Chapter 26
Health of older people

The world population is ageing; average life expectancy at birth (2012) was 79 years in high-income countries, a 5-year increase from 1990, compared with a 9-year increase, to 60 years for men and 63 years for women, in low-income countries. At age 60, life expectancy has only increased by a year, from 16 to 17 years, in low-income countries, compared with a three-year increase, from 20 to 23 years, in high-income countries.

While this increase reflects success in reducing the burden of communicable diseases, there are concerns that merely extending life without reducing the length of time spent with disability or morbidity will place intolerable burdens on health and social care systems. Healthy life expectancy (see Chapter 18) is estimated (2012) to be 53 years in low-income countries and 70 years in high-income countries. Ideally, compression of morbidity (Figure 26a) should delay the onset of morbidity until later ages at a faster rate than life expectancy is increasing, reducing the number of years spent with disability at the end of life. Whether this scenario is occurring globally remains debatable. In some developing countries, improving life expectancy is leading to more time spent in poor health (life extension or expansion of morbidity), while in more developed countries, long-term morbidity may be developing at a later age (shift to the right). The concept assumes that better prevention of cancer, cardiovascular and respiratory diseases, with adoption of healthier lifestyles, will improve healthy life expectancy. Much of the time spent in poor health, however, is due to mental and behavioural disorders, musculoskeletal problems and neurological conditions such as dementia and Parkinson’s disease for which effective prevention strategies are not yet available. For some conditions, such as diabetes and osteoarthritis, the rising prevalence of obesity is likely to increase their prevalence and result in more time spent in poor health.

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