WHO/HSC/AHE/99. tr: general a life course perspective of maintaining independence in older age Prepared for Who by Claudia Stein and Inka moritz under the guidance of WHO's Ageing and Health WORLD HEALTH ORGANIZATION GENEVA 1999
1 WHO/HSC/AHE/99.2 Distr.: General Orig.: English A life course perspective of maintaining independence in older age Prepared for WHO by Claudia Stein and Inka Moritz under the guidance of WHOs Ageing and Health WORLD HEALTH ORGANIZATION GENEVA 1999
This document was prepared for Ageing and Health(AHE) by under the guidance of Dr Alexandre Kalache Dr Claudia Stein and Ms Inka Moritz, AHE Group Leader WHOs Ageing and Health thanks the following departments and units, among others, for their comments on this document: Child and Adolescent Health Developmen Communicable Diseases Extended Programme on Immunisation Health Sy Mental Health Nutrition for Health and Development ubstance abuse Tobacco free Initiative Photos copyrights: Front cover left to right: numbers 1, 2 WHO/PAHO; 3 UNICEF/Noorani; 4 WHO/PAHO; 5 Keskisuomalainen/Ari Haapa-ahe World Health Organization 1999 This document is not a formal publication of the World Health Organization(WHO)but all rights are reserved by the Organization. The document ay be freely reviewed, abstracted, reproduced and translated, in part or in whole(with due acknowledgements ); however, it may not be sold used in conjunction with commercial purposes The views expressed in this document by named authors are solely the responsibility of those authors 2
2 This document was prepared for Ageing and Health (AHE) by under the guidance of Dr Alexandre Kalache Dr Claudia Stein and Ms Inka Moritz, AHE Group Leader. WHOs Ageing and Health thanks the following departments and units, among others, for their comments on this document: Child and Adolescent Health Development Communicable Diseases Extended Programme on Immunisation Health Promotion Health Systems Mental Health Nutrition for Health and Development Reproductive Health Substance Abuse Tobacco Free Initiative Womens Health © World Health Organization 1999 This document is not a formal publication of the World Health Organization (WHO) but all rights are reserved by the Organization. The document may be freely reviewed, abstracted, reproduced and translated, in part or in whole (with due acknowledgements); however, it may not be sold or used in conjunction with commercial purposes. The views expressed in this document by named authors are solely the responsibility of those authors. Cover design: Marilyn Langfeld Photos copyrights: Front cover left to right: numbers 1,2 WHO/PAHO; 3 UNICEF/Noorani; 4 WHO/PAHO; 5 Keskisuomalainen/Ari Haapa-aho
LIST OF CONTENTS 1. THE LIFECOURSE PERSPECTIVE OF AGEING 4.3 Illicit 2. FETAL DEVELOPMENT 344 4.4Ph ty 4.5 Dieta 9001 4.6 Body 2.1 Fetal 'programming... genital dis 65. INFLUENCES OF SOC| AL ENVIRONMENT…… 3. INFLUENCES IN INFANCY AND CHILDHOOD 5.1 Economic factors 5.2 Education 2223 3.1 Breastfeeding 5.3 Cultural and societal factors 3.2 Malnutrition in early life 6677788 Bibliography 1 33 Childhood obesity… 3. 4 Childhood infections 6. DISEASE DURING THE LIFE COURSE 3.5 Working children 6.1 Non-communicable diseases 6.2 Communicable diseases DOLESCENT AND ADULT LIFE STYLE…… b 999 55677 7. HEALTHY AGEING IN THE FUTURE 4.2 Alcohol 3
3 LIST OF CONTENTS Page 1. THE LIFECOURSE PERSPECTIVE OF AGEING ........................ 3 2. FETAL DEVELOPMENT........................................................... 4 2.1 Fetal programming....................................................... 4 2.2 Congenital disorders ...................................................... 5 Bibliography .................................................................. 6 3. INFLUENCES IN INFANCY AND CHILDHOOD ..................... 6 3.1 Breastfeeding ................................................................. 6 3.2 Malnutrition in early life ................................................ 7 3.3 Childhood obesity ......................................................... 7 3.4 Childhood infections ..................................................... 7 3.5 Working children........................................................... 8 Bibliography .................................................................. 8 4. ADOLESCENT AND ADULT LIFE STYLE ................................. 9 4.1 Tobacco use .................................................................. 9 4.2 Alcohol ......................................................................... 9 4.3 Illicit drug use ................................................................ 9 4.4 Physical activity ........................................................... 10 4.5 Dietary habits .............................................................. 10 4.6 Body composition........................................................ 11 Bibliography ................................................................ 