Publications

Abstract : With the unprecedented surge in geriatric populations, public health policies should prioritize plans for ensuring independence and dignity of elders. Demographic transformations have social, political, and economic implications that influence funding and provisioning geriatric care. While maximum life span is genetically determined, East Asia has shown the fastest improvements in life expectancy at birth, increasing from 45 years (1950) to 74 years (2005). 65-year olds would increase from 12.5% to 20% in the USA by 2030, while China and India would encounter larger numbers. Health promotion schemes and health care management strategies have propelled an abrupt rise in the survival rates of elders, accompanied by the increasing need for trained personnel, specialized care, and budgetary policies to earmark funds from young taxpayers to pay for geriatric care. “Compression of morbidity” hypothesis optimistically proposes that age-related disease and disability can be postponed to terminal years of life. Education, supportive technologies, and treatments improve the quality of life of elderly citizens in developed industrialized societies, but the obesity epidemic is a looming threat. Bioethicists warn that rising geriatric populations demand detailed plans to avert bankruptcy of insurance companies. It is important to understand that the infirmity of old age is, at least partly, the inevitable outcome of deleterious mutations accumulating in post-reproductive life. Reproductive success being key to survival, harmful mutations that express in early reproductive period of life are selectively deleted, while deleterious mutations expressing in post-reproductive life would accumulate. Antagonistic pleiotropy proposes that genes serving a favorable outcome in early life would accumulate, even if harmful in later life, leading to senescence. Genes promoting inflammatory repair in early life have been implicated in chronic inflammatory diseases of old age. Public health policies, especially in lifestyle disorders, can learn from evolutionary biology, but such research is scanty. While global mortality rates have plummeted towards the end of the twentieth century, death rates from Alzheimer’s disease, heart disease, cerebrovascular disease, influenza, and pneumonia registered exponential increases with age. Most common chronic conditions among elderly Americans are hypertension, coronary heart diseases, chronic joint symptoms, and stroke. Patterns in comorbidity-co-occurrence of chronic conditions help assess disease burden and prevalence. Hypertension, cholesterol, sedentary life, obesity, and smoking have been associated with mortality from CHD, cancer, and stroke. Lung, colon, prostate, bladder, and rectum cancers show the highest incidence in men, whereas breast, uterine, colon, rectum, and lung cancers are the highest in women. An OECD report suggests that dementia affects 30% of those aged 85–89. Epidemiological data on “functional impairment” or “disability,” reveal that greater understanding of the occurrence, causes, and consequences of disability help formulate preventive therapies for minimizing disability. Metrics of disability can be a powerful tool for estimating adverse reactions, presence and severity of multiple pathogeneses, including physical, cognitive, and psychological, as well as their potential synergistic effects. Activities of daily living (ADL), instrumental activities of daily living (IADL), and objective assessment of physical performance help assess capacity for independent community life, an essential aspect of long-term geriatric care.