Older People - An Introduction

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

111 years, still going strong.

Ageing describes the process of growing old. There are both complicated and simple explanations:

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.
2. Normal ageing is that which occurs without disease.

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; the rising health costs. The two main challenges are:

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, type 2 diabetes) than previous generations.

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. Ab arbitrary division exists with three ages of ‘old’, a starting point for considering the span of old age

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 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 National Service Framework for Older People categorised the three cohorts broadly as:

• 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.
  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).
• 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.
  Goals of health and social care policy: To identify emerging problems pre-crisis, ensuring effective response that prevents crisis and reduces long-term dependency.
• 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.
  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.

An Australian study 2020 investigating pre-frailty and frailty in healthy, independent community-dwelling adults suggests using frailty phenotypes (unintentional weight loss, exhaustion, low physical activity levels, poor handgrip strength, and slow walking speed) to detect pre-frailty in younger community dwellers aged from 40–75 years.

The video below gives a few pertinent points about old age

Life Expectancy

Human life expectancy has increased dramatically. The figures from the United Nations studies show that the percentage of the global population aged 60 years or over increased from 8.6 % in 1980 to 12 % in 2014 and is projected to rise further to 21 % in 2050.

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.  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 life expectancy of 52.9 years (Lesotho) to 84.2 years (Japan). Around the world, women live longer than men whilst wars and disease account for differences between countries.

Evidence from longitudinal studies demonstrates loss of independence from acquired disabilities with a gradual change toward sedentary lifestyles. This insufficient physical activity contributes to disability impacting on the use of social services and healthcare resources.

A series of six 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.

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.

See also Theories of Ageing

Resources

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.