Population aging in the Asia–Oceania region

Recently the term 'global aging', which refers to the universal trend of aging of the world population, is being widely used. First of all, I will shed some light on this trend of world population aging from the viewpoint of regional populations and their future projections.
Second, I will discuss about the determinants of population aging in the Asia and Oceania region. So far as the region is concerned, it will be divided into three groups of countries according to the level of population aging. The first group is the most advanced aged countries such as Japan, Australia, and New Zealand whose percentage of the elderly aged 65 and over is more than 10% in the year of 2000. The second group is the aging countries such as Korea, Taiwan, Singapore, and China whose percentage of the elderly is between 5 and 10%. and the third group is the remaining countries in this region whose percentage is less than 5%. The demographic aspects of each group are analyzed and the relationships between the fertility reduction and aging are also discussed in the perspectives of the demographic transition.
Third, I will discuss about the consequences of population aging in this region with special reference to Asian developing countries. In this section, I will mention the problems of dependency burden, the so-called population bonus, health expectancy, and social security systems. Fourth, some prominent characteristics concerning the living conditions and norms or attitudes of the elderly will be indicated, and I will also raise such points like family systems, living arrangements, social participation, and Ikigai (the worth of life) peculiar to Asian countries. Fifth and finally, I will touch on the topics of the issues and policies of the aging society. At present the social status of the elderly is improving in Asian countries and it is in the hope that the myth of aging will disappear in the near future.     

Family change,caste, and the elderly in a rural locale in Nepal

This study reports research conducted in a rural Nepalese Hindu Community to examine three questions: (1) the nature of family structure of the elderly roughly 4 decades ago; (2) whether the family structure at that time was the same for high and low castes; and (3) whether the past situation differs from that today. Four decades ago 78% of elderly high caste males were living in the ideal Hindu joint family structure compared with only 24% of the low castes. Today just 50% of the high castes and 42% of the low castes live in joint families. The difference in the past derives from access to and control over economic resources. Economic changes since 1950 have increased access to economic resources and altered the family structure of the high castes but not the low castes.This research was supported by grants from the National Science Foundation (BNS82-19188), the National Geographic Society (2641-83), and the American Federation for Aging Research. A version of this paper was presented at the 84th Annual Meeting of the The American Anthropological Association, December 1985.     

QT Dispersion Increases with Aging

Background: Age‐related changes in cardiovascular system are well‐known. Arrhythmias in elderly patients constitute most of the urgencies, consultations, or hospitalizations. QT dispersion (QTd) is a simple noninvasive arrhythmogenic marker to demonstrate the electrical instability of the heart. The aim of this study was to investigate how QTd changes with increasing age by calculating the QTd in the elderly and younger subjects. Methods: One hundred and forty‐six consecutive subjects (62 males and 84 females; age range: 18–82 years) were enrolled in the study. Sixty‐seven of the subjects were 65 years and over (mean age, 70 ± 4), 79 were younger than 65 (mean age, 37 ± 11). A 12‐lead ECG was recorded. The longest and the shortest QT intervals were measured manually on these ECG recordings. QTd was calculated from the formula, QTd = QTmax ? QTmin. Results: Demographic features were similar between the two groups. QTd of the elderly group was found to be significantly higher than the younger group (35.6 ± 15.6 in elderly, 24.2 ± 12.4 in younger group, P < 0.001). A positive relationship was found between QTd and age (r = 0.415, P < 0.001). QTd was greater in female than in male (31.9 ± 16.7 ms vs 26.0 ± 11.3 ms, respectively, P = 0.018). Conclusions: Our study shows that QTd increases with advancing age. We think that long‐term follow‐up of these patients would be useful to show if there is any relationship between the clinical outcomes and the increase in QTd.     

