Week 4 #2 Burden of Disease in the Context of Population Ageing

Learning Points

• Consider life expectancy at age 60 and how it differs from life expectancy at birth.

• Consider healthy life expectancy and whether life expectancy increases result in expansion or compression of morbidity.

• Briefly discuss the implications of an aging population on the health sector, including costs to the healthcare system.

• Identify and briefly describe primary and secondary preventive action to reduce the health burden of aging.

• Briefly describe what population pyramids can tell us about a population.

The Challenge of Population Ageing

• Australian Prime Minister Rudd, in 2010, stated that without significant changes, large, unsustainable budget deficits will be generated, or government services, including health services, will need to be reduced as the needs of an aging population become greater.

Global Health Estimates (GHE)

• Life expectancy, adult mortality, causes of death, and DALYs were assessed from 2000–2015.

Population of Australia

• 1950 Population: 8,177,347

• 2020 Population: 25,499,881

Male and Female Proportions of Population

• By 5-year age groups, data from 1971 & 2021 are compared.

Proportion of Population 65 Years and Older

• 1927: 5%

• 2017: 15%

• 2057: 22%

• The ABS (Australian Bureau of Statistics) has expanded population tables to provide numbers of people at ages 85-89, 100-104, and 105+.

Life Expectancy

• Life expectancy in 1800:

  • Europe: 34 years

  • Americas: 35 years

  • Asia: 28 years

  • Africa: 26 years

  • Oceania: 35 years

  • Global average: ~29 years

• Life expectancy in 1950:

  • Europe: 62 years

  • North America: 68 years

  • Caribbean: 51 years

  • South America: 51 years

  • Asia: 41 years

  • Africa: 38 years

  • Oceania: 61 years

  • Global average: ~46 years

• Life expectancy in 2015:

  • North America: 80 years

  • Europe: 78 years

  • Caribbean: 75 years

  • South America: 75 years

  • Asia: 72 years

  • Africa: 61 years

  • Oceania: 78 years

  • Global average: ~71 years

Life Expectancy by State/Territory (2006-08, 2016-18)

• New South Wales:

  • Males: 79.2 (2006-08), 80.6 (2016-18)

  • Females: 83.9 (2006-08), 84.9 (2016-18)

• Victoria:

  • Males: 79.6 (2006-08), 81.7 (2016-18)

  • Females: 83.9 (2006-08), 85.3 (2016-18)

• Queensland:

  • Males: 78.9 (2006-08), 80.2 (2016-18)

  • Females: 83.7 (2006-08), 84.7 (2016-18)

• South Australia:

  • Males: 79.2 (2006-08), 80.4 (2016-18)

  • Females: 83.8 (2006-08), 84.7 (2016-18)

• Western Australia:

  • Males: 79.3 (2006-08), 80.5 (2016-18)

  • Females: 84.0 (2006-08), 85.1 (2016-18)

• Tasmania:

  • Males: 77.7 (2006-08), 79.3 (2016-18)

  • Females: 82.3 (2006-08), 83.2 (2016-18)

• Northern Territory:

  • Males: 72.6 (2006-08), 75.5 (2016-18)

  • Females: 78.4 (2006-08), 80.2 (2016-18)

• Australian Capital Territory:

  • Males: 80.1 (2006-08), 81.2 (2016-18)

  • Females: 84.0 (2006-08), 85.3 (2016-18)

• Australia:

  • Males: 79.2 (2006-08), 80.7 (2016-18)

  • Females: 83.7 (2006-08), 84.9 (2016-18)

Major Global Health Issues Associated with Ageing

• Communicable diseases: tuberculosis, hepatitis, malaria, dengue, COVID-19, influenza, etc.

• Non-communicable diseases: heart disease, cancers, diabetes, respiratory diseases, Alzheimer’s disease, mental health.

• These lead to a change in our adult and elderly health profile.

Healthy Life Expectancy

• Health expectancy (HE) combines information on health and mortality.

• It is independent of age structure and size of the population.

• Trends in HE should be considered alongside trends in LE (life expectancy).

• Can address theories of compression of morbidity/disability.

• In 2010, healthy life expectancy (HALE) at birth was 71.8 years for women and 68.4 years for men. HALE at age 60 was 17.1 years for women and 15.5 years for men.

• Males:

  • Life expectancy at birth: 79.9 years

  • Expected years with disability: 17.5 years

  • With severe or profound core activity limitation: 5.6 years

  • Expected years without disability: 62.4 years

  • Without severe or profound core activity limitation: 11.8 years

• Females:

  • Life expectancy at birth: 84.3 years

  • Expected years with disability: 19.8 years

  • With severe or profound core activity limitation: 7.8 years

  • Expected years without disability: 64.5 years

  • Without severe or profound core activity limitation: 12.0 years

Number of Years Lived with Disability (at age 65)

• Women (2012):

  • Free of disability: 9.5 years

  • With disability but no severe or profound core activity limitation: 5.8 years

  • With a severe or profound core activity limitation: 6.7 years

• Women (1998):

  • Free of disability: 8.7 years

  • With disability but no severe or profound core activity limitation: 5.6 years

  • With a severe or profound core activity limitation: 5.5 years

• Men (2012):

  • Free of disability: 8.7 years

  • With disability but no severe or profound core activity limitation: 7.1 years

  • With a severe or profound core activity limitation: 3.7 years

• Men (1998):

  • Free of disability: 6.7 years

  • With disability but no severe or profound core activity limitation: 6.0 years

  • With a severe or profound core activity limitation: 3.0 years

• People with a severe or profound core activity limitation always or sometimes require help with communication, mobility, and/or self-care.

