau, 2003
Why Study Aging?
• Average lifespan has increased over the last centuries, as a consequence
of medical and environmental factor.
• By 2015, one of every five Americans will be between the ages of 50 and 64 (CDC
2009).
• By 2030, approximately 20% of Americans will be over the age of 65,
representing an overall 60% increase (U.S. Census Bureau, 2004).
• The pace of aging in the 21st century will be like that of no other period in human
history, with unprecedented growth occurring in all states (overall 60% increase,
U.S. Census Bureau, 2004).
• Understanding mechanisms of aging and determinants of life span will
help to reduce age-related morbidity and facilitate healthy aging.
Why Study Aging?
Characteristics of the older population include:
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High levels of multiple chronic conditions.
High level of hospital admissions and readmissions, and emergency room usage.
Consumption of 10 or more prescription drugs on a daily basis.
Limitations in terms of their activities of daily living.
Low functional levels, requiring physical assistance.
Prevention! Prevention!! Prevention!!!
• Clinical preventive services can help lower health risks and costs of treating chronic disease, as
well as prevent or delay the onset of disease (National Prevention, Health Promotion, and Public
Health Council , June 2011).
• Older adults who obtain clinical preventive services and practice healthy behaviors are more likely
to remain healthy and functionally independent (Cranksaw 2002, CDC 2011b).
The Increasing Burden of Chronic
Noncommunicable Diseases: 2008 and 2030
Source: World Health Organization, Projections of Mortality and Burden of Disease, 2004-2030.
Prevalence of Chronic Disease and Disability among Men
and Women Aged 50-74 Years
Source: American Journal of Public Health 2009; 99/3:540-548
COMMON CHRONIC CHILDHOOD DISEASES
• Asthma
• Cystic fibrosis
• Diabetes
• Obesity: diabetes, heart disease,
high blood pressure, high
cholesterol, stroke, some cancers,
arthritis, and sleep-disordered
breathing
• Malnutrition : Anemia
• Developmental disabilities: ADHD
and ASD
• Cerebral palsy
• Mental illnesses
• Chronic lung disease, retinopathy of prematurity
and developmental delays
Caused by:
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Genetic (inherited) conditions
Environmental factors and/or nutritional factors
A combination of both
Premature birth and low birth weight
Common Chronic Diseases in Young Adults (18 and over)
Five fatal diseases:
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Asthma
Ischemic heart disease
Chronic obstructive pulmonary disease
Diabetes mellitus
malignant neoplasms
Three nonfatal diseases:
• Arthritis
• Visual impairment
• Hearing impairment
Common Diseases in Older Adults
• Cardiovascular Diseases
 Coronary Heart Disease
 Cerebrovascular Disease
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Hypertension
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Abdominal Aortic Aneurysm
• Metabolic Disorders
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Diabetes Mellitus
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Hyperlipidemia
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Hypothyroidism
• Cancers
 Colorectal Cancer
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Prostate Cancer
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Cervical Cancer
Breast Cancer
Common Diseases/Conditions in Older Adults
• Infectious Diseases
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Influenza
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Pneumococcal Pneumonia
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Herpes Zoster (Shingles)
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Hepatitis
• Musculoskeletal Conditions
 Osteoporosis
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Arthritis
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Frequent falls
• Neurological Disorders
 Dementia
 Alzheimer’s disease
• Mental Health
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Depression
Common Diseases/Conditions in Older Adults
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Hearing Loss
Loss of visual acuity
Cataract
Glaucoma
Macular degeneration
Refractive errors
Prone to motor vehicle collisions
Visual, motor, cognitive and functional impairments
Incontinence
Lack of sleep (also difficulty sleeping and poor quality of sleep)
Abuse and Neglect
Physical violence, neglect, emotional abuse, and financial
exploitation
Mental Health and Aging
Prevalence of frequent mental distress among adults aged ≥65
Prevalence of frequent mental distress, by age,
among U.S. adults
Leading Causes of Mortality Among Aging Population
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Cardiovascular disease
Cancer
Diabetes
Vaccine-preventable diseases
Unintentional injury
Cardiovascular Diseases in Aging Population
• 57% of the aging population identified cardiovascular disease as the most
common health concern (Aging States Project, 2005).
