Older People - An Introduction: Difference between revisions

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== Introduction ==
== Ageing ==
[[File:Human ageing.jpg|thumb|Human ageing]]
The most widely held view of ageing is that it is just a part of the life cycle. That is a progressive physiological cycle leading to senescence, or a decline of biological functions and of the bodies ability to adapt to metabolic stress. Ageing is also seen as a wide-ranging event being a physical process, a psychological one and a social one. On the upside we acquire positive values, for example knowledge and experience. <ref>Senesienca What is ageing Available:http://www.ub.edu/senesciencia/noticia/what-is-ageing/ (accessed 12.11.2022)</ref>


[http://en.wikipedia.org/wiki/Ageing Ageing] describes the [http://www.who.int/topics/ageing/en/ process of growing old], with both complicated and simple explanations:
Watch this 5 minute video on why we age.{{#ev:youtube|https://www.youtube.com/watch?v=GASaqPv0t0g|width}}<ref>Ted ed Why do our bodies age. Available from: https://www.youtube.com/watch?v=GASaqPv0t0g (last accessed 23.5.2019)</ref>


1……gradual biological impairment of normal function, probably as a result of changes made to cells (mitotic cells, such as fibroblasts and post-mitotic cells, such as neurons) and structural components (such as bone and muscle). These changes would consequently have a direct impact on the functional ability of organs (such as the heart, kidney and lungs), biological systems (such as the nervous, digestive and reproductive system) and ultimately the organism as a whole.
See also [[Theories of Aging|'''Theories of Ageing''']]


2. ……normal ageing is that which occurs without disease.
== Divisions Of The Aged ==
 
[[File:Ageing.jpeg|thumb|Older People]]
[http://en.wikipedia.org/wiki/Ageing_of_Europe The Greying of the Nations]&nbsp;was a common phrase that described the process of a [http://www.eoearth.org/article/human population explosion worldwide population increase], a large proportion of who are [http://en.wikipedia.org/wiki/World_population older adults]. In recognition of this increase, 1999 was designated by the United Nations as [http://www.un.org/ageing/iyop.html The Year of the Older Person]. The expanding populations are impacting on global resources and economies given the cohorts out of work (children or retired people) compared to those in work. Governments are supporting increasing amounts of research to investigate their older populations to use results to provide / estimate the resources required to sustain as healthy a population as possible. The World Health Organisation is making "[http://www.who.int/mediacentre/news/releases/2014/lancet-ageing-series/en/ Ageing well]" a priority with information and research evidence published on its site: [http://www.who.int/ageing/en/ Ageing and Life Course].  
An arbitrary division exists with three ages of ‘old’,  a starting point for considering the span of old age<ref>World Health Organisation. [http://www.searo.who.int/entity/health_situation_trends/data/chi/elderly-population/en/ Health situation and trend assessment: elderly population]. Accessed 26 September 2018.</ref><ref>World Health Organisation. [http://www.who.int/healthinfo/survey/ageingdefnolder/en/ Health statistics and information systems: Proposed working definition of an older person in Africa for the MDS Project]. Accessed 26 September 2018.</ref><ref>The CALAS Team at Tel Aviv University: Cohen-Mansfield J, Shmotkin D, Blumstein Z, Shorek A, Eyal N, Hazan H. [http://journals.sagepub.com/doi/abs/10.2190/AG.77.1.c?journalCode=ahdb The Old, Old-Old, and the Oldest Old: Continuation or Distinct Categories? An Examination of the Relationship between Age and Changes in Health, Function, and Wellbeing].  Int J Aging Hum Dev2013; 77 (1): 37-57.
 
