Health Promotion And Older Adults€¦ · •The association between obesity (or high body mass index) and mortality is not straightforward and relatively weak at older ages . •

Céu MateusSenior Lecturer in Health Economics

Division of Health Research, Lancaster University

Health Promotion And Older Adults

Evolution of health stock

Birth Time

HMIN

Health

Appendicitis (surgery)Car accident (surgery)

Cancer (radiation)

Cancer complications

• Concepts of ageing– Think about your grandparents– Think about your parents– Think about people you know and are now 55,

65, 75 and 85

• Concepts of healthy– No illness– Have adapted to illness and ailments

Stanisława Golinowska

How much are our viewsconstrained by our

expectations?

It spite of illness, in spite even of the archenemy sorrow, one can remain alive long past the usual date of disintegration if one is unafraid of change, insatiable in intellectual curiosity, interested in big things, and happy in a small way.

Edith Wharton

What is health promotion?

• Health promotion enables people to increase control overtheir own health.

• It covers a wide range of social and environmentalinterventions that are designed to benefit and protectindividual people’s health and quality of life by addressingand preventing the root causes of ill health, not just focusingon treatment and cure


WHO definition of health

• Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

• Preamble to the Constitution of WHO as adopted by the International Health Conference, New York, 19 June - 22 July 1946

• The definition has not been amended since 1948.


Why look at health promotion and older adults?

• The world population is ageing– There is a long life span between retirement and health– Global burden of disease due to NCD has been increasing– Improve/maximize HRQoL of older people– Minimise costs to health– Minimise the burden to care providers

Elderly population EU28% of total population, 1970 – 2014

OECD (2017), Elderly population (indicator). doi: 10.1787/8d805ea1-en

https://www.oecd.org/els/health-systems/Health-at-a-Glance-Europe-2016-CHARTSET.pdf











Mortality and morbidity in the 21st centuryAnne Case and Angus Deaton

International Differences in Mortality at Older Ages: Dimensions and Sources

The National Academy Press 2010

• Poor position of the United States in terms of life expectancy above age 50.

• For some topics, there is surprisingly little direct evidence that can address the basic question.

• Fortunately, thanks to the HRS (the Health and Retirement Study) in the United States, ELSA (the English Longitudinal Study of Ageing) in the United Kingdom, and SHARE (the Survey of Health, Ageing and Retirement in Europe) across Europe and Israel, there are now comparable large-scale international surveys that contain important measures of many variables of relevance.

• A lot is known about international differences in smoking patterns and levels of obesity, but far less about international differences in stress, physical exercise, and social networks

• To better understand some of the main features of the diverging trends in life expectancy across countries, the paper by Glei, Meslé, and Vallin (Chapter 2) examines mortality changes and differences in 10 countries where high-quality mortality and cause of death data are available. In some of them, life expectancy has increased rapidly in recent years; in others, progress is lagging as in the United States.

• The purpose of the analysis is to identify particular causes of death that can explain the relatively poor performance in gains in e50 for the three countries with the least amount of progress, Denmark, the Netherlands, and the United States.

• It appears that differences in female mortality due to lung cancer and respiratory diseases are an important part of the story.

• Such a finding is clearly consistent with the hypothesis that smoking was an important factor in slowing the mortality decline among women in those three countries.

• The association between obesity (or high body mass index) and mortality is not straightforward and relatively weak at older ages.

• Maintaining a certain level of physical activity as one ages is important for a variety of reasons, including the maintenance of good cardiovascular health, lower risk of falls and fractures, higher levels of cognition and positive well-being, and higher levels of social participation.

• An accurate assessment of the extent to which physical activity contributes to variations in life expectancy is hard to achieve.

• Among other obstacles are a paucity of internationally comparable time-series data, a lack of common metrics, and questions about the relative quality of personal recall data versus data derived by objective measurement.

• In addition, there is no definitive theoretical framework to guide how to assess the effects of physical activity on life expectancy: this lack of a framework results in a lack of clarity about the most important variables and when and how to measure them.

