1 The impact of the aging and the role of research Richard Suzman Director, Behavioral and Social...
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1 The impact of the aging and the role of research Richard Suzman Director, Behavioral and Social Research Program National Institute on Aging, NIH Brussels March 22, 2006 Department of Health and Human Services
1 The impact of the aging and the role of research Richard Suzman Director, Behavioral and Social Research Program National Institute on Aging, NIH Brussels
1 The impact of the aging and the role of research Richard
Suzman Director, Behavioral and Social Research Program National
Institute on Aging, NIH Brussels March 22, 2006 Department of
Health and Human Services
Slide 2
2 Research on Aging Need to understand the macroeconomic and
social aspects of population in order to minimize the negative and
increase the positive Need to find ways to increase health
expectancy by decreasing age-related physical and cognitive
disability Critical to deal with Alzheimers Disease Europe has
nothing quite like the NIH ($28B)or NIA ($1B) and until recently
investment in research on aging, including research infrastructure,
was far too modest EU Survey on Health Ageing and Retirement
(SHARE) a good beginning
Slide 3
Department of Health and Human Services National Institute on
Aging National Institutes of Health
Slide 4
National Institute of Allergy and Infectious Diseases National
Institutes of Health National Institute on Aging Office of the
Director National Institute on Alcohol Abuse and Alcoholism
National Institute of Arthritis and Musculoskeletal and Skin
Diseases National Cancer Institute National Institute of Child
Health and Human Development National Institute on Deafness and
Other Communication Disorders National Institute of Dental and
Craniofacial Research National Institute on Drug Abuse National
Institute of Diabetes and Digestive and Kidney Diseases National
Institute of Environmental Health Sciences National Eye Institute
National Institute of General Medical Sciences National Heart,
Lung, and Blood Institute National Institute of Neurological
Disorders and Stroke National Institute of Nursing Research
National Institute of Biomedical Imaging and Bioengineering Fogarty
International Center National Human Genome Research Institute
National Center for Research Resources Center for Information
Technology Center for Scientific Review National Institute of
Mental Health 2001 Center for Alternative Medicine National Center
on Minority Health & Health Disparities
Slide 5
NIA Mission vEstablished in 1974 to support and conduct
research on aging processes, age-related diseases, and special
problems and needs of older people vExamining the Biology of
Cellular Aging vPreventing or treating Alzheimers disease vReducing
old age Disability -a final pathway vMacro aspects of population
aging
Slide 6
NIA Extramural Programs Geriatrics and Clinical Gerontology
Biology of Aging Neuroscience and Neuropsychology Behavioral and
Social Research (BSR)
Slide 7
7
Slide 8
8 GDP/per capita and Life expectancy Preston (1997 and 1996
)
Slide 9
9 Total fertility rate and life expectancy at birth: World,
1950-2050 Total fertility rate (births per woman) Life expectancy
at birth (years) The demographic causes of global population
ageing:
Slide 10
10 1
Slide 11
11 What Will Be the Major Population Trends Related to Aging in
Europe? Will Europe continue to age faster than the US, and are
official estimates of longevity too low? Will births increase? Will
old age disability in Europe, parallel the US declining trend, do
we have the data necessary to track disability (the ability to
function in daily life)? Will Europes retirement age continue to
decline?
Slide 12
12 Are Actuarial Projections of Life Expectancy Too Low? Small
increases in life expectancy over a number of years add up to very
large increases in the size of age groups such as the Oldest Old,
those 85+ Given 85+ disability levels, 85+ pop VIP Recent research
suggests no end to gains in old-age life expectancy Obesity
--Olshansky et. Al. NEJM
Slide 13
13 Forecasts of the United States Population Aged 85 and Over
0.9 1.5 2.2 3.1 4.2 14.3 16.8 23.5 53.9 19601970198019902000 0 10
20 30 40 50 60 Population (In millions) 1960-2000 Actual 2040
Census Bureau middle mortality 2040 Census Bureau low mortality
2040 Guralnik et al. 2040 Manton et al. 2040 Sources: Guralnik et
al. 1988; and Manton et al. 1993; and U.S. Census Bureau, 1983,
1992, and 2000b.
