Health and ageing in the developing world

Although ageing is not yet a high priority tissue for health planners, policy makers and clinicians in most developing countries there will be a growing need in coming years to pay more attention to the important health issues associated with population ageing in the developing world. This paper reports some of the relevant findings of a cross-national study (sponsored by the World Health Organization) of the health and social aspects of ageing in four developing countries--Republic of Korea, the Philippines, Fiji and Malaysia. The key findings are compared and contrasted with those of a similar eleven-country WHO study in Europe. In very broad terms, the overall demographic, physical, mental health and social patterns and trends associated with ageing as demonstrated by age-group and sex differences were consistent throughout the four countries studied. Comparisons with European findings in other similar studies underlined the fundamental universality of age-related changes in biophysical, behavioural and social characteristics. The importance of the family in developing countries was evident, with about three-quarters of those aged 60 and over in the four countries living with children, often in extended family situations. Levels of adverse health-related behaviour and the prospect of changing patterns of morbidity with further increases in the total and proportional numbers of aged persons point to a need for emphasis on preventive health measures and programmes directed to the maintenance of the physical and mental health of the ageing population.

Relative androgen deficiency in relation to obesity and metabolic status in older men

BACKGROUND

Although androgen deficiency in men has been linked with obesity and the metabolic syndrome, whether it predisposes to, or is a consequence of, type 2 diabetes mellitus (T2DM) is still unclear.

OBJECTIVE

To determine the relationship between plasma androgen levels, obesity, metabolic status and T2DM in men of 70 years or older.

DESIGN AND METHODS

A sample of 195 men from the Australian Longitudinal Study of Ageing with a mean age of 76.2 +/- 0.3 years were followed up for 8 years. Total testosterone (TT), fasting plasma glucose (FPG), urate, serum creatinine, total cholesterol (TC), HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), triglycerides (TG), blood pressure (BP), body mass index (BMI), waist circumference (WC) and diabetic status were assessed at baseline. Self-reported diabetic status was obtained after 8 years. Metabolic syndrome was diagnosed based on the Third National Cholesterol Education Program Adult Treatment Panel clinical criteria.

RESULTS

TT levels were lower in diabetic men compared with non-diabetic men (12.1 +/- 0.7 vs. 14.2 +/- 0.4 nmol/l, p = 0.026). TT levels in healthy, non-diabetic men over 80 years of age were lower (11.9 +/- 0.8 vs. 15.0 +/- 0.5 nmol/l, p = 0.002) than TT levels in those aged 70-79 years, inversely related to BMI (r = -0.26, p = 0.001), WC (r = -0.30, p < 0.001) and TG (r = -0.22, p = 0.005) and positively related to LDL-C (r = 0.25, p = 0.002). Men with the metabolic syndrome had significantly lower levels of TT and HDL-C, and higher values of BP, FPG, TG, BMI and WC, compared with those without. However, no significant difference in plasma TT levels was noted between men with incident T2Dm and healthy men. Stepwise linear regression analysis revealed that only LDL-C and WC related significantly to the variance of TT. Multiple logistic regression revealed FPG to be the only independent predictor of incident diabetes (odds ratio = 60.2, p = 0.003).

CONCLUSIONS

Testosterone levels continue to decline even in healthy men over the age of 80 years. Although TT levels were inversely related to visceral obesity and several components of the metabolic syndrome, our data do not support a predictive or causative role for decreasing TT levels in the development of incident T2Dm. Androgen deficiency is consequent upon, rather than a cause of, poor metabolic status.

Demographic and health issues in rural aging: a global perspective

The world is witnessing unprecedented changes in population structure, so that both the absolute number and proportion of older people are increasing worldwide. For many developing countries, rapid population aging and the phenomenon of a "double burden" of both infectious disease and emerging chronic diseases represent a major challenge. Many of those who will contribute to these extraordinary transitions will live in rural areas. Many countries, especially the poorest, still have a huge burden of infectious diseases, including increasing rates of HIV/AIDS along with a growing problem of chronic diseases. A number of critical policy considerations come to the fore in examining issues associated with rural aging, including: the need for rural development policies that take account of population aging and the needs of older people; improved coordination and integration of public health and care services in rural areas; support for nongovernmental organizations and community group efforts; and greater use of new technologies for communication. The year 1999 was pivotal for aging in terms of perceptions, attitudes, public action, better research and knowledge, and improved policy decisions that will benefit all of society into this new century. The Second United Nations World Assembly to be held in Madrid in April 2002 will provide further opportunity to build upon this progress and in the formulation of a new International Plan of Action on Aging to point the way for decisive action on positive policy and program initiatives for the future.

