The aging of populations is now an acknowledged
reality throughout the world. In broad
terms the rate of growth of the world's older
population is twice that of the total population
and for the very old (80 years and over) six
times. The net increase worldwide of those age
60 years and over is now almost one million
every month of which more than two thirds live
in the developing world. Over recent decades
continual significant increases in life expectancy,
especially at older ages, have been the norm in
most countries worldwide. The extent to which
these added years of life are accompanied by
greater or lesser degrees of illness, mental
disorders, disability and dependence is still
controversial. However, there can be no doubt
that this extraordinary global demographic and
accompanying epidemiologic transition has
profound impact upon health and well being of
populations. The range of ageing-associated
conditions is considerable and includes
Alzheimer's disease and other dementias, other
neurodegenerative disorders including Parkinson's
disease, cardiovascular and cerebrovascular
disease, vision and hearing loss, altered glucose
metabolism and type II diabetes, osteoporosis,
hip fracture, incontinence, depression, specific
infections including pneumonia, widowhood,
loneliness, social isolation and loss of
independence. These conditions follow the basic
pattern of the Gompertz logarithmic curve of
steadily rising risk of disease and death with
advancing age. 1

The prospects for delaying, ameliorating or
preventing these chronic conditions in spite of
advancing age is improving rapidly and with
greater investment in research and development
of more effective interventions there is the
potential of astoundingly beneficial and cost
effective results in the future.

Recent evidence indicates that levels of active
life expectancy have begun to rise at a faster
pace than life expectancy. Advances in preventive
health care, early intervention and improvements
in management and rehabilitation as well as
improved health behaviours have all probably
contributed to these trends. Thus, increasing
proportions of remaining life at older ages are
spent in good health and without major
functional limitations. There is a wide range of
potential interventions in health and functional
changes at late ages that suggest further
improvements can be made. They include exciting
prospects such as: Newer drug therapies that
have strong future potential to reduce ill-health
and restore functioning, including more effective
anti-hypertensive drugs. Refinement of hormonal
treatments such as exogenous estrogens balanced
with progesterone are reported to reduce the
incidence of osteoporosis by over a half as well
as moderating CVD risk factors in both women
and men and possibly lessening the risk and rate
of progression of dementias in women. Prospects
now exist for delaying progress of Alzheimer's
disease in mild and moderate phases with
specific drug interventions.

The Human Genome Project offers the
promise of new development of cures, vaccines
and treatments for many diseases. The advent
of gene therapy provides potential for
intervention in many chronic diseases
previously considered non-treatable.
 

Advances in biotechnology indicate prospects
for greatly improved diagnosis, screening,
surgical and prosthetic techniques. The issues
associated with diagnosis, assessment, management, rehabilitation and prevention of
chronic diseases and disability are emerging as
major challenges for modern medicine and
must be accorded increasing priority for
attention and the allocation of health resources.

More research and policy action is called for.
The United Nations Research Agenda on
Ageing for the 21st Century proposes a
systematic global investment in policy relevant
investigations that will assist policy makers
and others in their attempts to:
*Define policy goals
*Select priorities for policy interventions
*Identify measures for policy implementation
*Evaluate the impact of age specific and other policy measures
*Support capacity building

Several areas have been identified in the process:
* The attainment of healthy ageing including
improved understanding of processes and
contribution of basic molecular and cellular
ageing
* The development of care systems
* Responding to changing structures and functions
of families, kin, primary groups and
community
* The provision of economic security
* The implications of macro-societal change
and development. The examination of
policy processes and evaluation

In the last few decades we have learned a
great deal about ageing and the accompanying
health and functional implications. We are in a
better position, than ever before to confidently
predict future medico-demographic scenarios
that are likely to face us into the opening
decades of the present century.

Apart from the technical advances referred to
above it is clear that a great deal can be
achieved by positive promotion of healthy
ageing. This requires a coordinated and
comprehensive approach on the part of
governments, health and welfare authorities,
non-governmental organisations and the wider
community including older persons themselves.
Action is needed now to lessen the possible
negative health and social impacts of population
ageing and to ensure that each individual's
potential for longer life with good health and
functioning is maximised to the full. A new
image, a new approach and a new optimism
about ageing is needed to underpin the necessary
political, social, community and professional
initiatives that are urgently required to support
the goal of healthy ageing for all. It is critical
that current knowledge and understanding is
effectively applied to rational, scientific and
humanitarian resolution of the challenges that
face us in improving the health and well being
of populations in a rapidly aging world.

The up-coming Second World Assembly on
Ageing <www.un.og/esa/socdev/ageing/waa> to
take place in Madrid in April 2002 and the
International Strategy for Action on Ageing 2002
that will be endorsed by it along with the
preceding Valencia Forum <www.Valenciaforum.com> should provide a sound framework for pursuing these vital and laudable objectives for the future.


1Putting Aging on Hold - Delaying the diseases
of old age. An Official Report to the White
House Conference on Aging. American
Federation for Aging Research and Alliance for
Aging Research. 1995
.