Slide 14
14 Norway New Zealand Iceland Sweden Japan The Netherlands
Switzerland Australia Female life expectancy in the record-holding
country from 1840 to the present
Slide 15
15 Vaupel et al., Science (1998) Mortality decelerates and
human mortality at older ages has declined substantially Males =
blue Females = red Shoulder of mortality Humans Blue = exponential
curve fits data ages 80-84 Red = aggregation of 14 countries Light
blue = fits all data best Green = quadratic curve, fits data at
105+
Slide 16
16 Life Expectancy in G-7 Industrialized Nations, 2050 Source:
Shripad Tuljapurkar, Nan Li and Carl Boe. A UNIVERSAL PATTERN OF
MORTALITY DECLINE IN THE G-7 COUNTRIES. Nature 405: 789-792 (15
June 2000).
Slide 17
Smoking and subjective probability to survive Subjective
probability to survive: 50-64 => 75
Slide 18
Over-weight and subjective probability to survive Over-weight:
body-mass index > 30 Subjective probability to survive: 50-64
=> 75
Slide 19
19 The Worlds 25 Oldest Countries: 2002 (Percent of population
65 years and older) Source: U.S. Census Bureau
Slide 20
20 Public Pension Expenditure as a Percent of Gross Domestic
Product in 25 Countries: Circa 1997 Source: Palacios and
Pallares-Miralles 2000. 15.0 13.3 12.0 11.6 10.2 9.7 7.2 6.6 6.4
5.9 5.7 5.0 4.7 4.6 3.7 2.7 2.4 2.1 1.6 1.0 0.8 0.6 0.4 0.3 Italy
Uruguay France Germany Croatia United Kingdom Hungary United States
Japan Cyprus Israel Russia Kazakhstan Brazil Australia Turkey China
Sri Lanka Algeria Vietnam Ecuador Uganda Togo Mexico Cote
dIvoire
Slide 21
21 Projected Percent Increase in Elderly Population: 2000 to
2030 Source: U.S. Census Bureau
Slide 22
22 Old Age Dependency Ratio
Slide 23
23 Aging of boom generation can produce an opportunity for
economic growththe past Higher proportion of people of working age
can generate more income per capita With fewer children, families
can work more, save more, and invest more in each child's education
Result can be virtuous cycle of wealth creation the "demographic
dividend
Slide 24
24 Percent Change in Total Population for Selected Countries
and Regions 2000-2050 (Source: United Nations Population Division,
World Population Prospects, 1998 Revision) Ireland US France UK
Germany E.U. Europe Japan Russ. Fed Italy
Slide 25
25 Japan: declining pop. 1950-2050 Economist January 5th
2006
Slide 26
26 Can work life increase? If yes, can it increase enough? The
age of retirement has dropped steadily over the last century
Comparative analyses (Gruber and Wise) suggest that the structure
of public pensions affect how long people work, and that in
countries in which work at older ages is taxed rather than
rewarded, workers leave the labor force earlier
Slide 27
27 Tax Rates and Unused Capacity in 11 Developed Countries:
Circa 1995,,,,,,,,,,, 012345678910 Tax Force to Retire (55-69) 10%
20% 30% 40% 50% 60% 70% 80% Unused Productive Capacity (55-65)
Japan US Canada Sweden Spain UK France Germany Netherlands Belgium
Italy Source: Gruber and Wise 1999.