The priority of basic research on ageing vulnerability in a comprehensive research agenda on ageing for the 21st century

The prospects for individual and population ageing as we enter a new century pose some of the greatest social, economic and humanitarian challenges humankind as a whole has ever faced. The basic biological mechanisms that control human ageing remain ill understood but it is clear that for many individuals exhibiting predisposition to risk factors for certain chronic diseases, such as coronary heart disease, diabetes, osteoporosis, certain cancers and Alzheimer's disease, such predisposition is mediated through genetic processes that operate at a most fundamental biomolecular level interacting with nongenetic attributes. The prospect of improved understanding of the fundamental processes underlying the pathogenesis of common age-related diseases that may lead to identification of interventions that are effective in preventing, delaying or ameliorating the diseases and their consequences is compelling. It is this prospect that provides the prime justification for giving high priority to research on ageing vulnerability in a comprehensive research agenda on ageing for the 21st century.

Demographic, health, cognitive, and sensory variables as predictors of mortality in very old adults

Cognitive and sensorimotor predictors of mortality were examined in the Australian Longitudinal Study of Ageing, controlling for demographic and health variables. A stratified random sample of 1,947 males and females aged 70 and older were interviewed, and 1,500 were assessed on measures of health, memory. verbal ability, processing speed, vision, hearing, and grip strength in 1992 and 1994. Analyses of incident rate ratios for mortality over 4- and 6-year periods were conducted using Cox hierarchical regression analyses. Results showed that poor performance on nearly all cognitive variables was associated with mortality, but many of these effects were explained by measures of self-rated health and disease. Significant decline in hearing and cognitive performance also predicted mortality as did incomplete data at Wave 1. Results suggest that poor cognitive performance and cognitive decline in very old adults reflect both biological aging and disease processes.

The effectiveness of exercise training in lowering blood pressure: a meta-analysis of randomised controlled trials of 4 weeks or longer

OBJECTIVE

To identify the features of an optimal exercise programme in terms of type of exercise, intensity and frequency that would maximise the training induced decrease in blood pressure (BP).

DATA IDENTIFICATION

Trials were identified by a systematic search of Medline, Embase and Science Citation Index (SCI), previous review articles and the references of relevant trials, from 1980 until 1996, including only English language studies.

STUDY SELECTION

The inclusion criteria were limited to randomised controlled trials of aerobic or resistance exercise training conducted over a minimum of 4 weeks where systolic and diastolic BP was measured.

RESULTS

A total of 29 studies (1533 hypertensive and normotensive participants) were included, 26 used aerobic exercise training, two trials used resistance training and one study had both resistance and aerobic training groups. Aerobic exercise training reduced systolic BP by 4.7 mm Hg (95% CI: 4.4, 5.0) and diastolic BP by 3.1 mm Hg (95% CI: 3.0, 3.3) as compared to a non-exercising control group, however, significant heterogeneity was observed between trials in the analysis. The BP reduction seen with aerobic exercise training was independent of the intensity of exercise and the number of exercise sessions per week. The evidence for the effect of resistance exercise training was inconclusive.

CONCLUSIONS

Aerobic exercise training had a small but clinically significant effect in reducing systolic and diastolic BP. Increasing exercise intensity above 70% VO2 max or increasing exercise frequency to more than three sessions per week did not have any additional impact on reducing BP.

Factors associated with falling in older Adelaide residents

The aim of this study was to identify characteristics that predispose older residents of Adelaide to falling. Information collected in the baseline phase of the Australian Longitudinal Study of Ageing was used to draw cross-sectional comparisons between participants who reported having fallen on at least one occasion in the previous 12 months and those participants who reported not having fallen. The baseline cohort consisted of 1947 participants aged 70 years or more, of whom 550 (28 per cent) reported having fallen at least once in the previous year. Independent risk factors for falling were: age; having left school at an early age; a worsening of vision in recent years; and histories of Parkinson's disease, fractured hip, glaucoma, stroke (including transient ischaemic attack), corns or bunions, or arthritis. The findings regarding medical histories suggest some possible opportunities for reducing the risk of falls in the elderly by managing the symptoms and risk factors of underlying conditions such as stroke and loss of vision.