Process indicators for safe motherhood programmes: their application and implications as derived from hospital data in Nepal

Measuring maternal mortality ratios is fraught with problems and underestimates. Therefore process indicators have been proposed for monitoring the availability and use of obstetrics services. We report the results of process indicators for measuring the availability, use and quality of obstetric care in five districts in Nepal between 1997 and 1998. The number of comprehensive essential obstetric care (EOC) facilities was adequate for four of the five districts, but none had a minimum acceptable level of basic EOC facilities as set by UNICEF et al. The proportion of expected births in hospital was 21.5% in Rupandehi and < 5% in Baglung, Kailali, Okhaldunga and Surkhet. The minimum acceptable level is 15%. The 'met need' for obstetric care which pertains to the proportion of all women with direct obstetric complications that are treated in hospital was 14.9% in Rupandehi and < 5% in the other four districts, against the required minimum of 15%. The caesarean section rate calculated of all expected births in the population varied between 0.2% and 1.4%. The case fatality rate was 4.0% in Rupandehi Zonal Hospital. Analysis of these indicators clearly identified tremendous underuse of maternity services which has stimulated national policy discussions in Nepal with ensuing safe motherhood interventions and monitoring strategies.     

中国人口老龄化趋势与对策

近年来中国人口老龄化发展迅速,人口老龄化问题日益严重,人口老龄化趋势特点明显,建议国家从开发老年人力资源;健全老年医疗保障体系;发展高新技术,开发人工智能机器;构建老龄社会新型文化体系;制定更加符合老年人养老需求的政策法规等方面进行积极应对.     

Predictors of mortality in the old-old in Israel: the Cross-sectional and Longitudinal Aging Study

OBJECTIVES: To examine whether well-known predictors of mortality change their predictive power over time, being reduced or even reversed in the old-old. DESIGN: A multidimensional survey of the Cross-Sectional and Longitudinal Aging Study conducted from 1989 to 1992 with follow-up of mortality after 6, 8, 10, and 12 years since 1989. SETTING: Israel. PARTICIPANTS: Participants (N=1,369) were drawn from a national sample of the Jewish Israeli population aged 75 to 94. MEASUREMENTS: Data included sociodemographic factors and measures of health, physical condition, cognitive performance, and depression. RESULTS: The results showed that age, sex, disability, self-rated health, and marital status predicted mortality and that their predictive power changed over 9 years. CONCLUSION: In the old-old, predictors of mortality changed over time, and their predictive effect eventually diminished. The predictors found to be most significant (age, sex, disability, and self-rated health) support the common cause theory.     

Prospective predictors of successful aging in community-residing and institutionalized Canadian elderly

This study examined the unique and combined contribution of existential variables (purpose in life, religiousness, and death acceptance) and traditional resource measures (social resources, intellectual competence, and cognitive competence) as prospective predictors of successful aging in community-residing and institutionalized older adults. Using multiple hierarchical regression, the results showed that baseline successful aging, social resources, purpose in life, and low religiousness predicted successful aging in community-residing elderly 14 months later; baseline successful aging, social resources, purpose in life, and being of male gender predicted successful aging in institutionalized elderly. Intellectual and cognitive competence and death acceptance failed to account for significant variance in successful aging, although the latter approached significance in the community-residing older adults. In both samples, the existential variable of purpose in life accounted for unique variance in successful aging over and above that accounted for by demographic, baseline successful aging, and traditional predictors. The important role of existential constructs in promoting successful aging in community-residing and institutionalized elderly is discussed. Gary T. Reker is a full professor in the Department of Psychology of Trent University. His research interests have focused on the aging process, particularly in the role of personal optimism and personal meaning in wellness promotion. This work was supported by a Population Aging Grant from the Social Sciences and Humanities Research Council of Canada. The work was begun by Paul T.P. Wong and Gary T. Reker and continued by Gary T. Reker under grants from the Trent University Research Fund.     