</ref>  
There are recognised age differentials between mortality in the developed and the developing countries, however on average, the older adult group span a 20 - 30 year period. The need to survey populations for census work and research has led to an arbitrary division of this group into '''three ages of ‘old’, '''based in part on retirement ages, and in part on the development of co-morbidity leading to frailty:<br>  


#Between 60 – 75 years = young old  
#Between 60 – 75 years = young old  
Line 20: Line 21:
#Those 85+ are considered the frail older population
#Those 85+ are considered the frail older population


As populations age, it will be of interest to see if these age bands alter.  
As populations age, it will be of interest to see if these age bands alter.  


&nbsp;The divisions confirm older people to be a varied group requiring consideration according to their needs. In 2001 policy from the United Kingdom in the form of the [http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4003066 National Service Framework for Older People]<ref name="NSF OP">Department of Health (2001). National Service Framework for Older People. London, HMSO</ref> categorised the three cohorts broadly as:  
The National Service Framework for Older People<ref name="NSF OP">Department of Health (2001). [https://www.gov.uk/government/publications/quality-standards-for-care-services-for-older-people National Service Framework for Older People]. London, HMSO. Accessed 26 September 2018.</ref> (UK 2001) categorised three groups:  


*'''Entering old age:''' People from 50 to the official retirement age who have completed their career. They are supposed active and independent and many remain so into late old age.<br>''Goals of health and social care policy: To promote and extend healthy active life, and compress morbidity (the period spent in frailty and dependency before death).''
#Entering old age: People from 50 to the official retirement age who have completed their career. They are supposed active and independent and many remain so into late old age.
*'''Transitional phase''': A group in transition between healthy, active life and frailty, often occurring in the seventh or eighth decades, but can occur at any stage.<br>''Goals of health and social care policy: To identify emerging problems pre-crisis, ensuring effective response that prevents crisis and reduces long-term dependency.''
#Transitional phase: A group in transition between healthy, active life and frailty, often occurring in the seventh or eighth decades, but can occur at any stage.
*'''Frail older people''': A vulnerable group due to health problems e.g. stroke or dementia, social care needs or a combination of both. Frailty often experienced in late old age, so services people should be designed with their needs in mind.<br>''Goals of health and social care policy: To anticipate and respond to problems, recognising the complex interaction of physical, mental and social care factors which can compromise independence and quality of life.
#Frail older people: A vulnerable group due to health problems e.g. stroke or dementia, social care needs or a combination of both. [[Introduction to Frailty|Frailty]] often experienced in late old age, so services people should be designed with their needs in mind.<br>


There are several resources with interactive graphics to view different data and statistics on ageing health and populations:
== Views On Ageing ==
Traditionally, ageing was viewed as a negative process, leading to loss 0f social, physical and cognitive domains. In the 1980′s the views on ageing changed, with a more positive outlook on ageing, including a focus on successful ageing. However a new construct of ageing is emerging. In reality ageing for most older persons includes adversities such as illness, disability, loneliness, and [[Cognitive Impairments|cognitive impairment]]. Resilience in ageing is now viewed a  being a critical factor. Resilience allows  older persons to deal with, or doing well despite adversities; a goal that can be achieved regardless of the circumstances. This construct is considered a positive and more general one, that does justice to the reality of ageing: a complex process with a mix of gains and losses.<ref>Angevaare MJ, Roberts J, van Hout HP, Joling KJ, Smalbrugge M, Schoonmade LJ, Windle G, Hertogh CM. Resilience in older persons: A systematic review of the conceptual literature. Ageing research reviews. 2020 Nov 1;63:101144.Available: https://www.sciencedirect.com/science/article/pii/S1568163720302798?via%3Dihub<nowiki/>(accessed 12.11.2022)</ref>


