Vitamin Information Center

Aging and Health
MICHAL ENGELMAN
Department of Population and Family Health Sciences,
Johns Hopkins University, Bloomberg School
of Public Health, Baltimore, MD, USA
mengelma@jhsph.edu
Synonyms
Elderly and health; Health of the elderly; Older people
and health
Definitions
Population aging, the demographic process by which
older persons become a proportionally larger share of
the total population, is associated with changing patterns
of mortality, morbidity, and disability (UNPD
2002). In the older population different aspects of
health have to be considered.  Gerontology, the scientific
study of the biological, psychological, and sociological
phenomena associated with old age and aging,
and geriatrics, the branch of medicine that focuses on
health promotion and the prevention and treatment of
disease and  disability in later life, both deal with the
well-being of older people.
Basic Characteristics
A gradual  demographic transition – from patterns of
high fertility and high mortality to patterns of lower fertility
and later mortality – has been underway across
the globe. Lower birth rates and growing longevity have
led to an overall increase in both the absolute number
and relative proportion of older people in the general
population. By 2002, the population of individuals 60
years and over reached 626 million, or 10 percent of
the total world population. Of these, nearly 70 million
are among the oldest-old, aged 80 or over. The older
population is projected to expand rapidly in the coming
decades, more than tripling its current size and reaching
2 billion by 2050. The oldest-old population is expected
to grow more than 5.5 times to reach 379 million by
2050. Decreasing fertility rates contribute to the prediction
that older individuals will at that time constitute 21
percent of the total world population, twice their current
proportion and equal to the number of predicted children.
The proportion of the oldest-old will quadruple
to 4 percent by the same year (UNPD 2003). Women
constitute the majority of older people in most countries
(Velkoff, Lawson 1998).
The demographic changes are linked with  epidemiologic
transitions, in particular a shift in the leading
causes of death away from infectious, acute diseases
in early life towards chronic and degenerative illnesses in mid- and later life. Given the increase in total
 life expectancy, a number of gerontological theories
addressing the implications of increased longevity for
population health have emerged, each proposing different
relationships between old-age mortality, morbidity,
and disability, or limitations in performing activities of
daily living. (For a review, see Agree, Freedman 1999)
The theories range from the most pessimistic – in which
delayed mortality is translated to increased years of life
with disease and disability – to the most optimistic, in
which morbidity and disability are compressed towards
the end of life, increasing the healthy proportion of
total life expectancy. More nuanced perspectives recognize
the complexity, mutability, and inter-connectedness
of the processes determining morbidity, disability,
and mortality, and suggests a continuous dynamic
relationship between them. International trends in mortality
and disability outcomes are mixed, supporting
a dynamic model of longevity and health in later life
that is influenced by a multitude of biomedical, environmental,
and social factors.
Population aging is an aggregate mark of human success
in reducing fertility, improving living conditions,
and curbing risks of death through innovations in public
health and medicine. However, insufficient preparedness
for the needs of an aging population on the part of
health and social service providers is a challenge confronting
societies at all levels of development.
Geriatric Health
Aging populations have higher rates of chronic disease
and  disability, and the likelihood of having multiple
co-morbidities rises significantly with age. In high
and low-income countries alike, ischemic heart disease
and cerebrovascular diseases are the leading causes of
death. In more developed nations, cancers (lung, colon,
rectum, stomach, and breast), chronic obstructive pulmonary
diseases, diabetes mellitus, and Alzheimer’s
Disease and other dementias are also among the most
prevalent causes of death. A range of chronic and
adult-onset conditions including depression, hearing
loss, alcohol-use disorders, osteoarthritis, schizophrenia,
bipolar disorders, and chronic obstructive pulmonary
diseases are among the leading causes of global
disability (Murray et al. 2001). Chronic diseases may
contribute to the gradual loss of senses such as sight
and hearing, to impaired mobility, to increased risks of
falls and fractures, and to disability in the performance
of activities of daily living.
As  senescence, or the slowing-down of physical systems
that takes place as the body ages, progresses,
a range of physical and mental capacities is weakened.
Age-related mental illness, especially dementia,
are particularly difficult to cope with for both patients
and caregivers alike. Dementia is a condition of irreversible
decline in cognition, functioning and behavior.
Alzheimer’s disease (AD) accounts for approximately
60–70% of dementia cases, with vascular dementia
accounting for the majority of the rest. The prevalence
of AD is estimated to be 8–15% in persons over 65. The
primary risk factor for dementia is age, with the prevalence
doubling for every 5-year age group after the age
of 65 and reaching as high as 39 percent after age 90
(Jorm, Jolley 1998).
Chronic diseases exact a heavy burden on older adults
due to associated long-term illness, diminished quality
of life, and increased health care costs. Although
the risk of disease and disability clearly increases with
advancing age, poor health is not an inevitable consequence
of aging. A healthy lifestyle (including regular
physical activity, a nutritious diet, and avoidance
of tobacco) is the recommended course for prevention.
Screening for early detection is also recommended for
those illnesses (e. g. some cancers, diabetes and its complications,
etc.) for which a course of treatment is available.
Aging and Pharmacotherapy
Older people are particularly susceptible to the risks of
medication use. Age-related loss of physiologic reserve
leads to pharmacokinetic changes and increases interindividual
variability. The loss of renal function, for
example, decreases the clearance of common drugs in
older people, while the loss of lean body mass and fat
