Aging Clinical and Experimental Research

, Volume 14, Issue 4, pp 287–292 | Cite as

Evolution of the needs of older persons

  • Brigitte Santos-EggimannEmail author
Thematic Section


Most countries in the world experienced a ma’pr increase in life expectancy during the 20th century and a resulting aging of their populations. Further gains in life expectancy are uncertain, particularly in developed countries already characterized by a high longevity, and little is known concerning the health state of future generations of the elderly. But there is no doubt that further population aging will produce larger numbers of older persons both in developed and developing countries. As the prevalence of most chronic diseases is high in old age, population needs change rapidly in health care systems still organized essentially to provide acute care to children and young adults. Old age is heterogeneous, but a large proportion of older persons is affected by multiple chronic diseases, resulting in a wide range of needs. Health systems will have to adapt to this new situation while still providing appropriate responses to acute diseases affecting all ages. Although future needs are difficult to quantify, their nature is already apparent. Providing for these needs will require a major investment in manpower, a diversification of services delivered by health care systems, changes in the training of health professionals and extensive research to define effective treatments for elderly patients with multiple co-morbidities.

Key Words

Aging epidemiological transition needs of older persons systems of care 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    OECD Health Data 2000. Paris: Centre d’Etudes et de Documentation en Economie de la Santé (CREDES), version 07/15/2000.Google Scholar
  2. 2.
    Shrestha LB. Population aging in developing countries. Health Aff 2000; 19: 204–12.CrossRefGoogle Scholar
  3. 3.
    United Nations: Accessed 15.04.2002.
  4. 4.
    Loyd-Sherlock P. Population ageing in developed and developing regions: implications for health policy. Soc Sci Med 2000; 51: 887–95.CrossRefGoogle Scholar
  5. 5.
    Olson P. Caregiving and long-term health care in the People’s Republic of China. J Aging Soc Policy 1993; 5: 91–110.PubMedCrossRefGoogle Scholar
  6. 6.
    Brockington CF. Demographic Yearbook 1992: the disease picture of the developed and developing worlds compared. Public Health 1997; 111: 129–33.PubMedCrossRefGoogle Scholar
  7. 7.
    Seale C. Changing patterns of death and dying. Soc Sci Med 2000; 51: 917–30.PubMedCrossRefGoogle Scholar
  8. 8.
    Desai MM, Zhang P, Hagan Hennessy C. Surveillance for morbidity and mortality among older adults: United States. 1995–1996. MMWR Morb Mortal Wkly Rep 1999; 48: 7–25.Google Scholar
  9. 9.
    Kalache A. Aboderin I. Stroke: the global burden. Health Policy Plan 1995; 10: 1–21.CrossRefGoogle Scholar
  10. 10.
    Boult C, Kane RL, Louis TA, Boult L, McCaffrey D. Chronic conditions that lead to functional limitation in the elderly. J Gerontol 1994; 49: M28–36.PubMedCrossRefGoogle Scholar
  11. 11.
    Eisenstein EL, Shaw LK, Anstrom KJ, et al. Assessing the clinical and economic burden of coronary artery disease: 1986–1998. Med Care 2001; 39: 824–35.PubMedCrossRefGoogle Scholar
  12. 12.
    Kaste M, Fogelholm R, Rissanen A. Economic burden of stroke and the evaluation of new therapies. Public Health 1998; 112: 103–12.PubMedGoogle Scholar
  13. 13.
    Kawas CH. Brookmeyer R. Aging and the public health effects of dementia. N Engl J Med 2001; 344: 1160–1.Google Scholar
  14. 14.
    Fratiglioni L, De Ronchi D, Agüero-Torres H. Worldwide prevalence and incidence of dementia. Drugs Aging 1999; 15: 365–75.PubMedCrossRefGoogle Scholar
  15. 15.
    Levkoff SE. Macarthur IW. Bucknall J. Elderly mental health in the developing world. Soc Sci Med 1995; 7: 983–1003.Google Scholar