• Older adults have the highest rate of heart disease compared with any other age
group (44% percent of all cases of heart disease and 61% of all cases of stroke;
National Center for Health Statistics, 2001)
• Of the five major risk factors for cardiovascular disease (hypertension,
hypercholesterolemia, tobacco use, physical inactivity, and poor nutrition), 89% of
adults aged 51–61 years had at least one, and almost 20% had three or more risk
factors (CDC, 2001).
• After age 55, with each subsequent decade of life, an individual’s risk of stroke
more than doubles (CDC, 2004).
• Coronary Heart Disease (CHD) is the leading cause of death among the elderly
over the age of 65 years (CDC, 2010).
• HTN is a significant risk factor for morbidity and mortality in the elderly and
often requires pharmacological treatment when present.
Metabolic Disorders in Aging Population
Diabetes Mellitus
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Among U.S. residents aged >65 yrs, 10.9 million (26.9%) had diabetes in 2010 (CDC,2011)
50% had prediabetes (based on fasting glucose or hemoglobin A1c level) (CDC, 2011).
Diabetes-related morbidity and mortality are especially high among the elderly:
20% with macrovascular complications (eg, myocardial infarction) (Wallace J.I.: 1999)
9% with microvascular complications (eg, retinopathy, nephropathy) (Wallace J.I.: 1999)
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When treating elderly diabetics, the risk of hypoglycemic episodes is 2 fold compared to young
patients.
Hyperlipidemia
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The prevalence of high cholesterol (≥240 mg/dL) among older adults: 22% for men
: 39% for women
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The relative risk of high cholesterol to cardiovascular disease is not as daunting in the elderly as in
the general population.
Cancers in Aging Population
• Colorectal Cancer
 The incidence of colorectal cancer increases with age (Patel BB et al.; 2009).
• Prostate Cancer
 Age is a significant risk factor for prostate cancer
 Among 50-year-old men, the lifetime prevalence is 30% (Chodak G.; 2006)
 Among 80-year-olds, the lifetime prevalence is >50% (Chodak G.; 2006)
• Cervical Cancer
 10% of all cervical cancer cases occur in women greater than 75 years old (NCI, 2011)
 The incidence in age >65yrs is 1.2 times greater than that for 45 to 64 years olds.
• Breast Cancer
 Ages of 55 to 64 years: 21% of cases and ages 65 to 74: 20% of cases (NCI, 2011)
 Ages 75 to 84 years: 21% of cases and ages >85 years: 15.1% of cases (NCI, 2011)
The National Report Card on Healthy Aging
Source: The State of Aging and Health in America 2013, CDC.
Prevention strategies
• Chronic diseases and its associated disabilities can be attenuated by:
 Adoption of healthy behaviors:
Regular physical activity
Proper nutrition
Tobacco Cessation
Maintenance of healthy weight
Proper sleep
 Identification of health risks earlier
 Treatment and management of any identifiable chronic conditions
 Appropriate use of available preventive services
Proper Nutrition and Aging
SOURCE: Adapted from Ziliak and Gundersen, 2011.
Staying Healthy at 50+ (NIA, 2010)
DAILY STEPS TO GOOD HEALTH:
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Be tobacco free.
Be physically active.
Eat a healthy diet.
If you drink alcohol, drink only in moderation.
SCREENING TESTS AND PREVENTIVE MEDICINE:
Heart and Vascular Diseases
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Aspirin to prevent heart attack: Men at risk* — Ages 50 to 80.
Aspirin to prevent stroke: Women at risk* — Ages 55 to 80.
Abdominal Aortic Aneurysm Screening Test: Once for men who have smoked— Ages 65 to 75.
