Older People - An Introduction: Difference between revisions

No edit summary
m (Text replacement - "[[Cognitive Deficits" to "[[Cognitive Impairments")
 
(31 intermediate revisions by 6 users not shown)
Line 3: Line 3:


'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}    
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}    
</div>  
</div>
== 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]. There are  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>
# Gradual [[Theories of Aging|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.
# Normal ageing is that which occurs without disease.
‘The Greying of the Nations<ref>Hayutin AM. [http://longevity3.stanford.edu/wp-content/uploads/2012/10/PPAR-Graying_of_the_Global_Population_Jan_20081.pdf The graying of the global population]. Public Policy Aging Rep. 2008; 17(4): 12-17. Accessed 26 September 2018.</ref>&nbsp;was a common phrase that described the process of a [https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html significant worldwide increase in the population] , 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 [https://www.un.org/development/desa/ageing/resources/international-year-of-older-persons-1999.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].


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. Defining cut off points for each "age" has been challenging and remains without consensus with researchers suggesting different cut offs<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.
See also [[Theories of Aging|'''Theories of Ageing''']]
</ref>.


The following is a starting point for considering the span of old age:  
== Divisions Of The Aged ==
[[File:Ageing.jpeg|thumb|Older People]]
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>


#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. ''<br>
#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>


== Demographics (study of population size, density, distribution and statistics)   ==
== 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>


[http://www.un.org/NewLinks/older/99/older.htm Human life expectancy] has increased dramatically<ref>Lutz W, Sanderson WC, Scherbov S, Population Ageing, 1(1): 75-97 March 2008</ref>, as can be seen in the resources above. The figures from the [http://www.un.org/en/development/desa/population/publications/pdf/popfacts/PopFacts_2014-4.pdf United Nations studies] show that the percentage of the global population aged 60 years or over increased from 8.6&nbsp;% in 1980 to 12&nbsp;% in 2014 and is projected to rise further to 21&nbsp;% in 2050.<br>  
We can however take steps to have a healthy, longer life. See the video below.
{{#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>
== Life Expectancy ==
[[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>


Each country records its growth in populations differently. For example, in the UK, 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).  
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.


<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>


[[Image:Oldest old.jpg|frame|center]]                                                                                                     '''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>
== 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.


==  Life expectancy ==
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.


Life expectancy at birth reflects the overall mortality level of a population by providing a summary of mortality pattern across all age groups in a given year.&nbsp; It has increased rapidly since the onset of industrialisation and modernisation, prior to which life expectancy averaged 30 years. In 2016, however, life expectancy at birth for both sexes globally was 72 years, with a span of&nbsp;life expectancy of 52.9 years (Lesotho) to 84.2 years (Japan)<ref>United Nations Global Health Observatory. 2016. [http://www.who.int/gho/mortality_burden_disease/life_tables/situation_trends/en/ Life Expectancy]. Accessed 26 September 2018.</ref>. Women live longer than men all around the world whilst wars and disease account for differences between countries. 
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>
 
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.
 
A series of six [http://www.thelancet.com/series/ageing articles on Ageing] has been written in The Lancet to highlight what they call "a neglected area in the health sector and in social and economic-policy development". The papers address issues related to mortality, morbidity and disability, wellbeing, and potential health-system responses. <br>
 
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.
{| class="wikitable"
!Discussion Points
|-
|1. 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 [[Cardiovascular Disease|heart disease]] and [[diabetes]] or stress related and [[Mental Health Outcome Measures (for Physiotherapists in clinical practice)|mental health]] disorders. What is your experience or thoughts about this statement? You may wish to read a Blog by Josh Mitteldorf called ‘[http://joshmitteldorf.scienceblog.com/2012/12/17/rising-life-expectancy-but-not-in-the-us/ Playing the game for a longer life]’ to help you debate this issue.
|-
|2. 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 class="discussionpointbox">
'''Discussion Point 1'''
 
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 [[Cardiovascular Disease|heart disease]] and [[diabetes]] or stress related and [[Mental Health Outcome Measures (for Physiotherapists in clinical practice)|mental health]] disorders. What is your experience or thoughts about this statement?
 
You may wish to read a Blog by Josh Mitteldorf called ‘[http://joshmitteldorf.scienceblog.com/2012/12/17/rising-life-expectancy-but-not-in-the-us/ Playing the game for a longer life]’ to help you debate this issue.
</div> <div class="discussionpointbox">
'''Discussion Point 2'''
 
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 Ageing''']]<br>


== Resources ==
== Resources ==
Line 77: Line 62:


[[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

Original Editor - Bhanu Ramaswamy as part of the AGILE Project.

Top Contributors - Admin, Bhanu Ramaswamy, Lucinda hampton, Lauren Lopez, Wendy Walker, Kim Jackson, Rachael Lowe, Vidya Acharya and Amrita Patro  

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
Retrieved from "https://www.physio-pedia.com/index.php?title=Older_People_-_An_Introduction&oldid=327295"