Healthy ageing in the general public: lessons and trends Erik Buskens, MD PhD Prof. HTA Program Director Healthy Ageing
Evolutionary biology
Hunting gathering food - high energy expenditure for almost 7M y!
Homo sapiens Neanderthals Early Hominids
World population
Food!
How old do we get?
Priviliged world
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Demography
How old do we get? 1 in 3 women ≥90
How old will we become? (girls 2000 and later) Majority women will become ≥90 and median 100
Outlook?
• How do we define Healthy Ageing? • Why Healthy Ageing? • Healthy Ageing of/for whom? EU Grand Challenges ◦Health, demographic change and wellbeing; ◦Food security, sustainable agriculture, marine and maritime research, and the bio-economy; ◦Secure, clean and efficient energy; ◦Smart, green and integrated transport; ◦Inclusive, innovative and secure societies; ◦Climate action, resource efficiency and raw materials.
Shopping
Slick cars…
Old Age dependency ratios 4 to 1 dropping 2 to 1
Solidarity generations
Crisis vs. Ageing
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Challenge!
€90*109
According to proportion GDP (%), 2009 (Bron: OECD Health Data, 2011).
Challenge!
Costs health care 2012 Family income
care "rest"
Extrapolation 2040 Family income
care "rest"
Burden of illness? Injury Congenital anomaly
injury
Psychiatric disorder
CVD
Cancer
Cancer 4,0% = €3,0*109 Figuur 4: Kosten van kanker (ICD-10-codes C00-C97) in 2007, uitgesplitst naar leeftijd en geslacht
Figuur 5: Kosten van kanker (ICD-10-codes C00-C97) in 2007, uitgesplitst naar sector
(Bron: Kosten van Ziektenstudie). Nationaal Kompas Volksgezondheid, versie 4.13, 26 september 2013
CVD 9,3% = €6,9*109 Figuur 4: Kosten van hart- en vaatziekten (ICD-10-codes I00-I99) in 2007, uitgesplitst naar leeftijd en geslacht
Figuur 5: Kosten van hart- en vaatziekten (ICD-10-codes I00-I99) in 2007, uitgesplitst naar sector en geslacht
(Bron: Kosten van Ziektenstudie). Nationaal Kompas Volksgezondheid, versie 4.13, 26 september 2013
PAF Life Style
Journal of Preventive Medicine and Public Health. 2010;6:459-471
6.2 Percentage van het aantal nieuwe gevallen van coronaire hartziekten en beroerte dat te wijten is aan een bepaalde leefstijl- of risicofactor Leefstijl of risicofactor
% coronaire hartziekten
% beroerte
Roken
30
19
Onvoldoende groenteconsumptie (< 200 gram/dag)
9
-
Onvoldoende fruitconsumptie (< 200 gram/dag)
9
14
Te veel consumptie van verzadigd vet (> 10 energieprocenten)
5
-
Lichamelijke inactiviteit
16
23
Overmatig alcoholgebruik
-
7
Ernstig overgewicht
4
2
Verhoogde bloeddruk
32
33
Verhoogd cholesterol
20
-
L.A.T.M. van Leest & W.M.M. Verschuren. Centrum voor Preventie- en Zorgonderzoek, Rijksinstituut voor Volksgezondheid en Milieu, Bilthoven. Nederlandse Hartstichting / Leefstijl- en risicofactoren voor hart- en vaatziekten in de Nederlandse bevolking: prevalenties en trends
(Healthy) life years By education and sex
Dutch population
Preventie van welvaartsziekten, RVZ
‘Risk-life’ by education 53.1
Risk factors
Risk factor profile youth
Risk factors
81.4
72.3 74.1
7.3y 9.2y 21y
Risk factors
‘Expansion’ of disease low SES/education = potential compression? Age 11.8y
Over represented…
When and where to start?
Healthy Ageing Utility
Health
Ambition Prevention
Treat
Life course Age
LifeLines
LifeLines cohort studie
• 165.000 participants 3 generations North Nederlands • Combi genetic, biological & sociological data • all stages of research: fundamental, applied, translational, clinical 30 year follow-up !! Aselect: 45.000
father
Children: 35.000
propositus mother
child 1
Family: 2 children
Parents: 55.000
child 2
partners father
partner partners mother
Partners: 30.000
1st generation
80
Total: 165.000
2nd generation
50
3rd generation
25
0 jr
ERIBA • European Research Institute on the Biology of Ageing – 10 Top scientists from around world – Cell reproduction slows – Cells ‘unleashed’ – Genetic mutations disorder or repair
1-9-2014
– What causes cell senescence – Molecular mechanisms age related diseases – Mechanisms of epigenetics
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Who, what, when, where? Paradigm shift ‘ICD to ICF’
Healthy Ageing in clinic • Premature and immature birth • Cancer survivors • (Chronic) multi-morbidity (dementia, reumatism, COPD, HF, RF, post-transplant ..)
• Frail elderly
• Spinal cord injury?
Spinal cord injury
Fuhrer MJ. The subjective well-being of people with spinal cord injury: relationships to impairment, disability and handicap. Topics Spinal Cord Inj Rehabil 1996;1:56-71. Marcel W.M. Post et al.. Predictors of health status and life satisfaction in spinal cord injury. Archives of Physical Medicine and Rehabilitation 1998;79:395–401
6-point scale: very unsatisfied, unsatisfied, rather unsatisfied, rather satisfied, satisfied, and very satisfied van Koppenhagen CF et al. Changes and determinants of life satisfaction after spinal cord injury: a cohort study in the Netherlands. Arch Phys Med Rehabil. 2008 Sep;89(9):1733-40..
‘Life satisfaction is more strongly related to community participation than impairment and activity limitations.’ Christine Carpenter et al.. Community Participation After Spinal Cord Injury. Archives of Physical Medicine and Rehabilitation. 2007;88:427–433.
Who is frail?
Financial and other resources…. • Labour market – Stable supply yet increased demand, > 500.000 next decades NL (2% annual increase), i.e., 1 in 5
• ‘Old age dependency’ from 4 to 1 to 2 to 1 • We cannot afford to ‘waste’ human resources • How to uphold services, e.g., health care? • Productivity must increase & alternative modes! 1-9-2014
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Thank you!
[email protected] www.healthyageing.umcg.nl www.EpidemiologyGroningen.nl
Children in deprived areas 2010
SES 2010
Labour incapacitated compensation 2012
Low educational attainment (15 – 65) 2011
Healthy life expectancy 2005 - 2008
Life expectancy 2007 - 2010
Severe obesity 2008 - 2010
Excessive drinking 2012
Smoking 2012
Healthy Ageing concept: More Years, Better Lives Societal Utility
Health, HRQoL etc
Benefits primary prevention: Prevention Health 1,4 year 2 QALY Participation 70.000 pers Savings 3 biljon Benefits secondary prevention: Health 1,4 year 2 QALY Participation 70.000 pers Savings 1,5 biljon
Ambition
Intervention
Benefits tertiary prevention: Health 0 jaar 0,5 QALY Participation 0 Savings 6 biljon Age
Contant current monetary value 100 biljons €
In short… • Plenty challenges – Socio economic (health) differences – Solidarity regions and generations – Participation and retirement age – Services and infrastructure – Health care – Other sectors!
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