#Max Roser (2015) – ‘[http://ourworldindata.org/data/population-growth-vital-statistics/life-expectancy/  Life Expectancy]’. Published online at OurWorldInData.org&nbsp;
We can however take steps to have a healthy, longer life. See the video below.
#United nations pages: Health data and general statistics about each country can be found on the United Nations Global Health Observatory (GHO) [http://www.who.int/gho/countries/en/ data pages]
{{#ev:youtube|https://www.youtube.com/watch?v=qSt8aKtpDCA|width}}<ref>Scripps Research The Science of Healthy Aging: Six Keys to a Long, Healthy Life Available from: https://www.youtube.com/watch?v=qSt8aKtpDCA (last accessed 12.11.2022)</ref>
#The [http://www.gapminder.org/world/#$majorMode=map$is;shi=t;ly=2003;lb=f;il=t;fs=11;al=30;stl=f;st=f;nsl=t;se=t$wst;tts=C$ts;sp=5.59290322580644;ti=2050$zpv;v=1$inc_x;mmid=XCOORDS;iid=rsOONWhmGBtzb4j__0MJv7Q;by=const$inc_y;mmid=YCOORDS;iid=rH6TEe8f_WNq_8x9pWZ3W0A;by=const$inc_s;uniValue=8.21;iid=rVD6A2uAmeIE0BQNW1KSg3A;by=ind$inc_c;uniValue=255;gid=CATID0;by=grp$map_s;sma=49;smi=2.65$cd;bd=0$inds=i14_r,,,,,, Gapminder graphic]&nbsp;illustrates the demographic changes of global populations over the age of 60, and their pattern of growth from 1950 – a predicted older population in 2050.
== Life Expectancy ==
#[http://www.helpage.org/resources/ageing-data/global-ageing-statistics/ Help Age International] pages.<br>
[[File:Life-expectancy.png|thumb|513x513px|Life expectancy 1543 to 2019]]
Human life expectancy has increased dramatically<ref>Lutz W, Sanderson WC, Scherbov S. Global and regional population ageing: How certain are we of its dimensions? Population Ageing. 2008; 1 (1): 75-97.</ref>. Estimates suggest that in a pre-modern world, life expectancy was around 30 years in all regions of the world. Since 1900 the global average life expectancy has increased by more than 50%, and is now above 70 years. The imbalance of life expectancy is great across and within countries. eg in 2019 the country with the lowest life expectancy is the Central African Republic with 53 years, in Japan life expectancy is 83.<ref>Our world in data Life expectancy Available:https://ourworldindata.org/life-expectancy (accessed 11.11.2022)</ref>


== Demographics (study of population size, density, distribution and statistics)<br>  ==
The ageing of the population will have far-reaching implications for society. Direct challenges for the health system will consist of: changing health profiles; increased demand for health service use; rising health costs. The main challenges will be:
# The rapidly growing group of ‘old old’ (85 and over) people who have a variety of typical age-related health problems (eg., [[arthritis]], [[dementia]] and [[Oncology|cancer]])
# The younger group entering the ‘65 and over’ age bracket with a larger burden of lifestyle related diseases (eg, [[obesity]], [[Metabolic Syndrome|metabolic syndrome]], [[Diabetes Mellitus Type 2|type 2 diabetes]]) than previous generations.


[http://www.un.org/NewLinks/older/99/older.htm Human life expectancy] has increased dramatically. The first documented case of a 100 year old was in 1800 compared to the 11,000 centenarians recorded in the 2001 UK Census - the fastest growing section of the UK population (Figure 1).<br>  
== Digital Technologies and Ageing ==
The below video details "Digital technologies for older persons and healthy ageing" details how digital technologies can empower the older person.{{#ev:youtube|v=Vrg51jT31GA|300}}<ref>ITU Digital technologies for older persons and healthy ageing.. The Evolution of Dance. Available from:https://www.youtube.com/watch?v=Vrg51jT31GA [last accessed 12.11.2022]</ref>


'''Figure 1''': Fastest increase in the ‘oldest old’<ref>Population by age, gender, countries or UK wide national statistics online at http://www.statistics.gov.uk/</ref><br>
== Physiotherapy Implications ==
For [[Physiotherapy and Older People|physiotherapists working with the older population,]] one goal is the facilitation of an individual's'''&nbsp;'''later years to be active and a time of good health, although for some people it is a period of loss of health, wealth and status due to retirement from work, or loss from bereavement.