Leading Cause of Burden of Disease/Death Changes with Age

• Males:

  • Under 5: Pre-term/low birthweight complications

  • 5-14: Road traffic accidents

  • 15-24: Suicide

  • 25-44: Suicide/Intentional self-harm

  • 45-64: Coronary heart disease

  • 65-74: Coronary heart disease

  • 75-84: Coronary heart disease

  • 85+: Coronary heart disease

• Leading cause of non-fatal burden:

  • Under 5: Asthma

  • 5-14: Asthma

  • 15-24: Alcohol use disorders

  • 25-44: Back pain

  • 45-64: Other musculoskeletal conditions

  • 65-74: Chronic obstructive pulmonary disease

  • 75-84: Coronary heart disease

  • 85+: Dementia

Changing Health Conditions Profile

• Prevalence of selected self-reported health conditions among people aged 55 and over.

• Conditions include diabetes, heart/stroke/vascular disease, hypertensive diseases, arthritis, osteoporosis, and genito-urinary system diseases.

Implications of Ageing on Healthcare

• Greater demand for healthcare.

• Increased costs to governments and individuals.

• Need to respond to changing expectations.

• Enable healthy ageing through primary and secondary prevention.

Healthcare costs

• Admitted patient expenditure by age (2004-05 and 2012-13, adjusted for inflation) shows increasing costs with age.

Annual Costs of Dementia in Australia

• In 2017: 14.67 billion.

• Projected to be 36.85 billion per year by 2056.

Incidence of Dementia

• Meta-analyzed estimates of the incidence of dementia by world region/development status.

• The incidence per 1000 person-years varies by age group (60-64, 65-69, 70-74, 75-79, 80-84, 85-89, 90-94, 95+) and region (High-income countries, Low- and middle-income countries, Europe, North America, Latin America).

End of Life Care

• Important aspects include:

  • Being cared for and dying in a place of choice.

  • Support for important people involved in care.

  • Involvement in and control over decisions about care.

  • Access to high-quality care from well-trained staff.

  • The right people knowing an individual's wishes at the right time.

  • Support for physical, emotional, social, and spiritual needs.

  • Access to the right services when needed.

Healthy Ageing

• Defined as the process of developing and maintaining the functional ability that enables well-being in older age.

• Affected by intrinsic capacity (physical and mental capacities of an individual) and environments(home, community, services, ecosystem, broader society).

What is Needed for Healthy Ageing

• Individual:

  • Age-related changes

  • Behaviours

  • Genetics

  • Disease

• Environment:

  • Housing

  • Assistive technologies

  • Transport

  • Social facilities

Every Older Person is Different

• Some have the level of functioning of a 30-year-old.

• Some require full-time assistance for basic everyday tasks.

• Health is crucial to how we experience older age.

Healthy Ageing Definition

• Healthy ageing involves building and maintaining, for as long as possible, the functional ability that enables older people to be and to do the things they have reason to value.

Health Promotion for Old Age

• Old age requires building resources for later capacity (e.g., maternal nutrition, brain, muscle, bone, blood vessels).

• Reduce damage (e.g., avoiding smoking), protect against damage (e.g., antioxidants), and prevent loss (e.g., exercise).

• Minimize disease, protect against increased demands, and compensate for lost capacity.

Health Promotion in Old Age

• Physical, mental, and social activity.

• No smoking, moderate alcohol.

• Nutrition (vitamins), fluid intake.

• Vaccination, Aspirin.

• Secondary prevention, rehabilitation.

• Quality Use of Medicines (BP, cholesterol, Warfarin).

• Supportive environments.

Health Promotion Messages

• Healthy eating.

• Healthy weight.

• Weight gain.

• Food Safety.

• Hydration/bowel health.

• Oral health.

• Alcohol.

• Smoking.

• Physical activity.

• Social Activity.

• Mental health.

• Active brain.

• Driving for older people.

• Vaccinations.

What is Needed for Healthy Ageing?

• A change in the way we think about ageing and older people.

• Creation of age-friendly environments.

• Alignment of health systems to the needs of older people.

• Development of systems for long-term care.

• Healthy Ageing: Being able to do the things we value for as long as possible.

Why Invest in the Elderly?

• Investment in ageing populations brings returns through:

  • Health systems, leading to health and individual well-being.

  • Long-term care systems, enhancing skills and knowledge.

  • Workforce participation and lifelong learning, boosting mobility and consumption.

  • Age-friendly environments, fostering social connectivity.

  • Social protection, ensuring financial security.

• Benefits include personal dignity, safety and security, innovation, social and cultural contribution, and social cohesion.
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The Triumph and the Challenge of Population Ageing

• Ageing is a universal process.

• Prevalence of disease and disability is likely to increase as a result of population ageing.

• What is needed is a scientific pathway to improved physical health and mental functioning; living longer should be considered a bonus.