1. Ageing in Europe: Demographic Trends
With an ageing population, living longer and encountering more disabilities, there will be a need in Europe for valid and comparable longitudinal data on the health of both young and older adults in order to create a richer empirical basis for analysis and thus for policy planning and strategies development. The ageing of the populations of Europe is inevitable, given the trend toward healthier, more active and longer lives. In its Communication on the Demographic Future of Europe, the European Commission points to four salient demographic trends across Europe:
• The average number of children per woman is below the population replacement number of 2.1 per woman for industrialised countries, and this rate is falling further;
• The population consequences of the post-war baby boom;
• The dramatic increase in life expectancy since 1960; and
• The fact that immigration, although primarily of working age, will not compensate for the joint effect of low fertility and increased life expectancy.
The combined effect of these trends is an increasingly ageing population. At present, 27 EU countries have 18.2 million inhabitants aged 80+, which is 4% of the total population. Eurostat projects that by 2014 the corresponding number will be 24.1 million (5.2%).
The number of older people aged 65-79 has increased significantly since 2000 and will do so until around 2050. At the same time, however, health trends — and in particular the decline in fatalities from infectious diseases and better access to health care — appear to be giving support to the contentious notion of ‘compression of morbidity’ — namely that impairments and health problems are occurring later in life. As a recent UN Department of Economic and Social Affairs Report states, this demographic transition is a global phenomenon which, given the different rates at which countries experience the shift, will cause substantial geopolitical tensions between developed and developing countries in the next decades.
Eurostat projects that the relative size of the working age population will decrease, and by 2050 the EU will change from having four to only two persons of working age for each citizen over the age of 65. This increased burden on the pre-retirement population will greatly impact productivity and economic growth, and may not be offset by policies encouraging people to continue working past 65. Pressure on the health systems of Europe will also be profound, threatening to undermine the governing principles of equity, solidarity and universality. Since population ageing is accompanied by an epidemiological shift from the predominance of infectious diseases and high maternal and child mortality to that of non-communicable diseases, especially chronic ones, health systems will need to be reoriented to deal with increased populations of persons with disabilities (Olesen, Leonardi 2003).
2. Effect of an Ageing Population on Health Care
The effect of an ageing population on health care will be amplified by a disproportionate increase in dementia, depression and other mental and neurological illnesses (Draper, 2004). More generally, ageing, as emphasized by EC communication on Disability Action Plan 2006-2007, is strongly correlated with disability prevalence. Nearly 30% of people in the age group 55-64 report a disability and 63% of people with disabilities are older than 45.
Research into the projected demographic impacts on health systems have historically focused on the impact of increased younger populations, and determinants that affect the health of individuals as they age. With an ageing population, living longer and encountering more disabilities, there will be a need in Europe for valid and comparable longitudinal data on the health of older adults in order to create a richer empirical basis for analysis.
Current ageing studies involving persons aged 50+ tend to confuse the relationships between a person’s state of health, and his/her quality of life and well-being, relying on measures with limited validity. This confusion is due to conceptual overlapping of questions and a conflation of subjective and objective observation and report.
What are needed are valid and reliable outcome measures for good statistics, and innovative measurement instruments for cross-population comparative analyses. The objective of these measures and analyses methodologies would be to increase our scientific capacity to produce comparable longitudinal information on non-fatal health outcomes — both mental and physical — as well as reliable data on the linkages between health status, quality of life and well-being. These measures would reflect the fact that ageing is a process, and the measurement of determinants of ageing can be done at various stages of life.
Matilde Leonardi: Neurology, Public Health, Disability Unit- Neurological Institute Besta- Foundation IRCCS, Milan- Italy.
Somnath Chatterji: WHO Multi-country Studies Team (MCS), World Health Organization, Geneva, Switzerland.
E. Jerome Bickenbach: Department of Philosophy, Queen’s University, Kingston, Canada.
Tags: Ageing in Europe, Disability and ageing, EU MHADIE project, quality of life determinants