[[Image:Oldest old.jpg|frame|center]]  
Although no amount of [[Physical Activity|physical activity]] can stop the biological ageing process, there is evidence that regular [[Therapeutic Exercise|exercise]] can minimize the physiological effects of an otherwise sedentary lifestyle and increase active life expectancy by limiting the development and progression of [[Chronic Disease|chronic disease]] and disabling conditions. There is also emerging evidence for significant psychological and [[Cognitive Impairments|cognitive]] benefits accruing from regular exercise participation by older adults.


== <br>Life expectancy<br>  ==
Ideally, [[Principles of Exercise|exercise prescription]] for older adults should include [[Aerobic Exercise|aerobic]] exercise, muscle [[Strength Training|strengthening]] exercises, and [[flexibility]] exercises.<ref>[[Age and Exercise]]</ref><br>
 
The average life expectancy in the UK for females is 83.7 years, and for males is 77.5 years (National statistics online figures for 2006 – 8) although wide variations exist in different parts of the UK. The worldwide range of life expectancy spans from 36 years (Afghanistan) to 76 years (Japan).
 
Improvements in extrinsic (environmental) factors over the last century have enhanced the health of the population. The fall in the death rates at older ages contribute the most to the increase in the number of older people with increasing average life expectancy mainly from:<br>
 
*A reduction of child mortality<br>
*Biomedical advances, e.g. discovery of antibiotics<br>
*Improvement in sanitation and public health measures<br>
*Change in life habits<br>
*Improvement in socio-economic conditions.
 
In the UK, the number of people aged over 65 has doubled in the past 70 years, and those aged over 90 will double in the next 25 years. In 2002, there were 19.8 million people aged over 50 in the UK (Figure 2), of which over 11 million were over 60.
 
The trend of growth of older adults in developed countries is gradually slowing but continues in the developing countries. By the year 2030 most countries are expected to have similar age structures. '''The predicted social impact of the ageing population''' is that Western societies will develop a large group of affluent elderly voters with disposable income<ref name="Restrepo">Restrepo H, Rozental M (1994). The social impact of aging populations: some major issues. Soc. Sci. Me; 39 (9); 1323-1338</ref>. This is notable during major elections in the West where political parties actively seek to discuss the needs of older citizens. Despite what has just been stated, there exists a contradictory expansion between the rich and poor in many countries, and between those in better and worse states of health. Overall the older population fall into the latter categories of these issues with a correlated impact on the health of the nation as conditions like heart disease, diabetes and obesity rise<ref name="Marmot">Marmot M, Banks J, Blundell R, Lessof C, Nazroo J eds (2003). Health, wealth and lifestyles of the older population in England: The 2002 English longitudinal study of ageing. Institute for Fiscal Studies, London, UK. ISBN 1903274346</ref> <ref name="Bardasi">Bardasi E, Jenkins S (2002). Work history and income in later life. Joseph Rowntree Foundation: Accessed at: http://www.jrf.org.uk/publications/work-history-and-income-later-life 10.06.2010</ref>&nbsp;<ref name="Verbrugge">Verbrugge L, Gruber-Baldini A, Fozard J (1996). Age Differences and Age Changes in Activities: Baltimore Longitudinal Study of Aging. Journal of Gerontology: Social Sciences 51 B (1); S3O-S41</ref>.
 
'''Figure 2'''. UK Population: by gender and age, 2002, United Kingdom<ref>National Statistics online. Accessible at http://www.statistics.gov.uk/</ref><br>
 
[[Image:UK population.jpg|frame|center]]  
 
Evidence from longitudinal studies demonstrates loss of independence from acquired disabilities with a gradual change toward sedentary lifestyles<ref name="Marmot" /> <ref name="Verbrugge" />. This insufficient physical activity contributes to disability impacting on the use of social services and healthcare resources.
 