  16. 16.
    Cumming RG. Nevitt MC. Cummings SR. Epidemiology of hip fractures. Epidemiol Rev 1997; 19: 244–57.Google Scholar
  17. 17.
    Delmas PD. Fraser M. Strong bones in later life: luxury or necessity? Bull World Health Organ 1999; 77: 416–27.PubMedGoogle Scholar
  18. 18.
    Thylefors B. Négrel AD. The global impact of glaucoma. Bull World Health Organ 1994; 72: 323–6.Google Scholar
  19. 19.
    Khaw KT. How many, how old. how soon? BMJ 1999; 319: 1350–2.CrossRefGoogle Scholar
  20. 20.
    Dowd JE. Manton KG. Forecasting chronic diseases risks in developing countries. Int J Epidemiol 1990; 19: 1019–36.Google Scholar
  21. 21.
    Howson CP. Perspectives and needs for health in the 21st century: 20th century paradigms in 21st century science. J Hum Virol 2000; 3: 94–103.PubMedGoogle Scholar
  22. 22.
    Nusselder WJ, Mackenbach JP. Lack of improvement of life expectancy at advanced ages in the Netherlands. Int J Epidemiol 2000; 29: 140–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Fries JF. Aging, natural death, and the compression of morbidity. N Engl J Med 1980; 303: 130–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Murray CJL, Lopez AD. Regional patterns of disability-free life expectancy and disability-adjusted life expectancy: Global Burden of Disease Study. Lancet 1997; 349: 1347–52.PubMedCrossRefGoogle Scholar
  25. 25.
    Manton KG. Corder L. Stallard E. Chronic disability trends in elderly United States populations: 1982–1994. Proc Natl Acad Sci USA 1997; 94: 2593–8.CrossRefGoogle Scholar
  26. 26.
    Cutler DM. Declining disability among the elderly. Health Aff 2001; 20: 11–27.Google Scholar
  27. 27.
    Schoeni RF, Freedman VA, Wallace RB. Persistent, consistent, widespread, and robust? Another look at recent trends in old-age disability. J Gerontol 2001; 56: S206–18.CrossRefGoogle Scholar
  28. 28.
    Manton KG, Gu X. Changes in the prevalence of chronic disability in the United States black and non-black population above age 65 from 1982 to 1999. Proc Natl Acad Sci USA 2001; 98: 6354–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Jacobzone S. Coping with aging: international challenges. Health Aff 2000; 19: 213–25.CrossRefGoogle Scholar
  30. 30.
    Doblhammer G, Kytir J. Compression or expansion of morbidity? Trends in healthy life expectancy in the elderly Austrian population between 1978 and 1998. Soc Sci Med 2001; 52: 385–91.PubMedCrossRefGoogle Scholar
  31. 31.
    Allaire SH, LaValley MP, Evans SR, et al. Evidence for decline in disability and improved health among persons aged 55 to 70 years: the Framingham Heart Study. Am J Public Health 1999; 89: 1678–83.PubMedCrossRefGoogle Scholar
  32. 32.
    Colvez A, Blanchet M. Disability trends in the United States population 1966–76: analysis of reported causes. Am J Public Health 1981; 71: 464–71.PubMedCrossRefGoogle Scholar
  33. 33.
    Freedman VA, Martin LG. Contribution of chronic conditions to aggregate changes in old-age functioning. Am J Public Health 2000; 90: 1755–60.PubMedCrossRefGoogle Scholar
  34. 34.
    Liao Y, McGee DL, Cao G, Cooper RS. Quality of the last year of life of older adults: 1986 vs 1993. JAMA 2000; 283: 512–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Bishop CE. Where are the missing elders? The decline in nursing home use, 1985 and 1995. Health Aff 1999; 18: 146–55.CrossRefGoogle Scholar
  36. 36.
    Besdine RW, Rubenstein LZ, Cassel C. Nursing home residents need physicians’ services. Ann Intern Med 1994; 120: 616–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Wenger NS, Shekelle PG, and the ACOVE Investigators. Assessing care of vulnerable elders: ACOVE project overview. Ann Intern Med 2001; 135: 642–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Van de Water HPA. Health expectancy and the problem of substitute morbidity. Philos Trans R Soc Lond B Biol Sci 1997; 352: 1819–27.PubMedCrossRefGoogle Scholar