mass leads to an altered volume of drug distribution.
Polypharmacy – the use of multiple (usually 5 or more)
medications – is a common issue since geriatric patients
frequently have multiple co-morbidities each treated
with one or more medication. Furthermore, some medications
bring about  side effects that then lead to
the prescription of additional drugs to treat the added
symptoms. Polypharmacy increases the potential of
drug interactions, adverse drug reactions, and the use
of inappropriate medications, or drugs that should be avoided in certain doses, disease states, or in combination
with other drugs (Hanlon et al. 2001).
Care-Giving
Historically, older people in need of assistance received
care from younger family members. However, previously
high levels of mortality and fertility meant that
the proportion of individuals reaching older ages was
relatively small while a larger pool of children and relatives
was available to share care-giving responsibilities.
More recently, the proportion of the population
at older ages has been expanding as the numbers of
younger family members available to provide care has
been shrinking.
Women – wives, daughters, daughters-in-law, nieces
and granddaughters – have traditionally provided the
bulk of family care-giving and continue to do so despite
rising levels of labor force participation. Older people
are as likely to provide care as they are to receive it,
and in developing and developed countries alike, spouses
are the main caregivers for both men and women.
Because of the sex differential in longevity, however,
women are more likely than men to find themselves
without a spouse and to be living alone when they need
care (Velkoff, Lawson 1998).
A relatively small proportion of older people – between
1 and 10 percent – reside in institutions in developed
nations (Velkoff, Lawson 1998). There has been growing
concern – though not much documentation – that as
networks of family caregivers shrink the rate of institutionalization
among older people may rise. Additional
concerns about the quality and cost of institutional care
are garnering attention in many countries.
Aging in Developing Nations
In developing nations a rapid  demographic transition
has outpaced economic development. Since 1980,
developing countries have been home to a larger proportion
of the world’s population of persons aged 60
and above than their industrialized counterparts (Lloyd-
Sherlock 2000). By 2000, 249 million people, or 59%
of the world’s 65 years of age and over population lived
in developing countries (US Census Bureau 2001).
According to demographic projections, by 2050, more
than three-quarters of the world’s older people will
be living in developing countries. By 2050 developing
countries will posses a similar age structure to
today’s more industrialized nations. Older people will
then comprise over 30% of the population in East Asia,
more than 20% of the population in Southern Asia and
Latin America, and approximately 10% of the population
in Africa (UNPD2003).
Though they are among the most disadvantaged populations
in developing nations, older people have not
been prioritized by international aid agencies. Eighty
percent of older people in developing countries have no
regular incomes, and approximately 100 million older
persons live on less than a dollar a day. Older people
in developing regions are often excluded from economic
development, healthcare and education programs
due to age limits and discrimination and humanitarian
agencies often fail to identify older people as a target
in the planning and delivery of services in conflict
areas (Help – Age International 2002). While incidence
of chronic and age-related disease has been rising
rapidly in developing nations, there is a lack of professionals
in geriatric medicine, preventing older adults
from receiving the health care they need (Keller et al.
2002).
Though norms of filial piety are still strong in many
developing countries, changes in family structures and
co-residence patterns are rendering traditional support
networks more vulnerable. Recognizing the need for
increased awareness and action on issues related to
global aging, the Second World Assembly on Aging
adopted the Madrid International Plan of Action in
2002. The Plan calls on governments, non-governmental
organizations, and the international community to
adopt the concept of “a society for all ages,” to end
age-based discrimination and abuse, and incorporate
the concerns of older people into national and international
economic and social development policies (United
Nations Programme on Ageing, 2002). The formation
of implementation andmonitoring strategies for the
Plan is now in progress.
Cross-References
 Age-Dependency Ratio
 Demographic Transition
 Disability
 Epidemiologic Transition
 Geriatrics
 Gerontology
 Life Expectancy
 Population Aging
 Senescence
References
Agree EM, Freedman VA (1999) Implications of Population
Aging for Geriatric Health. In: Gallo JJ (ed) Clinical Aspects
of Aging, 5th edn. Williams and Wilkins Inc., Baltimore,
MD, pp 659–669
Hanlon JT, Schmader KE, Ruby CM, Weinberger M (2001) Suboptimal
prescribing in older inpatients and outpatients. JAGS
49:200–209
HelpAge International (2002) State of the World’s Older People
2002. HelpAge International, London
Jorm AF, Jolley D (1998) The incidence of dementia: a metaanalysis.
Neurology 51:728–733
Keller I,Makipaa A, Kalenscher T, Kalache A (2002) Global Survey
on Geriatrics in the Medical Curriculum. World Health
Organization, Geneva
Lloyd-Sherlock P (2000) Old age and poverty in developing
countries: New policy challenges. World Development
28(12):2157–2168
Murray CJ, Lopez AD, Mathers CD, Stein C (2001) The Global
Burden of Disease 2000 Project: Aims, Methods and Data
Sources. World Health Organization, Geneva
United Nations Population Division (UNPD), Department of
Economic and Social Affairs (DESA) (2002) World Population
Ageing: 1950–2050. United Nations, New York
United Nations Population Division (UNPD), Department of
Economic and Social Affairs (DESA) (2003) World Population
Prospects: The 2002 Revision. United Nations, New
York
UN Programme on Ageing, Division for Social Policy and Development
(2002) Madrid International Plan of Action on Ageing.
United Nations, New York
U.S. Census Bureau (2001) Series P95/01–1, An Aging World:
2001. US Government Printing Office, Washington DC
Velkoff VA, Lawson VA (1998) Gender and Aging: Caregiving.
International Programs Center. U.S. Census Bureau, Washington
DC