Exercise profile and subsequent mortality in an elderly Australian population

Although the importance of exercise as a public health issue is increasingly recognised, little attention has been paid to exercise in very old people. We examined exercise patterns in 1788 subjects aged 70 years and over who were participating in the Australian Longitudinal Study of Ageing. In the two weeks before interview, 39 per cent of subjects had taken no exercise and only four per cent had exercised vigorously. When compared with those who took no exercise, exercisers were more likely to be male and younger, to self-report better health, to be former smokers and regular alcohol users. Mortality rates at two years follow-up were inversely related to the level of exercise at baseline. This research indicates that exercise is important for the very old as well as younger groups.

The circumstances and contributions of older persons in three Asian countries: preliminary results of a cross-national study

"This article examines some of the findings from surveys carried out in Indonesia, Sri Lanka and Thailand as part of a cross-national study of ageing sponsored by the World Health Organization. It finds that the majority of elderly in these countries live in households with their children and in many cases also with their grandchildren. The elderly also contribute significantly to household activities. In the future, the special needs of very old women will have to be addressed as it will be difficult for their children to meet those needs without assistance."

Gerontological education in Australia

Courses in Gerontology and Geriatric medicine are now provided in most undergraduate training programs for medical, allied health and social work professionals in Australian Universities. The depth and coverage varies between schools but almost all undergraduate social workers, nurses, medical practitioners and allied health professionals will receive some training and in several cases more extensive optional programs are offered.

Ageing in Asia and the Pacific. A multidimensional cross-national study in four countries

Although ageing is not yet a high priority issue for health planners, policy makers and clinicians in most developing countries, there will be a growing need in coming years to pay more attention to the important health issues associated with population ageing in the developing world. This paper reports some of the relevant findings of a cross-national study (sponsored by the World Health Organization) of the health and social aspects of ageing in four developing countries: Korea, the Philippines, Fiji and Malaysia. The key findings are compared and contrasted with those of a similar 11-country WHO study in Europe. In broad terms, the overall demographic, physical, mental health and social patterns and trends associated with ageing as demonstrated by age group and sex differences were consistent throughout the four countries studied. Comparisons with European findings in other similar studies underlined the fundamental universality of age-related changes in biophysical, behavioural and social characteristics. The importance of the family in developing countries was evident with about three-quarters of those aged 60 and over in the four countries living with children, often in extended family situations. Levels of adverse health-related behaviour and the prospect of changing patterns of morbidity with further increases in the total and proportional numbers of aged persons point to a need for emphasis on preventive health measures and programmes directed to the maintenance of the physical and mental health of the ageing population.

An evaluation of planned early postnatal transfer home with nursing support

A community-based programme of planned early postnatal transfer home with the continuity of hospital nursing care was instituted in a defined geographic area of the western suburbs of Sydney in 1983. Mothers were offered the option of discharge in 24-48 hours after delivery, with home visits by a hospital midwife, subject to certain medical and social criteria. An evaluation of the programme in terms of morbidity, psychosocial impact on the family and costs was undertaken. For evaluation, a quasi-experimental study of parallel groups was designed in preference to randomized selection as it was believed that the personal choice would be fundamental to the success of the scheme. A contemporary control group was achieved with volunteer mothers who opted for the traditional five- to seven-day hospital stay. Studies of maternal response and the partner's response and adjustment were undertaken, including the administration of questionnaires that were designed to detect the presence of mild postnatal depression. No increased morbidity occurred in the early discharge group. The early discharge group performed more favourably on the questionnaire that was designed to measure their postpartum adjustment. Continued postnatal domiciliary surveillance reduces the risk that early neonatal pathological changes, especially jaundice, may be overlooked.

Effect of the protein, citrate and phosphate content of milk on formation of lactulose during heat treatment

Milk ultrafiltrate and milks of varying protein, citrate and phosphate concentrations were heated in sealed containers. Protein was found not to be involved in the mechanism of formation of lactulose, but increasing the protein content of milk reduced the concentration of lactulose after heating. This was considered to be due to increased condensation of lactose and lactulose with amino groups of the protein. Less lactulose was formed in milk ultrafiltrate than in skimmed milk accorded the same heat treatment, which was attributed to the buffering capacity of the milk protein in skimmed milk. Activation energies for lactulose formation in skimmed milk and in ultrafiltrate were 128 and 131 kJ/mol respectively. Citrate and phosphate catalysed the formation of lactulose. It is proposed that the formation of free lactulose in heated milk and ultrafiltrate proceeds exclusively by the Lobry de Bruyn-Alberda van Ekenstein transformation with the naturally occurring phosphate and citrate acting as base catalysts.