Remember though, '''for many people, their later years will be active and a time of good health''', although for some people it is a period of loss of health, wealth and status due to retirement from work, or loss from bereavement.
<div class="discussionpointbox">
'''Discussion Point'''
 
In developed countries, a decrease in population life expectancy is predicted. This is due to a combination of sedentary lifestyles and poor diet choice increasing the likelihood of high-risk diseases. These include heart disease and diabetes or stress related and mental health disorders. What is your experience or thoughts about this statement?
</div>
If you think the ageing population is only of concern to physiotherapists specialising in older people, think again! Table 1 records bi-yearly number of 60+ year olds admitted to a Sheffield Teaching Hospital (1999–2009) as a percentage of total admissions by speciality. Note the increasing trend of admissions of people over 60.
 
'''Table 1.''' Percentage of over 60’s admitted to Northern General Hospital (Figures reproduced with permission from the Northern General Hospital, Sheffield Teaching Hospitals Trust)
 
{| width="600" cellspacing="1" cellpadding="1" border="1" align="center"
|-
| '''Speciality Description'''
| '''1999<br>(%&gt;60)'''
| '''2001'''
| '''2003'''
| '''2005'''
| '''2007'''
| '''2009'''
|-
| Burns
| 17
| 13.3
| 15.1
| 12.9
| 22.4
| 18.6
|-
| Cardiology
| 57
| 59.0
| 60.8
| 60.4
| 61.9
| 62.1
|-
| Cardio-thoracic Sx
| 57
| 58.9
| 62.4
| 66.3
| 59.5
| 68.8
|-
| General / chest Medicine
| 60
| 64.5
| 65.2
| 75.4
| 67.7
| 56.2
|-
| General Surgery
| 44
| 40.0
| 40.5
| 39.4
| 40.1
| 39.0
|-
| Heart Transplant
| 27
| 28.0
| 35.4
| 55.8
| 53.3
| 100
|-
| Nephrology
| 42
| 43.3
| 50.1
| 56.5
| 59.8
| 63.8
|-
| Orthopaedics
| 40
| 41.4
| 44.5
| 45.2
| 45.6
| 45.9
|-
| Plastic Surgery
| 27
| 31.3
| 30.3
| 31.6
| 29.4
| 35.4
|-
| Rehabilitation
| 19
| 13.5
| 28.1
| 8.6
| 31.7
| 16.1
|-
| Spinal Disabilities
| 19
| 7.9
| 5.9
| 9.5
| 13.4
| 17.1
|-
| Spinal Injuries
| 18
| 21.9
| 23.8
| 21.3
| 22.1
| 26.0
|-
| Vascular Surgery
| 61
| 64.4
| 59.0
| 51.6
| 53.9
| 60.5
|-
| Average
| 37.54
| 37.49
| 40.1
| 41.11
| 43.12
| 46.88
|}
 
These people should receive the same level of service and care as anyone else. For example, those with co-morbidity and disability associated with ageing will require effective rehabilitation compared with those who have a laceration only following a fall; their intervention will be minimal before discharge.  
<div class="discussionpointbox">
'''Discussion Point'''
 
Evidence (mainly literature about musculo-skeletal physiotherapy or from monitoring demographics of hospital readmissions) illustrates a correlation between poor outcome from intervention and people in the lower socio-economic sectors of society (includes the older population). In striving to provide evidence of efficacy, at what point should we consider whether our input to such groups of our population is ineffective? Think about these both in terms of value through satisfaction of the individual receiving therapy, as well as the cost, given our finite resources of numbers of therapists and budget?
</div>  
'''Next page - '''[[Theories of Aging|'''Theories of Aging''']]<br>  