Abundant dietary vitamin C may lower the risk of developing type 2 diabetes, say researchers from the Institute of Metabolic Science at Addenbrooke’s Hospital in Cambridge, England.

Scientists there followed 21,831 men and women aged 40 to 75 over a 12-year period, during which they tracked diet, exercise, and blood content. By the end of the study, 423 men and 312 women-3.2 percent of the study group-had developed type 2.

The researchers concluded that the subjects with the highest levels of vitamin C in their blood were 62 percent less likely to develop type 2 than the subjects with lower levels.

Fruit and vegetables were the subjects’ main sources of vitamin C. The researchers said that other factors commonly associated with a risk for diabetes, such as age, sex, smoking, family history, weight, and alcohol consumption, did not significantly alter the beneficial effects of vitamin C.

Is Gum Disease a Precursor to Diabetes?

If you have gum disease, your chances of developing type 2 diabetes are nearly double those of people who don’t have gum disease, according to researchers at Columbia University’s Mailman School of Public Health in New York City.

That was their conclusion after a 20-year study that tracked 9,000 people without diabetes.

The presence of periodontal disease has often been noted as an accompaniment to diabetes, but nobody is sure whether it is a precursor to the disease or possibly even a contributing factor.

Because gum disease, like diabetes, involves tissue inflammation, there is some speculation that it is an indicator of susceptibility to inflammatory disease.

Thirty-five percent of adults have some form of gum disease, and one third of those experience a troubling level of infection.

Researchers don’t know what causes periodontal disease. Theories include genetics, smoking, and dry mouth caused by medications. Treatments include antibiotics, topical gels, extremely deep tooth cleaning, and even surgery to graft tissue from the roof of the mouth onto affected spots to encourage new gum growth.

The hope is that lowering the level of inflammation in the mouth may decrease the likelihood of inflammation developing elsewhere in the body.

Source: Diabetes Care, July 2008

Men who have their diet based on green vegetables, fruits and lentils have a higher chance of fathering a healthy child, a new research shows.

Scientists at the University of California, Berkeley and the Lawrence Berkeley National Laboratory found that men with relatively low levels of folate (a B Vitamin) had increased risks for sperm containing either too few or too many chromosome, a condition known as aneuploidy. This condition is connected to failure to conceive, miscarriages, and children born with conditions such as Down’s syndrome, Turner’s syndrome and Klinefelter’s syndrome.

“We looked at sperm to find different kinds of genetic abnormalities. The abnormalities we looked at here were having too few or too many chromosomes,” lead researcher Brenda Eskenazi, a professor of maternal and child health and epidemiology and director of the Center for Children’s Environmental Health at Berkeley’s School of Public Health said, according to the Washington Post.

The researchers analyzed sperm samples from 89 healthy, non-smoking men and questioned them about their daily intake of zinc, folate, vitamin C, vitamin E and beta-carotene. They found men with the highest intake of folate or folic acid (between 722 and 1150 micrograms a day) had 20 percent to 30 percent lower frequencies of aneuploidy compared to men with a lower intake. No correlation was made between the other vitamins and sperm aneuploidy.