Research on aging in Latin America: Present status and future directions

This essay examines the status of aging research in Latin America. It presents a profile of the aging population in the Region in relation to societal institutions, illustrating how the aged are only marginally served by them. Most of the available information is derived from secondary sources and comes from international and national agencies, and private organizations. Data-based research includes small-sample studies of specific issues and country-specific investigations by both U.S. and Latin American researchers. Paradigms used emphasize successful/productive aging, functional ability, and, to a lesser extent, work focused on health conditions or specific situations such as poverty. The best sources of contextual information are often unpublished or not published in the mainstream literature. Future directions recommended include organizing existing data to inform policy, identifying, with Latin American researchers, the most critical research questions, formalizing collaborative relationships, and holding a working conference of those involved in Latin American aging research to develop a future agenda.     

衰老肾脏细胞结构改变及分子机制研究进展

肾衰老是导致急性肾损伤和慢性肾脏病发病率增加的重要原因。即使在没有高血压等年龄相关疾病影响的健康老年人群,肾脏的结构和功能也会发生年龄相关的退行性变化,导致肾脏对损伤的易感性增加,修复能力受损,引起病理性改变。肾脏衰老是一个多因素参与的复合调控过程,阐明导致这些改变的机制,有助于改善急性肾损伤和慢性肾脏病带来的损害。本文回顾了既往发表的文献,从细胞结构功能改变及分子机制方面论述肾脏衰老过程,以期发现更多有效治疗措施。     

发展老年医学科应对我区老龄化的探索

随着人口老龄化进程的加快,老年患者不断增加。他们往往患有多种慢性疾病,因此对医疗服务的需求也不断增加。面对加速而来的老年社会,利用有限的医疗资源为老年人提供高效的医疗服务,对于政府及公共卫生保障体系是一项严峻的挑战,也需要医务工作者做出巨大的探索和努力。本文介绍了上海市松江区乐都医院为了应对该区老龄化的现状,推广现代老年医学理念,实现区域内医疗资源的合理利用所做的工作,并探讨发现的问题和解决的方法。     

International demographic trends and perspectives on aging

In 1980, more than 376 million persons were age 60 or older in the world. By the year 2000, this figure is expected to increase by 57% to 590.4 million. Approximately 61% of these persons will be living in the lesser developed countries of the world. The growth and distribution of older persons throughout the world will have far reaching consequences for the utilization of national resources, including health resources.This article is a revised and abridged version of International Research Document No. 12, Center for International Research, U.S. Bureau of the Census. That report of the same title, was expanded from a paper originally presented at the U.N. World Assembly on Aging, held in Vienna, Austria, 1982. The original paper was published in the conference proceedings World Health Statistics Quarterly, Vol. 35, Numbers 3/4,1983.     

Care of the Elderly: Survey of Teaching in an Aging Sub-Saharan Africa

In sub-Saharan Africa (SSA), a rapidly aging population is presenting challenges to health care systems. Doctors need specialized knowledge to be prepared for the increase in age-related medical conditions. This study aims to investigate the current provision of geriatrics education (GE) in SSA medical schools and discover some of the barriers faced in its implementation. Questionnaires were sent to a list of medical schools in SSA, supplied by the sub-Saharan African Medical Schools Study. Responses were received from 25/135 institutions (19%), representing 11 countries in SSA. Of these institutions, 4% taught geriatrics and 40% had no geriatrics teaching. The largest perceived barriers to GE were a lack of staff expertise (72%), lack of funding (52%), and absence of geriatrics in the national curricula (48%). There are still a large number of medical schools in SSA who do not teach geriatrics. Improvements in GE should be implemented through local approaches and national policy, while appreciating the cultural context and economic constraints of each country to prepare future doctors for the increasing challenges of an aging population.     

Population aging in Korea: Changes since the 1960s

This study describes the characteristics of the Korean elderly. This study also investigates the population aging in conjunction with social and economic changes in Korea. Finally, this study explores social and economic implications with respect to the current and projected situation of the Korea elderly. Korean society has experienced very rapid changes both in demographic transition and population aging mainly due to the rapid processes of industrialization and urbanization, especially since 1960s. The rapid process of population aging has brought about the increase of dependency ratio, increasingly imbalanced sex ratio, and the decrease of the proportion of the elderly living with children. This paper concludes that the responsibility for the welfare of the elderly should shift from the family to the government.     