Slide 28
28 Working-age Needed in 2050 To Retain the Potential Support
Ratio Observed in 1995, UN Population Division Scenario II
Slide 29
29 Replacement Migration: Can it stop declining and ageing
populations? During the first half of the 21 st century, the
populations of most developed countries are projected to become
smaller and older as a result of below-replacement fertility and
increased longevity In the absence of migration, the declines in
population size will be even greater than those projected, and
population ageing will be more rapid For the Eu-15 47.5 million
immigrants needed to keep population constant to 2050, 79 million
to keep working age population constant, and 674 million (13.5
million per annum) to keep support ratio (65+/15-64) constant
United Nations Population Division, 2001
Slide 30
30 Europe: migration that would be required to keep the ratio
of ages 65+ to ages 15-64 at the level seen in 1995 Post-1995
migrants and their descendants would make up about 3 / 4 of the
total population in 2050 Population in 2050 Population (millions)
Will migration keep the potential support ratio from falling? NO
United Nations Population Division
Slide 31
31 NIA Initiative on Population Aging and Macroeconomics
Implications of population aging for aggregate economic performance
What are the known links between population aging and
macroeconomics? 2004 Federal Reserve Meeting in Jackson Harvard-NIA
workshop June 2005
Slide 32
32 Discussion of key issues and promising research
opportunities Participants identified six key issues and promising
research areas: 1.Demographic forecasting 2.Savings, investment,
and finance 3.Labor, human capital, and migration 4.Changes in
sectoral structure 5.Public and private financing of pensions and
healthcare 6.Economic growth
Slide 33
33 Discussion of known links between population aging and
macroeconomics No historic precedent for combination of demographic
forces in operation: the demographic transition due to increased
life span and fertility declines, the post World War II baby booms,
and migration. Research offers little guidance to expected
macroeconomic consequences Links between population aging and
macroeconomics are likely mediated by the institutional context and
the economic context. Aging is a global phenomenon: when looking at
international issues such as labor migration and capital flows it
is important to keep national demographic pictures in view, as well
as their global context.
Slide 34
34 Savings, investment, and finance Future population aging is
expected to require increased current savings to finance more
person-years spent living in partial or full retirement. The
expected savings boost, will affect financial markets, rates of
return, and thereby investment. International differences in
demographic cycles will influence international capital flows.
Slide 35
35 Labor, human capital, and migration Population aging will
likely cause reductions in aggregate labor supply and will change
the composition of the labor force. The prospect of labor shortages
may also have large effects on the incentives for education and
immigration and the development and reliance on new
capital-intensive technologies.
Slide 36
36 Labor, human capital, and migration (continued) An
examination is needed of the extent accounting effects (based on
applying an aging population to current age specific LF
participation rates) may be offset by behavioral changes in
retirement behavior, female labor supply, and part-time work
patterns. The degree to which migration can offset population
aging. To the extent that countries will rely on different mixes of
policies and market mechanisms to cope with population aging, what
tradeoffs will occur?
Slide 37
37 Changes in sectoral structure The health and long-term elder
care sectors are likely to expand with population aging. Will this
happen in Europe to the same extent as in the USA? Specific
research topics include: An assessment of the manner and extent to
which the expansion of the health and long-term elder care sectors
will affect the structure of the economy and economic growth. A
forecast of the expansion of the health care sector, along with the
need for workers in the health sector and financing requirements.
An estimation of how much extra health will be produced by
expansion of the health sector, under different assumptions about
technological progress.
Slide 38
38 Public and private financing of pensions and healthcare
Financing of old-age pensions and healthcare costs involves both
macro and micro issues, whose implications for macroeconomic
performance and competitiveness deserve exploration. How reliance
on employer health and pension benefits may affect the
competitiveness of firms and increase international
outsourcing.
Slide 39
39 Massive Initiative needed on reducing old-age disability New
epidemiological and molecular findings suggest that aging is quite
plastic Molecular base being developed --cellular aging, apoptosis,
telomere shortening, genetic manipulations increase life span in
some species 30+. Mimic exercise and caloric reduction ?
