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Describe demographic trends in the first 50 years of the NHS (1948-1996) that account for an increased life expectancy in old age

  • Infant mortality/1000 live births has decreased considerably
  • Proportion of deaths below 65 (eng/wales) have decreased


How has the population structure changed over the last 50 years of the NHS?

  • Overall population increased by 20%
  • 0-4 age - increased by 9%
  • 80+ age - increased by 240%

Older population have grown fastest - by 2007, there were more people over 65 than under 18. The over 85s are fastest growing group, set to double by 2020. 


Which 'group' of people born in the 20th century are contributing to the current ageing population?

Baby boomers - born in late 40s, 50s, 60s - now oldies!


What is a survival curve?

Graphical representation of population survival with age


What is meant by 'squaring of the rectangle' in reference to survival curves?

A steep survival curve (red) is characteristic of populations that do not age or live under such severe conditions that none survive to old age.

A less steep (more horizontal) curve (green) suggests improvements in living conditions + less death.



What are the reasons for squaring the rectangle of survival in the UK?

  • Decreased infant mortality
  • Increased standard of living
  • Improvements in public health
  • Improvements in sanitation
  • Improved diet - 1842 abolition of corn laws allowed importation of cheap American food


Describe the trends in retirement with age/time

  • Expected length of retirement inc 4-8 fold since 1870
  • Nearly all of this due to inc life expectancy rather than early retirement
  • Avg length of retirmenet inc by 5 years between 1981 and 2001 - [substantial, not meagre]. 


Name some chronic disabling diseases that have an exponential relationship with age

  • Stroke
  • Alzheimer's
  • Parkinson's
  • Osteoarthritis 


What factors impact on disability?

  • Isolation + poverty
  • Physiological ageing bringing clinical threshold closer
  • Acute illness -> global impact
  • Chronic illness 


What are the four scenarios in regards to the future of old age and woe?

  1. 1 year of additional woe for every year of life gained (pessimistic)
  2. Less than 1 year of additional woe for one year of life gained (some good/bad)
  3. No additional woe for each year of life gained (things stay same)
  4. Less woe despite life gained: Fries' Compression of morbidity (optimistic)


What is healthy life expectancy (HLE) and how has it changed?

HLE refers to life expectancy but free from limiting long-standing illness, and it has also increased like life expectancy itself. 


What are the Global Health Survey trends (1980-2001)?

  • No overall change in proportion of elderly people reporting their health as good, fairly good or not good
  • Proportion of people reporting long-standing illness has not changed significantly either


Has an ageing population meant that more older people are taking up beds in hospitals?

No - results from a seven-year cohort study in Germany found that use of acute hospital beds does not increase as the population ages. 


What is ageing?

  • Progressive generalised impairment of function
  • Resulting in loss of adaptive response to stress 
  • Growing risk of age related disease
  • Non focal + symptom free 


Frailty is not the same as ageing. What is frailty?

A physiological syndrome characterised by decreased reserve + diminished resistance to stressors, resulting from cumulative decline across multiple physiological systems and causing vulnerability to adverse outcomes. 

Predicts morbidity and mortality. 


What is physical frailty?

Combination of weight loss, fatigue, impaired grip strength, diminished physical activity or a slow gait + loss of muscle. 


What is the relationship between ageing and disease?

  • Disease needs to be identified as it may respond to treatment or be preventable. 
  • Ageing is not reversible but may be compensatable.
  • All changes should not be put down to age. 


Name the 4 Strehler's Concepts that must be required for a true ageing process to occur

  • Universal 
  • Intrinsic
  • Progessive
  • Deleterious 


What is meant by 'universal'?

  • Identifiable in all members of a species
  • May effect individuals to a diff extent
  • Eg. collagen cross links, loss of calcium from bones


What is meant by 'intrinsic'?

  • Restricted to changes of endogenous origin
  • Eg. skin in axilla, hair loss


What is meant by 'progressive'?

  • All changes continue progressively with time
  • Eg. greying of hair, loss of muscle power


What is meant by 'deleterious'?

  • Should be eventually harmful to the organism
  • Eg. reduced visual acuity, loss of hearing


How is ageing different to disease in relation to Strehlers' concepts?


What does J Grimley Evans' theory suggest?

  • Spend a longer time living and shorter time dying
  • Eg. stroke at 90, probably die, if not die then shortly die after anyway - In comparison to stroke at 50, live another 40 years with disability
  • The older the age one attains without becoming disabled the shorter the period of dependency to be expected before death. 
  • Suggests that for disability in later life, postponement of age of onset would result in prevention of suffering 


What reasons underly postponement of disability in old age?

  • Health promotion
  • Illness prevention
  • Appropriate use of existing technologies
  • Technologies around the corner 


Describe problems in drug treatment of older people

  • 10% on contraindicated drugs
  • 6% acute admissions due to inappropriate prescriptions


Name 2 problems in regards to the ageing population

  • Economics of health costs
  • Combating ageism 


Why is keeping older people healthy the cheaper option?

  • Prevention is cheaper than cure
  • Postponement and compression of morbidity is cheaper than community or institutional care for people with chronic disability 


Describe the health expenditure of old age in the UK

  • Age specific need for health care is falling
  • Expenditure on health care always maximal in last year, irrespective of age of death (so the overall spending is increasing)
  • BUT smaller increase in per capita costs for older ages compared w/ younger age groups (but not increasing per individual old person)
  • Combined NHS + hosp/comm services for 85+ has decreased in real per capita costs between 1985 and 1996/99