The Assessment and Sustainable Management of Sickle Cell Disease in the Indigenous Tharu Population of Nepal

Sickle cell disease is an inherited hemoglobinopathy associated with significant morbidity and mortality. Reports suggest a high sickle cell disease burden among the indigenous Tharu population of Nepal, who for centuries have inhabited regions where malaria is endemic. Unfortunately, health care resources are limited and often inaccessible for Tharu individuals suffering from sickle cell disease. We conducted a large-scale screening effort to estimate the prevalence of Hb S (HBB: c.20A>T) among the Tharu population and delivered community-based education sessions to increase sickle cell disease awareness. A total of 2899 Tharu individuals aged 6 months to 40 years in the rural district of Dang in Western Nepal were screened using a sickling test, of whom, 271 [9.3%; 95% confidence interval (95% CI): 8.3–10.4%] screened positive for Hb S. Those who screened positive were offered diagnostic gel electrophoresis testing. Of the 133 individuals who underwent diagnostic testing, 75.9% (n?=?101) were confirmed to be Hb AS heterozygotes, 4.5% (n?=?6) were confirmed to be Hb SS homozygotes and 19.5% (n?=?26) were false positives. These findings support a large burden of sickle cell disease among the Tharu population and highlight the importance of appropriate resource allocation and management. With a positive predictive value of 80.0% (95% CI: 73.0-87.0%), the sickling test in conjunction with raising local sickle cell disease awareness may be a simple and sustainable way to promote access to health resources.     

Migration and regional population aging in the Philippines

There is a growing realization that developing countries will be affected in the future by the problems associated with population aging. Although internal migration could exacerbate the problems of aging at subnational levels, there remains a paucity of research on the role of migration in elderly population change for the developing countries of the world. This study uses 1980 census data for the Philippines to explore the spatial and temporal dynamics of the country's elderly population. Through examination of internal migration patterns among the thirteen regions of the country and population projections, this paper demonstrates the potentially large role that migration plays in determining local patterns of aging.The National Capital Region, which is a primary destination of labor force migrants, exhibits the greatest projected increase in the share of the nation's elderly population, while the centrally located Visayas regions show rapid reductions in the future. The Visayas regions, however, may be expected to have the highest concentrations of elderly in their populations. Such findings suggest that labor force migration patterns, with subsequent aging-in-place, will most strongly influence near future distributions and concentrations of the elderly, and that national planning for the future's elderly population should incorporate regional examinations as a means of appropriately distributing financial and service related support.     

INAUGURAL ARTICLE by a Recently Elected Academy Member:Female reproductive aging in seven primate species: Patterns and consequences

Age-related changes in fertility have increasingly been documented in wild animal populations: In many species the youngest and oldest reproducers are disadvantaged relative to prime adults. How do these effects evolve, and what explains their diversity across species? Tackling this question requires detailed data on patterns of age-related reproductive performance in multiple animal species. Here, we compare patterns and consequences of age-related changes in female reproductive performance in seven primate populations that have been subjects of long-term continuous study for 29 to 57 y. We document evidence of age effects on fertility and on offspring performance in most, but not all, of these primate species. Specifically, females of six species showed longer interbirth intervals in the oldest age classes, youngest age classes, or both, and the oldest females also showed relatively fewer completed interbirth intervals. In addition, five species showed markedly lower survival among offspring born to the oldest mothers, and two species showed reduced survival for offspring born to both the youngest and the oldest mothers. In contrast, we found mixed evidence that maternal age affects the age at which daughters first reproduce: Only in muriquis and to some extent in chimpanzees, the only two species with female-biased dispersal, did relatively young mothers produce daughters that tended to have earlier first reproduction. Our findings demonstrate shared patterns as well as contrasts in age-related changes in female fertility across species of nonhuman primates and highlight species-specific behavior and life-history patterns as possible explanations for species-level differences.