11 5. INFLUENCES OF SOCIAL ENVIRONMENT .......................... 12 5.1 Economic factors ......................................................... 12 5.2 Education .................................................................... 12 5.3 Cultural and societal factors......................................... 13 Bibliography ................................................................ 14 6. DISEASE DURING THE LIFE COURSE .................................. 15 6.1 Non-communicable diseases ....................................... 15 6.2 Communicable diseases .............................................. 16 Bibliography ................................................................ 17 7. HEALTHY AGEING IN THE FUTURE .................................... 17 Page
THE LIFECOURSE PERSPECTIVE OF AGEING threshold'shown in Figure 1 is not rigidly defined. In a supportive environment an individual who has experienced substantial loss in Ageing can be defined as the process of progressive change in the given functional capacity may continue to live independently while biological, psychological and social structure of individuals. For statistical another, with the same degree of functional loss in a less supportive environment will experience loss of independence. There are also im- example those aged 60 years and above, depending on cultural and portant gender differences in the way we age, with women having a personal perceptions. However, ageing is a life-long process, which begins before we are born and continues throughout life Figure 1: A life-course perspective for maintenance of the highest possible level of functional capacity The functional capacity of our biological systems (eg. muscular strength, cardiovascular performance, respiratory capacity etc. )increases during Functio nal capacity the first years of life, reaches its peak in early adulthood and naturally eclines thereafter This is captured in Figure 1, which has been developed as the conceptual framework of the WHO Programme on Ageing and Health. The slope of decline, however, is largely determined by external factors throughout the life course. The natural decline in cardiac or respiratory function, for example, can be accelerated by smoking, leaving the individual with lower functional capacity than would normally be xpected for his/her age. Similarly, poor nutrition in childhood may predispose through weaker bone structure to the development of osteoporosis in adulthood, thus increasing the slope of decline. The difference in decline in functional capacity between two individuals is often only evident later in life when a sharper descent may result in disabilit bi lity thresh妇 Health and activity in older age are therefore a summary of the living circumstances and actions of an individual during the whole life span Early life interventions to ensure the highest possible functional capacity his conceptual approach presents new opportunities, as people are able to influence how they age by adopting healthier life styles and by adapting to age-associated changes. However, some life course factors, which influence health and ageing, may not be modifiable by the individual For those in older age above the disability threshold, revisiting previous Socio-economic factors, including economic disadvantages and environmental threats, may affect the ageing process by predisposing to disease in later life. In this respect it is important to note that the'disability For those age below the disability threshold, interventions are interventions ing the quality of life
4 1. THE LIFECOURSE PERSPECTIVE OF AGEING Ageing can be defined as the process of progressive change in the biological, psychological and social structure of individuals. For statistical purposes, the aged are commonly placed into specific age groups, for example those aged 60 years and above, depending on cultural and personal perceptions. However, ageing is a life-long process, which begins before we are born and continues throughout life. The functional capacity of our biological systems (eg. muscular strength, cardiovascular performance, respiratory capacity etc.) increases during the first years of life, reaches its peak in early adulthood and naturally declines thereafter. This is captured in Figure 1, which has been developed as the conceptual framework of the WHO Programme on Ageing and Health. The slope of decline, however, is largely determined by external factors throughout the life course. The natural decline in cardiac or respiratory function, for example, can be accelerated by smoking, leaving the individual with lower functional capacity than would normally be expected for his/her age. Similarly, poor nutrition in childhood may predispose through weaker bone structure to the development of osteoporosis in adulthood, thus increasing the slope of decline. The difference in decline in functional capacity between two individuals is often