Cholesterol Screening Test: All men and women — Ages 50 and older.
Diabetes Screening Test: Men and women — Ages 50 and older with high blood pressure.
Cancer
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Staying Healthy at 50+ (NIA, 2010)
Breast Cancer Screening (Mammogram): All women — Ages 50 and older, every 1 to 2 years.
Breast Cancer Preventive Medicines: Women at risk*— Ages 50 to 80.
Cervical Cancer Screening (Pap Test): All women — Ages 50 to 65, at least every 3 years.
Colorectal Cancer Screening Test: All men and women — Ages 50 and older.
Bone Disease
• Osteoporosis Screening (Bone Density Scan): Women at risk* — Ages 60 to 65, and all women — Ages 65 and older.
Sexual Health
• HIV and Sexually Transmitted Infection Screening Tests: Men and women at risk* — Ages 50 and older.
Mental Health
• Depression Screening: All men and women — Ages 50 and older.
Immunizations
• Flu Vaccine: All men and women — Ages 50 and older, annually.
• Other Vaccines: You can prevent some serious diseases, such as pneumonia, whooping cough, tetanus, and shingles, by being
vaccinated. Talk with your doctor or nurse about which vaccines you need and when to get them.
Healthy Aging: Lessons from the Baltimore
Longitudinal Study of Aging
• Get Moving: Consider Exercise and
other Physical Activities
• Pay Attention to Weight and Shape
• Healthy Food for Thought: Think About
what You Eat
• Participate in Activities You Enjoy
• Participate in your health care
Disease specific Prevention
(United States Preventive Services Task force)
• Cardiovascular Diseases
Tobacco Cessation (Primary prevention)
 Aspirin chemoprevention: For men, age 45 to 79
: For women, age 55 and 79
 Detection, Evaluation, and Treatment of High Blood Cholesterol.
 Screening of all adults for high blood pressure.
• Diabetes Mellitus
• Screening for type 2 diabetes in asymptomatic adults with sustained hypertension
(HTN; >135/80 mmHg): ( by USPSTF)
• Screening for type 2 diabetes in all asymptomatic adults >45yrs. And repeating every 3
years (by American Diabetic Association).
• Cancers
Disease specific Prevention
 Colorectal cancer: High consumption of fruits and vegetables (primary prevention)
: Screening for colon cancer age 50 to 75 yrs (secondary prevention)
: Fecal occult blood testing
: Sigmoidoscopy and/or colonoscopy
 Prostate Cancer: Prostate-specific antigen screening(USPSTF do not recommend for or
against it in men <75 years but recommend against it in men <75.)
 Cervical Cancer: Pap smears (USPSTF currently recommends that women >65 years
cease screening; American Cancer Society recommends screening
stop at age 70).
 Breast Cancer: Mammography (every 2 years for all women ages 50 to 74).
: Annual clinical breast examinations >40 yrs (American Cancer Soceity)
The Public Health and Aging Service Network
Prevention
CDC ‘s mission is “to promote health and quality of life by preventing and
controlling disease, injury, and disability,”
Center for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Healthy Aging Program (HAP)
Injury Prevention
Disability Prevention
Adult Immunization
Prevention and early detection of disease
Healthy Aging Mini-Grant program
• Jointly funded by CDC and AoA
• Managed by CDD and NASUA (National Association of State Units on Aging)
• 24 states have conducted health promotion activities in various areas,
such as: Physical activity
: Proper nutrition
: Medicare preventive services
: Arthritis self-management
: Immunization
: Stress management.
National Prevention plan
• The National Prevention Strategy is a comprehensive plan to help increase the number of
Americans who are healthy at every stage of life.
• For aging populations:
 Advance Care Planning: Ensuring their wishes are known and honored if they are unable to
speak for themselves.
 Caregiving:
 Clinical Preventive Services: Preventing the onset or progression of disease or disability.
1) Immunization: Influenza and Pneumococcal vaccination.