== Resources ==
There are several resources with interactive graphics to view different data and statistics on ageing health and populations:
#[http://ourworldindata.org/data/population-growth-vital-statistics/life-expectancy/ Life Expectancy] by Max Roser (2015).
#United Nations Global Health Observatory (GHO) [http://www.who.int/gho/countries/en/ data pages] which give health data and general statistics about each country.   
#The [https://www.gapminder.org/tools/#$state$time$value=2050&delay:276.2838709677424;&marker$select@$geo=aut;;&size$which=population_aged_60plus_years_total_number&domainMin:null&domainMax:null&extent@:0.022083333333333333&:0.4083333333333333;;&color$which=world_6region;;;&chart-type=map Gapminder graphic] which&nbsp;illustrates the demographic changes of global populations over the age of 60, and their pattern of growth from 1950 to a predicted older population in 2050.
#[http://www.helpage.org/resources/ageing-data/global-ageing-statistics/ Help Age International] pages.
== References  ==
== References  ==
Department of Health (2001). National Service Framework for Older People. London, HMSO<br>
<references />  
<references />  


[[Category:Older_People/Geriatrics]]
[[Category:Older_People/Geriatrics]]
[[Category:Occupational Health]]
[[Category:Older People/Geriatrics - Anatomy]]
[[Category:Older People/Geriatrics - Conditions]]
[[Category:Conditions]]
[[Category:Anatomy]]
[[Category:AGILE Project]]

Latest revision as of 11:16, 17 February 2023

Ageing[edit | edit source]

Human ageing

The most widely held view of ageing is that it is just a part of the life cycle. That is a progressive physiological cycle leading to senescence, or a decline of biological functions and of the bodies ability to adapt to metabolic stress. Ageing is also seen as a wide-ranging event being a physical process, a psychological one and a social one. On the upside we acquire positive values, for example knowledge and experience. [1]

Watch this 5 minute video on why we age.

[2]

See also Theories of Ageing

Divisions Of The Aged[edit | edit source]

Older People

An arbitrary division exists with three ages of ‘old’, a starting point for considering the span of old age[3][4][5]

  1. Between 60 – 75 years = young old
  2. Between 75 – 85 years = old
  3. Those 85+ are considered the frail older population

As populations age, it will be of interest to see if these age bands alter.

The National Service Framework for Older People[6] (UK 2001) categorised three groups:

  1. Entering old age: People from 50 to the official retirement age who have completed their career. They are supposed active and independent and many remain so into late old age.
  2. Transitional phase: A group in transition between healthy, active life and frailty, often occurring in the seventh or eighth decades, but can occur at any stage.
  3. Frail older people: A vulnerable group due to health problems e.g. stroke or dementia, social care needs or a combination of both. Frailty often experienced in late old age, so services people should be designed with their needs in mind.

Views On Ageing[edit | edit source]

Traditionally, ageing was viewed as a negative process, leading to loss 0f social, physical and cognitive domains. In the 1980′s the views on ageing changed, with a more positive outlook on ageing, including a focus on successful ageing. However a new construct of ageing is emerging. In reality ageing for most older persons includes adversities such as illness, disability, loneliness, and cognitive impairment. Resilience in ageing is now viewed a being a critical factor. Resilience allows older persons to deal with, or doing well despite adversities; a goal that can be achieved regardless of the circumstances. This construct is considered a positive and more general one, that does justice to the reality of ageing: a complex process with a mix of gains and losses.[7]

We can however take steps to have a healthy, longer life. See the video below.

[8]

Life Expectancy[edit | edit source]

Life expectancy 1543 to 2019

Human life expectancy has increased dramatically[9]. Estimates suggest that in a pre-modern world, life expectancy was around 30 years in all regions of the world. Since 1900 the global average life expectancy has increased by more than 50%, and is now above 70 years. The imbalance of life expectancy is great across and within countries. eg in 2019 the country with the lowest life expectancy is the Central African Republic with 53 years, in Japan life expectancy is 83.[10]

The ageing of the population will have far-reaching implications for society. Direct challenges for the health system will consist of: changing health profiles; increased demand for health service use; rising health costs. The main challenges will be:

  1. The rapidly growing group of ‘old old’ (85 and over) people who have a variety of typical age-related health problems (eg., arthritis, dementia and cancer)
  2. The younger group entering the ‘65 and over’ age bracket with a larger burden of lifestyle related diseases (eg, obesity, metabolic syndrome, type 2 diabetes) than previous generations.