Understanding the social drivers Perfect multi-national
initiative
Slide 40
40 Number of Chronically Disabled Americans Age 65 and Over (In
Millions) 4 6 8 10 1982 Total Population Age 65+ 26.9 Million 7.5
7.1 7.0 1994 Total Population Age 65+ 33.1 Million 1999 Total
Population Age 65+ 35.3 Million 1989 Total Population Age 65+ 30.8
Million If disability rate did not change since 1982 Based on
declines in chronic disability rate occurring since 1982 6.4 8.3
9.4 Source: National Long Term Care Surveys 1982-1999, (Kenneth
Manton, Ph.D.) 21
Slide 41
41 Projections of Number of Disabled Americans Age 65 &
Over Source: National Long Term Care Survey 1982-1994 (Kenneth
Manton, Ph.D.) Revised November 1999 (In millions) 22
Slide 42
42 Ageing, Fitness, and Neurocognitive Function (PI: Edward
McAuley, Art Kramer) Summary of Findings: Aerobic exercise resulted
in improvement of executive control (frontal region tasks) but did
not generalize to tasks not requiring executive control
Slide 43
43 ACTIVE Advanced Cognitive Training for Independent and Vital
Elderly RESULTS All interventions improved targeted cognitive
abilities Training effects were durable to 2 years .
Slide 44
44 Regimens can overcome education effects on adherence Years
of Schooling (%) GRAPH A: GREATER EDUCATION = GREATER ADHERENCE
GRAPH B: INTENSIVE REGIMENS = GREATER ADHERENCE FOR LESS
EDUCATED
Slide 45
Obese Are More Disabled Age Obese Not Obese Rate per 10,000
Source: Lakdawalla, Bhattacharya, Goldman, Health Affairs,
2004.
Slide 46
46 Estimated Percentage of People over Age 65 with Probable
Alzheimers Disease Age Group Percent Source: Evans D, et al. JAMA,
Vol. 262, No. 18, 1989.
Slide 47
47 Estimated Number of New AD Cases (in thousands) Number
Source: Herbert et al. (2001). Alzheimer Dis Assoc Disord, 15(4),
169-173 There are currently 4.5 million Americans with AD. The cost
of care is estimated at $100 billion per year.
Slide 48
48 Projected Number of Persons with Alzheimers Disease Source:
Evans, et al. Arch Neurol 2003; 60: 1119-1122. In 2000, there were
4.5 million Americans with AD with a cost of care estimated at $1
billion. By 2050, the number of Americans with AD will increase to
13.2 million.
Slide 49
Slide 50
50 Progress in Alzheimer's Disease Research
190619901993198419951996199719981999 Dr. Alois Alzheimer describes
the disease Amyloid sequenced Familial AD Chromosome 21 Amyloid
mutation First Drug approved Cognex Chromosome 19 ApoE4 risk factor
Familial AD Chromosome 1 Presenilin 2 Familial AD Chromosome 14
Presenilin 1 Second drug approved Aricept Plaque- making transgenic
mouse model Estrogen and anti- inflammatories may slow development
of AD Familial Dementia Chromosome 17 tau Mild Cognitive Impairment
as AD risk factor Vaccine clears plaques in mouse model Tangle-
making transgenic mouse model Discovery of enzyme making amyloid
1975 Deficit of acetylcholin e in AD Brain 27
Slide 51
Funded AD Prevention and Selected Treatment Trials April
2002
Slide 52
52 Data for Policy: US Health and Retirement Study (HRS)
Meeting policy challenges requires both scientific understanding
and data. Need understanding of determinants and consequences of,
e.g., retirement decisions HRS is a premier that provides public
data for of scientific and policy researchers of economic, health
and demographic aspects of retirement and aging. Model for
SHARE
Slide 53
It is important to learn from one another how our policies and
programs can promote active aging and advance structural reforms to
preserve and strengthen our pension, health and long-term care
systems. Our governments will work together to promote active aging
through information exchanges and cross- national research. We
encourage collaborative biomedical and behavioral research to
improve active life expectancy and reduce disability, and have
directed our officials to identify gaps in knowledge and explore
developing comparable data in our nations to improve our capacity
to address the challenges of population aging. Communique:The
Denver Summit of the Eight 37
Slide 54
NAS 2001 Report -- Preparing for an Aging World: A Case for
Cross-National Research 1.Development and use of multidisciplinary
research designs are crucial to production of data on aging
populations that can best inform public policies. 2.Longitudinal
research should be done to disentangle and illuminate complex
interrelationships among work, health, economic status, and family
structure. 3.National and international funding agencies should
establish mechanisms that facilitate harmonization (and in some
cases standardization) of data collected in different countries.