• Following a review of the strengths and limitations of self-report and objective measures of physical activity, the authors present data from four different internationally comparable data sets that have recorded the frequency, duration, and intensity of physical activity.

• They show that the ranking of countries in terms of physical activity is only moderately consistent across studies, implying that conclusions regarding the relationship between physical activity and health outcomes must be drawn cautiously.

• Using data from the ELSA, HRS, and SHARE, the authors analyze the relationship between various measures of physical activity and inactivity and self-reported health and self-reported diabetes.

• More definitive conclusions must wait for more sophisticated cross-national comparisons that use objective measures of physical activity and multivariate analyses of time trends in physical activity.

Explaining divergent levels of longevity in high income countries

The National Academy Press, 2011• Goals:

– Trends in life expectancy at older ager– Identify possible lessons about modifiable risk factors– Discern implications for the future trajectory of mortality at advanced ages

Summary

• Last 25 years: life expectancy rose at a slower pace in the US than in other high income countries

• widening gap• the same holds for self-assessed health and biological

markers

• US – poor performance but high spending• Patterns of mortality at older ages

• Data: human mortality database

• Variations in life expectancy at birth are dominated by what happens over age 50

• Higher mortality rates for lung cancer and respiratory diseases in the US, Denmark and the Netherlands are an important part of the story of recent years

• Mortality due to heart disease: a big impact in results• Poor performance of US also due to: cerebrovascular conditions (stroke),

diabetes and mental health• Stroke factors: no comparable cross-country data on the current level of

risk• Problems with evidence• Epidemiology: reflects differences of opinions with respect to the

magnitude of the relationship between obesity and mortality

• Panel approach: to establish the strength of the evidence for a number of the most commonly proffered explanations:• Poor health behaviours such as smoking, overeating and

exercise• Inefficient health care system• Different levels of social integration and socioeconomic

inequalities

• Need for an integrated framework across the entire life course for all the dimensions

• The role of physical activity to international differences on trends in mortality

• coverage of elderly in the US with Medicare

• Cancer detection and survival appear to be better in the US that in most other high income countries

• Survival rates following a heart attack also are favourable in the US• US worst at prevention than other countries? Evidence is inconclusive• For women, mortality improvements are likely to remain slower than

males• Beside smoking, most of the evidence was gathered from observational

studies• dramatic change in the use of HRT

• Failures to prevent unhealthy behaviours are costly

Assessing the economic costs of unhealthy diets and low physical activity: an evidence review and proposed framework (2017)http://www.euro.who.int/__data/assets/pdf_file/0004/342166/Unhealthy-Diets-ePDF-v1.pdf?ua=1

http://www.euro.who.int/__data/assets/pdf_file/0004/342166/Unhealthy-Diets-ePDF-v1.pdf?ua=1


http://dx.doi.org/doi:10.1016/j.arr.2017.06.003

Evidence-based health promotion

• The use of information derived from formal research and systematic investigation to identify causes and contributing factors to health needs and the most effective health promotion actions to address these in given contexts and populations.

https://academic.oup.com/heapro/article-lookup/doi/10.1093/heapro/dal033


What lies ahead?

• Better educated• More in charge of their own health• Part of the decision making process concerning

their own health and treatment• E-health and artificial inteligence will be disruptive• If income plays such an important role in health at

older ages, what can we expect when the incomegap is widening?


Old age isn't so bad when you consider the alternative.Maurice Chevalier

If I'd known how old I was going to be I'd have taken better care of myself.

Adolph Zukor (January 7, 1873 – June 10, 1976), on approaching his hundredth birthday

Riveting, honest, and humane, Being Mortal shows that the ultimate goal is not a good death but a good life – all the way to the very end

Health Promotion And Older Adults€¦ · •The association between obesity (or high body mass index) and mortality is not straightforward and relatively weak at older ages . •

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