Digital Technologies and Ageing[edit | edit source]

The below video details "Digital technologies for older persons and healthy ageing" details how digital technologies can empower the older person.

[11]

Physiotherapy Implications[edit | edit source]

For physiotherapists working with the older population, one goal is the facilitation of an individual's later years to be active and a time of good health, although for some people it is a period of loss of health, wealth and status due to retirement from work, or loss from bereavement.

Although no amount of physical activity can stop the biological ageing process, there is evidence that regular exercise can minimize the physiological effects of an otherwise sedentary lifestyle and increase active life expectancy by limiting the development and progression of chronic disease and disabling conditions. There is also emerging evidence for significant psychological and cognitive benefits accruing from regular exercise participation by older adults.

Ideally, exercise prescription for older adults should include aerobic exercise, muscle strengthening exercises, and flexibility exercises.[12]

Resources[edit | edit source]

There are several resources with interactive graphics to view different data and statistics on ageing health and populations:

  1. Life Expectancy by Max Roser (2015).
  2. United Nations Global Health Observatory (GHO) data pages which give health data and general statistics about each country.
  3. The Gapminder graphic which illustrates the demographic changes of global populations over the age of 60, and their pattern of growth from 1950 to a predicted older population in 2050.
  4. Help Age International pages.

References[edit | edit source]

  1. Senesienca What is ageing Available:http://www.ub.edu/senesciencia/noticia/what-is-ageing/ (accessed 12.11.2022)
  2. Ted ed Why do our bodies age. Available from: https://www.youtube.com/watch?v=GASaqPv0t0g (last accessed 23.5.2019)
  3. World Health Organisation. Health situation and trend assessment: elderly population. Accessed 26 September 2018.
  4. World Health Organisation. Health statistics and information systems: Proposed working definition of an older person in Africa for the MDS Project. Accessed 26 September 2018.
  5. The CALAS Team at Tel Aviv University: Cohen-Mansfield J, Shmotkin D, Blumstein Z, Shorek A, Eyal N, Hazan H. The Old, Old-Old, and the Oldest Old: Continuation or Distinct Categories? An Examination of the Relationship between Age and Changes in Health, Function, and Wellbeing. Int J Aging Hum Dev2013; 77 (1): 37-57.
  6. Department of Health (2001). National Service Framework for Older People. London, HMSO. Accessed 26 September 2018.
  7. Angevaare MJ, Roberts J, van Hout HP, Joling KJ, Smalbrugge M, Schoonmade LJ, Windle G, Hertogh CM. Resilience in older persons: A systematic review of the conceptual literature. Ageing research reviews. 2020 Nov 1;63:101144.Available: https://www.sciencedirect.com/science/article/pii/S1568163720302798?via%3Dihub(accessed 12.11.2022)
  8. Scripps Research The Science of Healthy Aging: Six Keys to a Long, Healthy Life Available from: https://www.youtube.com/watch?v=qSt8aKtpDCA (last accessed 12.11.2022)
  9. Lutz W, Sanderson WC, Scherbov S. Global and regional population ageing: How certain are we of its dimensions? Population Ageing. 2008; 1 (1): 75-97.
  10. Our world in data Life expectancy Available:https://ourworldindata.org/life-expectancy (accessed 11.11.2022)
  11. ITU Digital technologies for older persons and healthy ageing.. The Evolution of Dance. Available from:https://www.youtube.com/watch?v=Vrg51jT31GA [last accessed 12.11.2022]
  12. Age and Exercise