Department of Health Service & Population Research, King’s College London.
Dr C Kralj, Ms C Daskalopoulou, Professor F Rodríguez-Artalejo, Dr E García-Esquinas, Dr TD Cosco, Professor M Prince, Dr AM Prina on behalf of the ATHLOS consortium.
One of the great challenges of the 21st Century is global population ageing. By 2050 there will for the first time be the same number of old as young in the world – with 2 billion of each – each accounting for 21 per cent of the world’s population. By then not only will countries in Europe and North America have a near third of their populations aged over 60, but middle-income countries will begin to join them: Chile, China, Iran, the Republic of Korea, the Russian Federation, Thailand and Viet Nam. And while low income countries, in particular in the Sub-Saharan African region, will stay young in terms of percentages, it is here that the dramatic growth in the numbers of older adults will occur, reaching 160 million by the middle of the century.
Yet despite this there is still slow progress in addressing the significant health policy challenges of the demographic transition. Health care structures, training and professionalization are limited, geriatric medicine underdeveloped, and support for family and communities to provide informal care is not a priority in many middle and low income countries.
As a recent WHO report (World Report on Ageing and Health 2015) pointed out, there is a need for a comprehensive, global public-health response to population ageing that will transform health systems, but this can only occur with greater understanding of health at older ages and a focused conceptualisation on how it might be improved. This is particularly crucial as around one fifth of the current global burden of disease now arises from conditions developed in those over age 60.
As the Healthy ageing: a systematic review of risk factors argues, ageing pathways may be driven by different life course exposures including lifestyle, biological factors, psychological and social factors. An in-depth understanding of similarities and discrepancies in ageing trajectories among older populations will enable the identification of the most important determinants of health across the life-span. Understanding the life-course factors contributing to late life health and wellbeing is thus essential not only to improve older adults quality of life, but also to mitigate the future expansion of economic costs associated with ill-health. The invaluable 5 year EU funded ATHLOS project commences this study with this systematic review which will play a crucial role in determining this understanding.
Late life biological, environmental and social changes, combine with life course events and behavioural risk factors to influence individual health and wellbeing. Understanding whether people are living longer and healthier lives, or increasingly longer but disabled lives, and the inequalities within our older populations which drive these trajectories is vital for the development of health and social care policies. It is also essential to ensure that all adults, wherever they may live, will have the possibility of long, active contributory lives and appropriate care as and when they become frail and dependent.