https://www.demogr.mpg.de/publications/files/3444_1264435180_1_Christensen%20et%20al%20Lancet%20374%209696%202009.pdf

Ageing populations: the challenges ahead

Defeating Alzheimer's disease and other dementias : a priority for European science and society

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Defeating Alzheimer's disease and other dementias: a priority for European science and society

Human senescence has been delayed by a decade. This finding, documented in 1994 and bolstered since, is a fundamental discovery about the biology of human ageing, and one with profound implications for individuals, society and the economy. Remarkably, the rate of deterioration with age seems to be constant across individuals and over time: it seems that death is being delayed because people are reaching old age in better health. Research by demographers, epidemiologists and other biomedical researchers suggests that further progress is likely to be made in advancing the frontier of survival — and healthy survival — to even greater ages.

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Biodemography of human ageing.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(14)61462-8.pdf

Health, functioning, and disability in older adults—present status and future implications

OBJECTIVES: To study the effect of long term exposure to airborne pollutants on the incidence of acute coronary events in 11 cohorts participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE). DESIGN: Prospective cohort studies and meta-analysis of the results. SETTING: Cohorts in Finland, Sweden, Denmark, Germany, and Italy. PARTICIPANTS: 100 166 people were enrolled from 1997 to 2007 and followed for an average of 11.5 years. Participants were free from previous coronary events at baseline. MAIN OUTCOME MEASURES: Modelled concentrations of particulate matter <2.5 μm (PM2.5), 2.5-10 μm (PMcoarse), and <10 μm (PM10) in aerodynamic diameter, soot (PM2.5 absorbance), nitrogen oxides, and traffic exposure at the home address based on measurements of air pollution conducted in 2008-12. Cohort specific hazard ratios for incidence of acute coronary events (myocardial infarction and unstable angina) per fixed increments of the pollutants with adjustment for sociodemographic and lifestyle risk factors, and pooled random effects meta-analytic hazard ratios. RESULTS: 5157 participants experienced incident events. A 5 μg/m(3) increase in estimated annual mean PM2.5 was associated with a 13% increased risk of coronary events (hazard ratio 1.13, 95% confidence interval 0.98 to 1.30), and a 10 μg/m(3) increase in estimated annual mean PM10 was associated with a 12% increased risk of coronary events (1.12, 1.01 to 1.25) with no evidence of heterogeneity between cohorts. Positive associations were detected below the current annual European limit value of 25 μg/m(3) for PM2.5 (1.18, 1.01 to 1.39, for 5 μg/m(3) increase in PM2.5) and below 40 μg/m(3) for PM10 (1.12, 1.00 to 1.27, for 10 μg/m(3) increase in PM10). Positive but non-significant associations were found with other pollutants. CONCLUSIONS: Long term exposure to particulate matter is associated with incidence of coronary events, and this association persists at levels of exposure below the current European limit values.

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Long term exposure to ambient air pollution and incidence of acute coronary events: prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE Project

Background and aims: A large, national, long-term, longitudinal, multi-purpose study has been launched in Sweden - the Swedish National study on Aging and Care (SNAC). The study involves four resea ...

A longitudinal study integrating population, care and social services data. The Swedish National study on Aging and Care (SNAC).

There is limited knowledge about older people’s length of stay (time untildeath) in institutional care and how it has changed over time. The aim ofthis study was to analyse changes in the length of ...

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Rapid decrease in length of stay in institutional care for older people in Sweden between 2006 and 2012: results from a population-based study.

Sweden has a well-developed welfare system following the Nordic model and it maintains - even though there have been some reductions in the last decade - good economic security and comprehensive services for the elderly. The national policy for the elderly aims at enabling older persons to live independently with a high quality of life. A great majority of the elderly in Sweden live in ordinary homes - very few live with their grown-up children. The municipalities are responsible for providing long-term social services and care for the frail elderly in the form of home help services for those that live in ordinary housing, and special housing accommodation for those with extensive needs. The county councils are responsible for health care and provide home nursing care and rehabilitation. Sweden used to have the oldest population in the world. The proportion of 80+ years old in the population increased from 3% to over 5% between 1980 and 2000. Due to financial restrictions as a result of the economic recession in the last decade, the health and social services for the elderly have not been able to keep up with the population development. The previous generous allocation of care has been replaced by a more restrictive approach. This has mainly affected persons with lesser needs for help, younger elderly, and married persons. The number of elderly persons is expected to increase rapidly in the coming decades. However, due to improved health among the elderly, this will lead to a relatively limited increase of needs. Depending on assumptions concerning the health development, the required increase in volume of health and social services is expected to fall somewhere between 10-30% during the coming 30-year period.

The systems of care for frail elderly persons: the case of Sweden

The female advantage in life expectancy (LE) is found worldwide, despite differences in living conditions, the status of women and other factors. However, this advantage has decreased in recent years in low-mortality countries. Few researchers have looked at the gender gap in LE in old age (age 65) in a longer historical perspective. Have women always had an advantage in LE at old age and do different countries share the same trends? Life expectancy data for 17 countries were assessed from Human Mortality Database from 1751 to 2007. Since most of the changes in LE taking place today are driven by reductions of old age mortality the gender difference in LE was calculated at age 65. Most low-mortality countries show the same historical trend, a rise and fall of women’s advantage in LE at age 65. Three phases that all but two countries passed through were discerned. After a long phase with a female advantage in LE at 65 of <1 year, the gender gap increased significantly during the twentieth century. The increase occurred in all countries but at different time points. Some countries such as England and France had an early rise in female advantage (1900–1919), while it occurred 50 years later in Sweden, Norway and in the Netherlands. The rise was followed by a more simultaneous fall in female advantage in the studied countries towards the end of the century, with exceptions of Japan and Spain. The different timing regarding the increase of women’s advantage indicates that country-specific factors may have driven the rise in female advantage, while factors shared by all countries may underlie the simultaneous fall. More comprehensive, multi-disciplinary study of the evolution of the gender gap in old age could provide new hypotheses concerning the determinants of gendered differences in mortality.

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The rise and fall of women’s advantage: a comparison of national trends in life expectancy at age 65 years

Statistics Sweden has interviewed representative samples of the population annually since 1980. This study looks at ages 65–84 (n ≈ 3,000 per year) and presents prevalence rates for functional ability (walking and running ability, vision and hearing, and disability) for different age groups and for men and women. Prevalence rates of functional problems increase with age, for all indicators and for men and women. With the exception of hearing, women have poorer function than men. Different function indicators showed different trends over time. For example, vision (reading text) improved over the studied time period, while hearing (a conversation between two or more people) showed a clear worsening over the time period. Seen over the entire time period 1980–2005, mobility items (running, walking) and disability indicators showed improvement. However, figures suggested that most of this improvement occurred during the 1980s and early 1990s. Regression analyses of the estimated trends up until 1996 show for the most part significant improvement, but this positive development seems to cease after 1996 and in some cases there seems to be a significant upswing in problems. On other hand, for hearing, the negative trend of increased problems seems to have been broken after 1996. Results emphasize the necessity to follow population trends over long periods of time with multiple waves and multiple indicators.

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Mårten Lagergren

Papers

A longitudinal study integrating population, care and social services data. The Swedish National study on Aging and Care (SNAC).

Rapid decrease in length of stay in institutional care for older people in Sweden between 2006 and 2012: results from a population-based study.

The systems of care for frail elderly persons: the case of Sweden

The rise and fall of women’s advantage: a comparison of national trends in life expectancy at age 65 years

Functional ability in the elderly Swedish population from 1980 to 2005.