The effects of age on reproductive performance remain poorly understood in nonhuman animals, particularly in wild populations. This is true despite several decades of growth in research on age-related changes in fertility patterns in the wild (1–4), which has revealed a number of species in which either older parents or very young parents—or both—are compromised, relative to prime-aged parents, in their ability to produce healthy offspring. In wild mammals in particular, reproductive traits can often be reasonably approximated with a negative quadratic function: An initial increase in reproductive performance after sexual maturity is associated with increasing parental competence and enhanced body condition; this may then be followed by a period of prime reproductive performance and finally by a subsequent decline associated with general senescence (5–12). The effects of old versus young parental age on fertility and offspring performance are distinct, but they both have important implications for understanding the evolution of life-history traits and their correlates.Negative effects of old age on reproductive performance—reproductive senescence—are well-known in humans and also widespread among long-lived iteroparous animals (1, 2, 13). However, the details of which reproductive traits show senescence, and in what manner, vary between species. Age-related declines in reproductive performance (“fertility senescence”) and age-related reduction of offspring performance (“parental-effect senescence”) represent two distinct components of reproductive senescence (14). Fertility senescence is one of the best-documented aspects of aging in wild animal populations, although data are often restricted to females (15). Evolutionary explanations for age-related declines in fertility are strongly connected to theories of biological aging, which invoke the weakening influence of natural selection with advancing age (16, 17). Parental-effect senescence, also known as the Lansing effect (18), has been well-documented in humans and in laboratory animal models (19), and more recently in a small number of wild animals (20–22). It can affect any component of offspring fitness, including offspring health, survival, rate of sexual maturation, or fecundity. For example, in humans, delayed childbearing is associated with steep increases in the risks of infant mortality, miscarriage, polysomy, and other congenital abnormalities, reduced lifespan, and other negative health outcomes in offspring (23–26). The mechanisms that underpin parental-effect senescence in different species remain poorly understood, but may include epigenetic influences on offspring phenotypes or age-related declines in the ability to provision and care for eggs, embryos, or dependent offspring (9, 11, 13, 27). The limited evidence on parental-effect senescence in animals thus far highlights the heterogeneity of parental-effect senescence across species, not only in which offspring traits are affected by parental senescence, but in the magnitude of the effects (3, 4).Negative effects of very young maternal age are also frequently associated with reduced fertility and offspring performance, but as with parental-effect senescence, the effects of young maternal age on offspring performance are heterogeneous across species. For example, in Soay sheep the youngest mothers show reduced fertility, reduced offspring birth weight, and reduced offspring survival relative to prime-aged mothers (11). In contrast, in red deer, young females show reduced fertility and reduced offspring birthweight, but not reduced offspring survival relative to older mothers (28, 29). In many, but not all, nonhuman primate species, offspring of primiparous females experience higher mortality than those of multiparous females. This result has been attributed to the inexperience or relatively small body size of primiparous mothers (30–34). However, small body size and inexperience are common characteristics of primate primiparas, while a survival disadvantage for firstborn offspring is not universal, indicating that the relevance of this explanation varies across species (35).The evolution of parental-age effects may be linked to the evolution of longevity, fertility, parental care, and social behavior (3, 4). This broad importance of parental-age effects and their implications for multiple aspects of life history and behavior highlight an important emerging question in evolutionary biology: How do these effects evolve, how do they differ between the sexes, and what explains their diversity across species? Detailed data on patterns of reproductive senescence in multiple species are required to tackle this question effectively.In this study, we contribute data on patterns of age-related changes in fertility and age-related changes in maternal effects in wild nonhuman primates. Specifically, we compare patterns and consequences of female reproductive aging in seven primate populations that have been subjects of long-term continuous study for 29 to 57 y (36–39) (SI Appendix, Table S1). For example, previous studies on these populations have documented age-related changes in mortality, contributing to our understanding of the evolution of senescence (37, 40, 41), and species-specific patterns of age at last live birth, contributing to our understanding of the evolution of human menopause (38). High-quality individual-based datasets on aging in wild animals are uncommon and difficult to gather (42), making this dataset a unique and exceptionally valuable resource for examining female reproductive aging in our closest living relatives. Our cross-species approach provides a comparative landscape in which the evolution of human aging and reproduction can be situated and allows us to test for both components of reproductive senescence: fertility senescence and parental-effect senescence. First, we aimed to determine how variable are patterns of age-related changes in female fertility across primate species, focusing specifically on whether a cross-species signature of aging could be reliably detected as a lengthening of interbirth intervals (IBIs) after the birth of a surviving offspring with advancing maternal age. Second, we sought to determine whether maternal age effects could be observed in components of fitness in the next generation, focusing on offspring survival during infancy and age at first reproduction (AFR) in daughters. We chose to analyze these three components of female reproductive performance because they could be extracted and measured unambiguously for each of the seven primate populations from our comparative life-history dataset. In the aggregate, our results provide important insights into the extent of, and variability in, age-dependent reproductive performance in wild primates.     

