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Commonwealth Health Partnerships 2015

adults aged 60 and over suffer from a mental or neurological disorder, and 6.6 per cent of all disability among over 60s is attributed to neurological and mental disorders (Murray et al., 2012). The most common neuropsychiatric disorders in this age group are dementia and depression. The number of people with dementia will continue to grow, particularly among those older than 80 years. The total number of people with dementia worldwide in 2010 is estimated at 35.6 million and this figure is projected to nearly double every 20 years, with much of the increase taking place in developing countries (Prince et al., 2013); 50–75 per cent of dementia will be due to Alzheimer’s disease. These diseases are now high on the international political agenda because they represent a major development issue as well as social and economic challenges for all countries. NCDs contribute 74.6 per cent of all the years lived with disability, with the diseases mentioned here contributing 45 per cent of that number (Vos et al., 2012), and represent a major factor in early retirement from formal work (Handa and Neitzert, 1998). The World Health Organization (WHO) has adopted the Global Action Plan (2013–20) for their prevention and control, and a global monitoring framework, including nine global targets and 25 indicators. The World Health Assembly has adopted the overarching target of a 25 per cent reduction in premature mortality from NCDs by the year 2025 (WHO, 2013). It is never too early or too late It is critical to address the problems of NCDs throughout the life course as the problems of adulthood and ageing may have their genesis at conception or even before. There are biological as well as behavioural aspects that impinge on early childhood development and predispose the organism to develop NCDs later in life (Darnton-Hill et al., 2004). Early epigenetic changes may programme the individual to develop one or other of the NCDs (Godfrey et al., 2010): maternal nutrition plays a role in the propensity of children to become obese, which is a major factor in the development of adult chronic disease; the habit of smoking tends to begin in adolescence and the likelihood of continuing to smoke increases if the habit commences after adolescence. L i n k i n g p r o d u c t i v e a g e i n g t o N C D p r e v e n t i o n a n d c o n t r o l Prevention must take place throughout the life course and emphasis should continue to be placed on the important risk factors – tobacco, alcohol, improper diet and lack of physical activity. By addressing these risk factors it is indeed possible to reduce premature mortality and reach the goal of a 25 per cent reduction in this by 2025. Serious doubts have been raised about the propriety of this approach in the sense that focusing on persons younger than 70 years of age is an example of age discrimination (Lloyd-Sherlock et al., 2012). Much of the emphasis is on premature deaths, i.e. below the age of 70 years, where 42 per cent of NCD deaths occur. While primary prevention of NCDs depends to a large extent on modifying individual behaviour and promoting a favorable and enabling environment, secondary prevention, treatment and control depend heavily on health systems. The WHO has estimated that up to two-thirds of premature deaths from NCDs are linked to exposure to risk factors, but up to half are linked to weak health systems. The ability of a health system to incorporate NCDs is especially critical with regard to the elderly, as with increasing age there is increasing probability of comorbidities (Fortin et al., 2005). Health systems are critical Universal health coverage (UHC), which would provide effective health services efficiently while ensuring financial protection, implies the existence of efficient health systems. However, there is a third aspect that may be very significant for the elderly: the satisfaction of knowing that there are services available when needed – health security – must be factored into UHC and, given that elderly people tend to have lower incomes, this must be of special significance to that group. Nolte and McKee (2008) propose that the essential elements for an effective response to chronic disease are sustained financing, skilled and motivated health professionals, supportive information systems Human ageing Commonwealth Health Partnerships 2015 75 60 50 40 30 20 10 0 Deaths (000s) 17% decrease 13.5% increase All causes Communicable plus* 1990 2010 increase 30% NCDs Injuries * Communicable, maternal, neonatal and nutritional disorders 24% increase Figure 1 Analysis of global deaths There is more to old age than ageing. Not everything that differentiates older from younger people is due to ageing. Older people may be different not because they have changed over their lifetimes, but because they were always different, having been born in a different world. Ageing, in the sense of senescence rather than maturation, is characterised by a progressive lack of adaptability of an individual organism as time passes. Sooner or later the organism encounters a situation it cannot be with and it dies. A rising age-associated risk of death is therefore the hallmark of senescence. The chief challenge of ageing facing the individual and the policy-maker is not the rise in risk of death, but the impairments in physical and mental functions that can occur with increasing age. Impairments do not necessarily cause disability. Disability arises when there is an ecological gap between what an individual needs or (reasonably and socially appropriate) wants to do, and what her environments require for it to be done. – Sir John Grimley-Evans, EMS Symposium Ageing in Emerging Markets, Oxford, January 2015


Commonwealth Health Partnerships 2015
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