Implications of policy and management decisions on access, quality, and type of services for the elderly in Australia

There can be little argument that the need for a clearly articulated health care policy for the ageing is a legitimate concern. An optimum health system response will only evolve in a climate of clear definition of responsibilities, in concert with an effective policy-making mechanism. Within the health system there is likely to be a greater consensus concerning the elements of such a policy than would have been possible at any previous time. What is more likely to be debated is the question of what constitutes the legitimate boundaries of health as a concept to be applied to ageing populations and individuals. It is in our view essential that arguments about professional demarcation and alternative paradigms of ageing do not cloud the fundamental health and health care issues; these must be vigorously addressed if the otherwise inevitable burden of age-related illness and disability is to be effectively tackled.

Ageing in the developing countries of Asia and the Pacific--implications for health care

While ageing is still clearly not a high priority issue for health planners, policy makers and clinicians in developing countries of Asia and the Pacific, there will be a growing need in coming years to pay more and more attention to the important health issues associated with population ageing in countries which make up this region of the world. This paper reports some of the relevant findings of a WHO sponsored cross national study of the health and social aspects of ageing in four of the countries, namely Korea, the Philippines, Fiji and Malaysia. The key findings are compared and contrasted with those of a similar WHO eleven country study in Europe. The paper argues that there is an urgent need to develop health care strategies which will minimise the impact of population ageing and will maintain the growing numbers of old people in relatively good physical and mental health through preventive measures and through programmes directed to the maintenance of physical and mental health.

A study of religious attitudes of the elderly

A study is reported of the religious beliefs, attitudes, and practice of old people in the West of Scotland, based on a questionnaire given to 501 people aged 65 years and over randomly selected from those living at home. Almost all had had a full range of religious instruction, and regarded their parents as religious. Weekly church attendance was commoner among Catholics (70%) than Protestants (40%), among women than men, among those whose beliefs were those of organized religion, and among those with unrestricted mobility. The pattern of participation in church organizations and social activities was similar. A firm belief in an after-life was expressed by 80% of Catholics and 60% of Protestants, and higher proportions derived comfort from religion, especially in bereavement. Over 70% expressed no fear of their own death. In this elderly population, religious beliefs and attitudes remain important considerations, which should therefore be of concern to all those involved in the care of the elderly.

Ischaemic heart disease in the elderly

Studies were made for evidence of heart disease on 501 people aged 65 and more living at home; 22-4 per cent had clinical and/or electrocardiographic evidence of ischaemic heart disease. The prevalence of ischaemic heart disease increased with age, and was slightly greater in men than women. The frequency of ischaemic heart disease increased with increasing current cigarette consumption and with total cigarette consumption. There was no increase in relation to any of the following possible risk factors: systolic and diastolic blood pressure, blood glucose, serum cholesterol, skinfold thickness, percentage of ideal body weight. The survival over a 5-year period of all subjects with ischaemic heart disease did not differ significantly from that of all subjects together, but the mortality of subjects with ischaemic heart disease and an abnormal electrocardiogram was 1-5 to 2 times that of subjects in whom ischaemic heart disease was diagnosed on the basis of angina pectoris or past cardiac infarction, the electrocardiogram being normal.

Neurological disorders in the elderly at home

Eight hundred and eight subjects participated in three surveys of random samples of people aged 65 years or more living in their own homes. Neurological history and examination showed the prevalence of completed stroke to be 73 per 1000. Eighty-seven subjects per 1000 gave a history of transient cerebral ischaemic attacks. These prevalence rates were unaffected by age or sex. Senile dementia was diagnosed in 24 subjects per 1000 under 75 years and 109 per 1000 over that age. The prevalence of dementia of all types was 43 per 1000 under, and 140 per 1000, over 75 years of age. Parkinsonism was diagnosed in 16 subjects per 1000, and essential tremor in 17 per 1000. The prevalence of epilepsy was four subject per 1000. Other neurological disorders were diagnosed in 36 subjects, and a similar number had neurological abnormalities to which a definite diagnosis could not be given.

Skinfold thickness on the dorsum of the hand in the elderly

The skinfold thickness on the dorsum of the right hand over the second metacarpal was measured with Harpenden calipers in 276 women and 152 men aged 65 and over living at home. Mean values were higher in men than women and declined with age in both sexes. Skinfold thickness was related to body size, as estimated from lean body mass, but was unrelated to the presence of osteoporosis as assessed from bone mass of the second metacarpal or the presence of vertebral fractures. The skinfold thickness was low in those subjects who had senile purpura and also in a small group of subjects on long-term steroid therapy.