Brief report: The aging of the homeless population: Fourteen-year trends in San Francisco

BACKGROUND: Homelessness is associated with high rates of health and substance use problems. OBJECTIVE: To examine trends in the age, housing, health status, health service utilization, and drug use of the homeless population over a 14-year period. DESIGN: Serial cross-sectional. PARTICIPANTS: We studied 3,534 literally homeless adults recruited at service providers in San Francisco in 4 waves: 1990-1994, 1996-1998, 1999-2000, and 2003. MEASUREMENTS: Age, time homeless, self-reported chronic conditions, hospital and emergency department utilization, and drug and alcohol use. RESULTS: The median age of the homeless increased from 37 to 46 over the study waves, at a rate of 0.66 years per calendar year (P<.01). The median total time homeless increased from 12 to 39.5 months (P<.01). Emergency department visits, hospital admissions, and chronic health conditions increased. CONCLUSIONS: The homeless population is aging by about two thirds of a year every calendar year, consistent with trends in several other cities. It is likely that the homeless are static, aging population cohort. The aging trends suggest that chronic conditions will become increasingly prominent for homeless health services. This will present challenges to traditional approaches to screening, prevention, and treatment of chronic diseases in an aging homeless population.     

Serum Insulin-Like Growth Factor-1 Binding Proteins 1 and 2 and Mortality in Older Adults: The Health, Aging, and Body Composition Study

OBJECTIVE: To evaluate the relationship between serum insulin-like growth factor 1 (IGF-1), IGF-1 binding protein 1 (IGFBP-1), and IGF-1 binding protein 2 (IGFBP-2) and fasting insulin, fasting glucose, adiposity, and mortality in older adults.
DESIGN: A prospective cohort study with mean follow-up of 6.2 years.
SETTING: Participants were recruited and followed at two centers affiliated with academic medical institutions.
PARTICIPANTS: Six hundred twenty-five men and women aged 70 and older and in good health at the time of enrollment.
MEASUREMENTS: Serum IGF-1, IGFBP-1, and IGFBP-2; fasting serum insulin; fasting serum glucose; visceral fat; and total percent fat.
RESULTS: Higher IGFBP-1 and higher IGFBP-2 were significantly associated with lower fasting insulin, lower fasting glucose, and lower adiposity, but higher IGFBP-1 and IGFBP-2 were associated with greater mortality. In multivariate adjusted models, the hazard ratio for all-cause mortality was 1.48 (95% confidence interval (CI)=1.14–1.92) per standard deviation (SD) increase in IGFBP-2 and 1.34 (95% CI=1.01–1.76) per SD increase in IGFBP-1. No association was found between IGF-1 and all-cause mortality.
CONCLUSIONS: Higher IGFBP-1 and IGFBP-2 are associated with lower adiposity and decreased glucose tolearance but also with greater all-cause mortality. Higher levels of serum IGF-1 binding protein (IGFBP) may indicate greater IGF-1 activity and thus represent an association between higher IGF-1 activity and mortality in humans.