40
Slide 55
NAS 2001 Report -- Preparing for an Aging World: A Case for
Cross-National Research 4.Cross-national research, organized
cooperatively, should be emphasized as a tool to help policy
makers: evaluate institutional and programmatic features of policy
related to aging in light of international experience, and assess
more accurately the impact of potential modifications to existing
programs. 5.Countries should aggressively consolidate information
from multiple sources to generate linked databases. 41
Slide 56
56 $ 3,922 $ 4,439 $ 4,940 $ 5,444 $ 6,304 1996 Per-capita
Medicare Spending Average age-sex race adjusted per-capita Medicare
spending Ratio: High to Low: 1.61
Slide 57
* * * Israel SE DK IE DE CHAT FR SP IT GR BE NL PL CZ UK
Principle 1: A laboratory for cross- national social science &
policy analysis Korea Japan USA SV
Slide 58
Mannheim Research Institute for the Economics of Aging OECD, 27
Feb 200658 SHARE wave 1 SHARE data collection April 2004-July 2005:
about 27,000 individuals aged 50+ SHARE data release 1: April 2005
(release 2 in 2006) Wave 2: September 2006 (biannual spacing)
Slide 59
Mannheim Research Institute for the Economics of Aging OECD, 27
Feb 200659 Purpose and Principles Main aims: General understanding
of the impact that the ageing process will have on European
societies on the individual and the societal level: description
(indicators), stress on causal analysis Principle 1: Get the full
picture: Health economic conditions family and social environment:
the interactions are important Principle 2: Use European variation
in policies, histories, cultures to understand causes and effects
of welfare state interventions
Slide 60
Mannheim Research Institute for the Economics of Aging OECD, 27
Feb 200660 Belgium funders SHARE was financed by several Belgian
institutions, other than the European Union and NIA (400 vignettes
households): The Science Policy Administration financed the main
survey (1,500 households) and the Social Security Administration
the Pretest (120 interviews). The Flemish region financed extra 700
household interviews (1st and 2nd wave). Also the Universities of
Lige and Antwerp, as well as the Belgium National Bank supported
our research (Pilot interviews). But other Belgian institutions
support the project as well: the National Office of Pensions, the
Scientific Institute of Public Health - Louis Pasteur, the National
Institute of Statistics. SHARE users: the National Planning Bureau
(in charge of Belgium long-term projections for the Government),
and the recently created Federal Center of Expertise in Health Care
(also known as Kennis Centrum).
Slide 61
Mannheim Research Institute for the Economics of Aging OECD, 27
Feb 200661
Slide 62
Mannheim Research Institute for the Economics of Aging OECD, 27
Feb 200662 Effort-reward ratio > 1.0 (%) Work quality Medium (
30-40 % ) Low ( > 50% ) Poor ( 40-50% ) High ( > 30% )
Slide 63
Mannheim Research Institute for the Economics of Aging OECD, 27
Feb 200663 Working conditions and the desire to retire earlier
Slide 64
Mannheim Research Institute for the Economics of Aging OECD, 27
Feb 200664 Time assistance to older parents >= 35 % 25-34 %