  39. 39.
    Friedman B, Elixhauser A. Increased use of an expensive, elective procedure: total hip replacements in the 1980s. Med Care 1993; 31: 581–99.PubMedCrossRefGoogle Scholar
  40. 40.
    Frankel S, Eachus J, Pearson N, et al. Population requirement for primary hip-replacement surgery: a cross-sectional study. Lancet 1999; 353: 1304–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Gray CS. Crabtree HL. O’Connell JE. Allen ED. Waiting in the dark: cataract surgery in older people. BMJ 1999; 318: 1367–8.Google Scholar
  42. 42.
    Lubick Goldzweig C, Mittman BS, Carter GM, et al. Variations in cataract extraction rates in Medicare prepaid and fee-for-service settings. JAMA 1997; 277: 1675–8.Google Scholar
  43. 43.
    Buchner DM. Wagner EH. Preventing frail health. Clin Geriatr Med 1992; 8: 1–17.Google Scholar
  44. 44.
    Pendergast DR, Fisher NM, Calkins E. Cardiovascular, neuromuscular, and metabolic alterations with age leading to frailty. J Gerontol 1993; 48 Spec No: 61–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Newman AB, Gottdiener JS, Mcburnie MA, et al. Associations of subclinical cardiovascular disease with frailty. J Gerontol 2001; 56: M158–66.CrossRefGoogle Scholar
  46. 46.
    Pressley JC, Patrick CH. Frailty bias in comorbidity risk adjustments of community-dwelling elderly populations. J Clin Epidemiol 1999; 52: 753–60.PubMedCrossRefGoogle Scholar
  47. 47.
    Walston J. Fried LP. Frailty and the older man. Med Clin North Am 1999; 83: 1173–94.CrossRefGoogle Scholar
  48. 48.
    Stück AE, Egger M, Hammer A, Minder C, Beck J. Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA 2002; 287: 1022–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Zerzan J. Stearns S. Hanson L. Access to palliative care and hospice in nursing homes. JAMA 2000; 284: 2489–94.Google Scholar
  50. 50.
    Bernabei R, Gambassi R, Lapane K, et al. Management of pain in elderly patients with cancer. JAMA 1998; 279: 1877–82.PubMedCrossRefGoogle Scholar
  51. 51.
    Muir KW, Roberts M. Thrombolytic therapy after stroke: a review with particular reference to elderly patients. Drugs Aging 2000; 16: 41–54.PubMedCrossRefGoogle Scholar
  52. 52.
    European Secondary Prevention Study Group. Translation of clinical trials into practice: a European population-based study of the use of thrombolysis for acute myocardial infarction. Lancet 1996; 347: 1203–7.Google Scholar
  53. 53.
    Guadagnoli E, Landrum MB, Peterson EA, Gahart MT, Ryan TJ, McNeil BJ. Appropriateness of coronary angiography after myocardial infarction among Medicare beneficiaries. N Engl J Med 2000; 343: 1460–6.PubMedCrossRefGoogle Scholar
  54. 54.
    Krumholz HM, Radford MJ, Ellerbeck EF, et al. Aspirin for secondary prevention after acute myocardial infarction in the elderly: prescribed use and outcomes. Ann Intern Med 1996; 124: 292–8.PubMedCrossRefGoogle Scholar
  55. 55.
    Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff 2001; 20: 64–78.CrossRefGoogle Scholar
  56. 56.
    Brodsky J, Habib J, Mizrahi I. Long-term care laws in five developed countries: a review. Geneva: World Health Organization. 2000: 20–3.Google Scholar
  57. 57.
    Benjamin AE. Consumer-directed services at home: a new model for persons with disabilities. Health Aff 2001; 20: 80–95.CrossRefGoogle Scholar
  58. 58.
    Stone RI. Providing long-term care benefits in cash: moving to a disability model. Health Aff 2001; 20: 96–108.CrossRefGoogle Scholar
  59. 59.
    Andersen G, Knickman JR. Changing the chronic care system to meet people’s needs. Health Aff 2001; 20: 146–60.CrossRefGoogle Scholar

Copyright information

© Springer Internal Publishing Switzerland 2002

Authors and Affiliations

  1. 1.Health Services Research Unit, Institute of Social and Preventive MedicineUniversity of LausanneLausanneSwitzerland

Personalised recommendations