only evident later in life when a sharper descent may result in disability. Health and activity in older age are therefore a summary of the living circumstances and actions of an individual during the whole life span. This conceptual approach presents new opportunities, as people are able to influence how they age by adopting healthier life styles and by adapting to age-associated changes. However, some life course factors, which influence health and ageing, may not be modifiable by the individual. Socio-economic factors, including economic disadvantages and environmental threats, may affect the ageing process by predisposing to disease in later life. In this respect it is important to note that the disability threshold shown in Figure 1 is not rigidly defined. In a supportive environment an individual who has experienced substantial loss in any given functional capacity may continue to live independently while another, with the same degree of functional loss in a less supportive environment will experience loss of independence. There are also important gender differences in the way we age, with women having a Early life interventions to ensure the highest possible functional capacity Adult life interventions aimed at slowing down the decline For those in older age above the disability threshold, revisiting previous interventions For those in older age below the disability threshold, interventions are aimed at improv interventions ing the quality of life 5DQJHRI IXQFWLRQ )XQFWLRQDOFDSDFLW\ $JH /LIHFXUYHRIKLJKHVW IXQFWLRQDOFDSDFLW\ /LIHFXUYHRIUHGXFHG IXQFWLRQDOFDSDFLW\ 'LVDELOLW\WKUHVKROG FKDQJHVLQH[WHUQDOHQYLURQPHQWFDQORZHUGLVDELOLW\WKUHVKROG Figure 1: A life-course perspective for maintenance of the highest possible level of functional capacity
higher life expectancy but on the whole suffering more disabilities in 2. FETAL DEVELOPMENT older age than men. 2.1 Fetal 'programming' This report presents a summary of the life course events, which determine the ageing process. It is acknowledged that the elements may not be The life course begins when we are still in the womb, and the influences sequential, but a chronological order has been chosen for practical we are exposed to during this time may leave a lasting mark on it purposes. Although some of the factors are presented individually, they Current research strongly suggests that adverse influences during fetal are often inter-linked and rarely occur in isolation. life, including undernutrition and lack of oxygen, prompt the fetus to make numerous adaptations to sustain its development. These adapta Bibliography ions may result in persisting changes to organ structure and metabolism, which are called 'programmed. They are thought to lead to disease in 1. The World Health Magazine No 4, July-August 1997 adult life, such as circulatory diseases, diabetes, chronic airflow obs- truction and disorders of lipid metabolism Figure 2. 1 shows that the risk for coronary heart disease and stroke falls with increasing birthweight, a surrogate marker for growth in the womb People who have been undernourished in the womb may therefore be Figure 2.1: Relative Risk of non-fatal coronary heart disease and stroke according to birthweight Age adjusted relative risk B irt mwe ight(pounds) (Source: Barker DIP. Mothers, Babies and Health in Later Life. Churchill Livingston, 1998)
5 Bibliography 1. The World Health Magazine No 4, July-August 1997 higher life expectancy but on the whole suffering more disabilities in older age than men. This report presents a summary of the life course events, which determine the ageing process. It is acknowledged that the elements may not be sequential, but a chronological order has been chosen for practical purposes. Although some of the factors are presented individually, they are often inter-linked and rarely occur in isolation. Figure 2.1: Relative Risk of non-fatal coronary heart disease and stroke according to birthweight ! %LUWKZHLJKW SRXQGV $JHDGMXVWHGUHODWLYHULVN (Source: Barker DJP. Mothers, Babies and Health in Later Life. Churchill Livingston, 1998) 2. FETAL DEVELOPMENT 2.1 Fetal programming The life course begins when we are still in the womb, and the influences we are exposed to during this time may leave a lasting mark on it. Current research strongly suggests that adverse influences during fetal life, including undernutrition and lack of oxygen, prompt the fetus to make numerous adaptations to sustain its development. These adaptations may result in persisting changes to organ structure and metabolism, which are called programmed. They are thought to lead to disease in adult life, such as circulatory diseases, diabetes, chronic airflow obstruction and disorders of lipid metabolism. Figure 2.1 shows that the risk for coronary heart disease and stroke falls with increasing birthweight, a surrogate marker for growth in the womb. People who have been undernourished in the womb may therefore be