Ageing, the Elderly, Gerontology and Public Health

Challenges associated with ageing from a public health perspective

1. Foundations of
Public Health
Lecture 7 -Gerontology
PhuaKai Lit, PhD (Johns Hopkins)
Retired public health professor
(Monash University Malaysia School
of Medicine and Health Sciences)

2. Lecture Objectives
What is “Gerontology”
Classification of the elderly -young-old, old-old,
oldest-old
Individual ageing versus population ageing
Population pyramid
Health and other challenges associated with ageing
e.g. multiple illnesses, fragmented care,
polypharmacy
Geriatrics -branch of medicine that treats the
health problems of the elderly
Long term care -price, quality

3. What is “Gerontology”?
•Gerontology can be defined as the multi-
disciplinary study of the elderly and the process of
growing old (especially of the young-old into the
old-old and oldest-old categories)
•The focus would be on the social, psychological
and physical/mental aspects of life as an elderly
person.

4. Classification of the Elderly in Terms
of Age
The classifications are arbitrary to some
extent
Young-old: 60-70 years of age? Note that
people aged 60 onwards are considered old
in Japan while people who are 65 and above
are considered old in the USA.
Old-old: 70-eighty?
Oldest-old: Eighty and above? The oldest-old
tend to consume more health care
resources.

5. Individual Ageing versus
Population Ageing
Individual ageing --increasing chronological age of
an individual over time. Note that some people age
faster physically than others. This is affected by
whether the person has a healthy lifestyle or not. The
job that one does can also speed up physical ageing.
Population ageing --the percentage of elderly people
in a population increases over time, from around 15%
to 25% and above. This is largely due to falling birth
rates and only secondarily due to increasing life
expectancy of people in the older age groups.

6. Population Pyramid
A population pyramid depicts the age and sex
composition of the population of a particular
geographical location (e.g. country) at a certain point
in time.
A country with a high birth rate will have a more
triangular-looking population pyramid while a country
with a low birth rate will have a more rectangular-
looking one.

7. Population Pyramid

9. Ageing Challenges
Physical: decline in physical functioning as one ages.
Decline in mental functioning for some people too.
Need for home modifications for “ageing in place”.
Social: for some people, loss of social prestige after
retirement (“I am just a retiree”), loss of power (if one
used to be the CEO of a big company), loss of
spouse or relatives or friends if one lives a long life
Psychological: for some people, loss of identity or
meaning in life after retirement. Dealing with free
time.
Economic: drop in income after stopping paid work.
Loss of employer-supplied medical insurance.
Working class people have little savings upon
retirement. Housewives may not be covered by social
welfare schemes (i.e. employment-linked schemes) in
old age. Financial scams are a threat to the elderly
and their mental health.

10. Health Care Issues
Paying for care in old age -hospital care,
long term care, drugs for chronic diseases
Multiple health problems -common in the
elderly (e.g. having hypertension, arthritis
and diabetes at the same time)
Fragmented care -care provided by multiple
doctors (can result in polypharmacy i.e.
taking many medical drugs at the same time)
Polypharmacy -side-effects of drugs, risk of
adverse drug interactions
Long term care -price, quality can be
problematic (elder abuse in nursing homes)

11. Thank You
Additional Resources:
phuakl.tripod.com/age.html