2) Screening tests: Colorectal cancer screening, Breast cancer screening
Lipid disorder screening, Diabetes screening and
Osteoporosis screening.
3) Counseling: Smoking cessation.
Low Rates of Use of Preventive Services
• Rates of older adults (ages >65) not receiving clinical preventive services are (CDC
2011b):
 Vaccinations: More than 31% reported not receiving an influenza vaccination in the past.
 Breast Cancer Screening: Nearly 17% of women reported not receiving a mammogram within the past two years.
 Colorectal Cancer Screening: More than 36% reported not receiving colorectal cancer screening.
 Diabetes Screening: 31% without diagnosed diabetes reported not receiving a test for high blood sugar or diabetes
within the past three years.
 Osteoporosis Screening: 62% of black women and 54% of American Indian/Alaska Native women reported never
receiving osteoporosis screening compared to 33% of white women.
 Lipid Disorder Screening: 5% reported not receiving blood cholesterol screening within past 5 years.
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Smoking Cessation Counseling: 31% of older women reported not receiving advice to quit smoking during their
annual checkup, compared to 24% of older men.
Barriers To Receipt Of Preventive Services
• A 2009 survey by AARP identified the following top barriers:
 Cost of the screening
 Insufficient funds to cover copayments or deductibles
 Uncertainty over what health insurance would cover; lack of importance to
them; or lack of health insurance
 Unawareness of the services recommended for their age group
 Physicians may not take the time to recommend or provide the routine services
 May not know that the cost of most of the services is covered by Medicare
 Do not have a primary care provider or a usual source of care
 May be deterred from receiving services due to physical or social barriers
(transportation, disability, culture or language challenges, or fear).
• The biggest barrier to preventive care may be a lack of political will (Economist Intelligent Unit,
2012).
Paradox in Prevention of common age-related Diseases
• Continually increasing resources are being expended to combat the age-related diseases.
• But the causes of these diseases still remain questionable. At the same time, the
incidence and morbidity related to these diseases either remain constant or increase
(Wallace, 2010a).
• Huge investments in biomedical research in the recent past have resulted in some
important accomplishments, such as sequencing of the human genome, identification of
thousands of human chromosomal single nucleotide polymorphisms (SNPs).
• However, these accomplishments have failed to reveal the genetic causes for the
common age-related diseases (Wallace, 2008).
• To resolve the crisis, a new paradigm must be generated that comprise the potential of
the previous founding whereby adding new elements that address the current problems
being compared and possibly overcome (Kuhn, 1996).
Prevention Research Centers Healthy Aging Research
Network (PRC-HAN)
• The only existing network of academic centers that focuses on community-based
participatory research on older adult health.
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Established in 2001
Receives support from CDC.
Works to better understand the determinants of healthy aging in older adult populations.
Identifies interventions that promote healthy aging.
Assists in the translation of research that promote healthy aging into sustainable communitybased programs throughout the nation.
• Assesses interventions that target health disparities among older adults.
• Examines a broad range of programmatic and environmental interventions for physical activity
promotion.
Research on Healthy Aging
Research Highlights
• NIH researchers identify new gene mutation associated with ALS and dementia: April 7,
2014
• NIH researchers find basal forebrain controls decision-making speed in rodents: March
26, 2014
• Researchers find association between abnormal tau and damaged brain cell DNA: March
6, 2014
• NIH-supported clinical trial finds antidepressant reduces Alzheimer’s agitation:
February 25, 2014
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Rare genetic variants may double risk for Alzheimer’s disease: January 30, 2014
New clinical trials to test Alzheimer’s drugs: December 23, 2013
Amylin deposits in the brain may link dementia and diabetes: July 30, 2013
Smoking in middle age is associated with increased rate of cognitive decline in men:
March 22, 2012
Living Long & Well in the 21st Century: Strategic
Directions for Research on Aging (NIA, 2014)
• Improve our understanding of healthy aging and disease and disability among older adults.
• Continue to develop and disseminate information about interventions to reduce disease and
disability and improve the health and quality of life of older adults.