The current recommended daily intake of folate for men over the age of 19 is 400 micrograms. Health experts recommend women of childbearing age maintain a healthy intake of folate because it is essential for healthy fetal developmental and to prevent neural tube birth defects such as spina bifida or anencephaly (severe type of brain damage). That’s the reason why folic acid is now added to bread, cereal, flour and other grain products in the U.S.

This study is the first to “say that male diet may be important for healthy offspring as well.”

“The emphasis related to the birth of a healthy baby has been weighted towards the health and diet of women, not just during pregnancy, but before. What we’re finding now is that a nutritious diet, specifically folate intake, may be beneficial for men as well when it comes to producing healthy offspring,” Dr. Eskenazi said.

She also adds that if other studies confirm her team’s findings of the link between folate intake and aneuploidy, scientists may recommend men tale folic acid for at least three months before trying to conceive.

The idea that diet can improve sperm quality is less well established. “There is increasing evidence from a number of studies to suggest that dietary factors can correlate with sperm health. The story so far suggests that dietary factors won’t help you make more sperm, but good diet might just improve that quality of the ones that are made,” said Dr. Allan Pacey, senior lecturer in andrology at the University of Sheffield and honorary secretary of the British Fertility Society, BBC News reported.

The study findings are published in the March 20 issue of the journal Human Reproduction.

Researchers have found an association between a vitamin found in leafy green vegetables, fruit and pulses and levels of chromosomal abnormalities in men’s sperm. Men who consumed high levels of folate (a water-soluble B vitamin that occurs naturally in food) and folic acid (the synthetic form of the vitamin) tended to have lower levels of abnormal sperm where a chromosome had been lost or gained (known as aneuploidy).

Writing in Europe’s leading reproductive medicine journal, Human Reproduction, today (Thursday 20 March), the authors say estimates suggest that between 1-4% of sperm in a healthy man have some type of aneuploidy, but there are large variations among individuals, the mechanisms are poorly understood and little is known about the effects of men’s diet on their sperm.

In the first study of its kind to investigate the relationship between sperm aneuploidy and paternal diet, they analysed sperm samples from 89 healthy, non-smoking men and questioned them about their daily total intake (from diet and from vitamin supplements) of zinc, folate, vitamin C, vitamin E and beta-carotene.

One of the principal investigators of the study, Brenda Eskenazi, Professor of Maternal and Child Health and Epidemiology and Director of the Centre for Children’s Environmental Health at the School of Public Health, University of California, Berkeley, USA, said: ‘We found a statistically significant association between high folate intake and lower sperm aneuploidy: there was increasing benefit with increasing intake, and men in the upper 25th percentile who had the highest intake of folate between 722-1150 micrograms, had 20-30% lower frequencies of several types of aneuploidy compared with men with a lower intake.

‘However, this study cannot prove that high folate intake caused the lower sperm aneuploidy levels, only that there is an association. This is the first study of its kind and the results indicate the need for further research, especially a randomised controlled trial, on this topic.’

The researchers found no consistent associations between intakes of zinc and the other vitamins and sperm aneuploidy.

Prof. Eskenazi said: ‘While the importance of maternal diet on reproduction, especially folate intake, is well known, the results of our study suggest the importance of studying paternal nutrition when considering male-mediated developmental consequences. In previous studies, we and others have shown that paternal micronutrient intake may contribute to successful conceptions by improving the quality of the sperm. This study is the first to suggest that paternal diet may play a role after conception in the development of healthy offspring.’

The current recommended daily intake (RDA) for men aged over 19 is 400 micrograms, and the authors say that if other studies confirm their findings of the link between folate intake and aneuploidy, then a possible intervention would be to increase the RDA for men considering becoming fathers for at least three months before trying to conceive in order to reduce the risk of chromosomal abnormalities in their children.

Ms Suzanne Young, a researcher in Prof Eskenazi’s group and the study co-ordinator, said: ‘Increasing folate intake can be as simple as taking a vitamin supplement with at least 400 micrograms of folate or eating breakfast cereal fortified with 100% of the RDA for folic acid. In addition, green leafy vegetables, such as spinach, can have up to 100 micrograms of folate per serving.’

Disentangling the effects of folate from other micronutrients (e.g. the other vitamins) can be difficult, but the authors think they have succeeded in doing this by looking at several different nutrients in statistical analyses. Ms Young said: ‘The results of the different analyses were different, which gave us some confidence that we could look at the effect of these micronutrients separately. The definitive way to answer this question would be with a randomised control trial with folate supplementation.’

Source: European Society for Human Reproduction and Embryology