• Improve our understanding of Alzheimer’s disease, other dementias of aging, and the aging
brain. Develop drug and behavioral interventions for treating these diseases, preventing their onset
and progression, and maintaining cognitive, emotional, sensory, and motor health.
• Improve our understanding of the consequences of an aging society and provide that
information to inform intervention development and policy decisions.
• Improve our ability to reduce health disparities and eliminate health inequities among older adults.
• Support the infrastructure and resources needed to promote high-quality research and
communicate its results.
Anti-Aging: Can We Prevent Aging?
• Antioxidants
• Calorie Restriction, Intermittent Fasting, Resveratrol, and Rapamycin
• Hormones:
 Human Growth Hormone
 Testosterone
 Hormones in Women: Estrogen and progesterone
 DHEA: Converts to testosterone and estrogen
Source: National Institute on Aging, NIH; 2012
A New Focus For Medical Research
Medical Research on
Delayed Aging
• Delayed aging could increase life
expectancy by an additional 2.2 years
of good health.
• The economic value of delayed
aging is estimated to be $7.1 trillion
over fifty years.
• In contrast, addressing heart disease
and cancer separately would yield
diminishing improvements in health
and longevity by 2060.
• A highly efficient way to forestall
disease, extend healthy life, and
improve public health.
Source: Goldman D. P. et al.; Health affair, 2013.
Degeneration and Cell Death During Aging
Cell stress responses. Expression of HS genes is induced in response to physiological and environmental
stress conditions including longevity stimuli, such as fasting, caloric restriction or acetylcarnitine, and protein
conformational diseases. HSF1 can also be directly stimulated by longevity stimuli such as the histone
deacetylase SIRT1 that directly activates HSF1 by deacetylation, thus fostering longevity. During aging, a
gradual decline in potency of the heat shock response occur and this may prevent repair of protein damage,
leading to degeneration and cell death. Source: Molecular Aspects of Medicine, 2011.
Proposed scheme for pathways contributing to cellular oxidative stress
Nuclear Factor kappa beta (NF-κB) and Reactive Oxygen Species (ROS) such as hydrogen peroxide (H2O2) and superoxide
contribute to the tissue injury and DNA damages in humans during old ages, resulting in muscle atrophy, aging of the immune system
and inflammation. it is proposed that the signaling cascades mediated via Sirtuins and FoxO represent the lifespan extending, anti-aging type
of regulation. Source: Molecular Aspects of Medicine, 2011.
Financial burden
• By 2030, the number of U.S. adults age 65 or older will more than double to about 72 million
(AoA 2011a).
• This rapid increase in the number of older adults will put pressure on public health and health
care systems, and the aging services network, making the role of clinical preventive services even
more important.
• The aging of the American population will bring increased health concerns about serious chronic
illness, the ability to delay the onset of disabilities, and the associated costs of health care.
• Older adults in better health, compared to those in poorer health, have a longer life expectancy
and lower cumulative health expenditures until death.
• a 70-year-old adult with no functional limitations can expect to live an additional 14.3 years with
healthcare expenditures of $136,000; conversely, a person of similar age who has at least one
activity of daily living limitation has a life expectancy of 11.6 years and cumulative healthcare
expenditures of $145,000 (N Engl J Med, 2003).
Financial Burden
• Aging is the driver of the deficit issue in most developed economies.
• National spending for "formal long-term care" in 2000: $137 billion
 Paid for by Medicaid: $62 billion or 45%
 Paid for by Medicare: $20 billion or 14%
 One-third of long-term care expenses are paid out-of-pocket by individuals and families.
The cost of long-term care will reach $207 billion in 2020 and $346 billion in 2040.
• By 2030, spending for Social Security, Medicare and Medicaid will amount to almost 60%
of the federal budget.
• Source: Cost of care, PBS.org; 2005.
Aging Population and Polypharmacy
It is the use of more medications than is clinically necessary.
In USA, individuals >65 years of age account for 12% of the population, but
consume 32% of prescriptions (US Census Bureau, 2010).
Polypharmacy leads to:
 adverse drug events and decreased adherence to drug regimens
 poor quality of life
 unnecessary drug expenses
Use of >6 drugs may be an independent predictor of increased
mortality in the geriatric patient ( Incalzi R.A et al., 1992).
Primary prevention should include:
 Assessing the total number and type and dose of medications
 Reviewing for possible interactions
 Minimizing nonessential medications
 Gradual optimization and reassessing.
References
• Hormesis, cellular stress response and vitagenes as critical determinants in aging and longevity
http://www.sciencedirect.com.proxy.library.vcu.edu/science/article/pii/S0098299711000513
• CDC Focuses on Need for Older Adults To Receive Clinical Preventive Services
http://www.cdc.gov/aging/pdf/cps-clinical-preventive-services.pdf
• Aging and Public Health: Partnerships That Can Affect Cardiovascular Health Programs
http://www.sciencedirect.com.proxy.library.vcu.edu/science/article/pii/S0749379705002680
• Exercise and the aging immune system
http://www.sciencedirect.com.proxy.library.vcu.edu/science/article/pii/S1568163712000438
• Aging and Disease Prevention
http://www.mdconsult.com.proxy.library.vcu.edu/das/article/body/4427044884/jorg=journal&source=&sp=24732666&sid=0/N/930882/1.html?issn=0749-0690
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Predicting mortality and length of stay of geriatric patients in an acute care general hospital;
http://www.mdconsult.com.proxy.library.vcu.edu/das/citation/body/4427327444/jorg=journal&source=MI&sp=13697327&sid=0/N/13697327/1.html?issn=
• Age-related increase in colorectal cancer stem cells in macroscopically normal mucosa of patients with adenomas: a risk factor for
colon cancer.
• http://www.mdconsult.com.proxy.library.vcu.edu/das/citation/body/4427438622/jorg=journal&source=MI&sp=21615661&sid=0/N/21615661/1.html?issn=
• Chronic Diseases of Children, Torpy, J. M. MD el al.; JAMA, 2010
http://jama.jamanetwork.com/article.aspx?articleid=185394
References
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National Cancer Institute: 2011
http://seer.cancer.gov/statfacts/html/cervix.html#incidence-mortality
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National Disability Authority: Ageing & Disability; 2013
http://www.nda.ie/cntmgmtnew.nsf/0/FBE570D7C6D435C280257.
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Nutrition and Healthy Aging in the Community: Workshop summary; 2012
file:///C:/Users/SylviaRozario/Documents/Spring%202014/EPID%20624/Chronic%20Diseases/Final%20power%20point%20presentation/Agi
ng%202/Food%20insecuirity%20for%20aging/Food%20insecuirity%20rates%20for%20people%20age%2050%20and%20over.pdf
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Preventive care and healthy aging; Economist Intelligence Unit, 2012
http://www.commed.vcu.edu/IntroPH/Aging/2013/Preventive%20care%20and%20healthy%20ageing.pdf
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Coping with the Demographic Challenge: Fewer Children and Living Longer; 2005-2006
http://www.commed.vcu.edu/IntroPH/Aging/2013/demochall_livinglonger.pdfhealth
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The state of health and aging in America, CDC, 2013
http://www.cdc.gov/aging/pdf/state-aging-health-in-america-2013.pdf
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Substantial Health And Economic Returns From Delayed Aging May Warrant A New Focus For Medical Research.
http://www.commed.vcu.edu/Chronic_Disease/aging/2014/delayingaging.pdf
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Cost of care: "Taking Care-Ethical Caregiving in our Aging Society", The President's Council on Bioethics, September 2005
http://www.pbs.org/wgbh/pages/frontline/livingold/cost/costofcare.html
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Seven chronic conditions: their impact on US adults' activity levels and use of medical services, APHA, 1995
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.85.2.173
Thank You
QUESTIONS?