Kenneth Howse

Healthy ageing: the role of health care services:

The implications of the imminent surge in population ageing for the work of health care services in high-income countries remain unclear. It is widely expected, however, that the prevention and management of chronic disease will increasingly dominate their workload, and that this is likely to require a major shift in the way that care is delivered. This paper argues that the central contribution of health care services to a healthy ageing strategy is to drive improvements in the prevention and management of chronic disease, and it explores some of the implications of this view in the light of evidence mainly from the UK.

International Handbook on Ageing and Public Policy

With the collective knowledge of expert contributors in the field, The International Handbook on Ageing and Public Policy explores the challenges arising from the ageing of populations across the globe. With an expansive look at the topic, this comprehensive Handbook examines various national state approaches to welfare provisions for older people and highlights alternatives based around the voluntary and third-party sector, families and private initiatives. Each of these issues are broken down further and split into six comprehensive sections: Context Pensions Health Welfare Case Studies Policy Innovation and Civil Society Academics interested in policy challenges for mature societies will find this Handbook a highly relevant reference tool. It also offers an important message for policy makers and practitioners in the field of public policy.

Statin prescribing according to gender, age and indication: what about the benefit-risk balance?

RATIONALES, AIMS AND OBJECTIVES The increasing dispensing of statins has raised concern about the appropriateness of prescribing to various population groups. We aimed to (1) investigate incident and prevalent statin prescribing according to indication, gender and age and (2) relate prescribing patterns to evidence on beneficial and adverse effects. METHODS A cohort of Danish inhabitants (n = 4 424 818) was followed in nationwide registries for dispensed statin prescriptions and hospital discharge information. We calculated incidence rates (2005-2009), prevalence trends (2000-2010) and absolute numbers of statin users according to register proxies for indication, gender and age. RESULTS In 2010, the prevalence became highest for ages 75-84 and was higher in men than women (37% and 33%, respectively). Indication-specific incidences and prevalences peaked at ages around 65-70, but in myocardial infarction, the prevalence was about 80% at ages 45-80. Particularly, incidences tended to be lower in women until ages of about 60 where after gender differences were negligible. In asymptomatic individuals (hypercholesterolaemia, presumably only indication) aged 50+, dispensing was highest in women. The fraction of statin dispensing for primary prevention decreased with age: higher for incident than prevalent prescribing. Independent of age, this fraction was highest among women, e.g. 60% versus 45% at ages 55-64. The fraction for potential atherosclerotic condition (PAC, e.g. heart failure) increased with age. CONCLUSION Prevalence of statin utilization was highest for ages 75-84, although indication-specific measures were relatively low. Despite inconclusive evidence for a favourable risk-benefit balance, statin prescribing was high among people aged 80+, asymptomatic women and PAC patients.

Healthy ageing, resilience, and wellbeing

The extension of life does not appear to be slowing, representing a great achievement for mankind as well as a challenge for ageing populations. As we move towards an increasingly older population we will need to find novel ways for individuals to make the best of the challenges they face, as the likelihood of encountering some form of adversity increases with age. Resilience theories share a common idea that individuals who manage to navigate adversity and maintain high levels of functioning demonstrate resilience. Traditional models of healthy ageing suggest that having a high level of functioning across a number of domains is a requirement. The addition of adversity to the healthy ageing model via resilience makes this concept much more accessible and more amenable to the ageing population. Through asset-based approaches, such as the invoking of individual, social and environmental resources, it is hoped that greater resilience can be fostered at a population level. Interventions aimed at fostering greater resilience may take many forms; however, there is great potential to increase social and environmental resources through public policy interventions. The wellbeing of the individual must be the focus of these efforts; quality of life is an integral component to the enjoyment of additional years and should not be overlooked. Therefore, it will become increasingly important to use resilience as a public health concept and to intervene through policy to foster greater resilience by increasing resources available to older people. Fostering wellbeing in the face of increasing adversity has significant implications for ageing individuals and society as a whole.

What is fertility stalling and why does it matter

Abstract Stalls in fertility declines have been reported for countries in Asia, Latin America, and Africa. Recent interest has focused mostly on Sub-Saharan Africa. This papers reviews past studies of fertility stalls and considers the implications of alternative methods of defining and measuring the phenomenon. It offers some reflections on the theoretical and policy significance of various attempts to identify and explain stalls.

Towards an Evidence-Based Active Ageing Strategy

The aspiration of an active, healthy and engaged life is now a reality for many people in European countries because they have a life expectancy among the highest in the world. In 2012, the composite measure of the Active Ageing Index (AAI) was developed in the activities of the European Year for Active Ageing and Solidarity between Generations. It renewed the focus on the potential of active ageing as a policy strategy for the European as well as other countries globally. The AAI is an analytical tool for policymakers to enable them to devise evidence-informed strategies in promoting active and healthy ageing among older people (Active Ageing Index 2012: Concept, methodology and final results. Geneva: European Centre Vienna, 2013). In 2015, the AAI international seminar “Building an evidence base for active ageing policies: Active Ageing Index and its potential” brought together 150 researchers, civil society representatives, policymakers and other stakeholders, who focussed on how to achieve better active ageing outcomes—measured, for instance, by the AAI. It provided a multidisciplinary forum for those interested in the use of the AAI and other similar research to enhance the knowledge about ageing and older people in Europe and in countries across the world. The AAI seminar was structured around five principal topics, which are the same as five parts of this book, containing chapters on the topics: (I) Use of the AAI for policymaking, (II) Subnational adaptations of the AAI, (III) Comparative analysis of active ageing, (IV) Methodological improvements in measuring active ageing and (V) Use of the AAI in non-EU countries around the world.

Psychosocial aspects of successful ageing and resilience: critique, integration and implications / Aspectos psicológicos del envejecimiento exitoso y la resiliencia: crítica, integración e implicaciones

Abstract As the number of older adults increases worldwide, it is becoming increasingly important to find effective ways of fostering better ageing trajectories. The models used to shape this process inform research, policy and practice and impact older adults themselves. Two important ageing models are successful ageing (SA) and resilience (RES). Aligning the conceptual framework in research contexts with those of older adults’ perspectives is an integral component of driving forward the research agenda in a manner that has the greatest potential to benefit older adults. Studies conducted with laypersons indicate that psychosocial components are important components of successful ageing models; therefore, it is imperative that these non-biomedical components are incorporated. There are many similarities between SA and RES models, but an important distinguishing feature is the incorporation of adversity into conceptualizations of resilience. SA models suggest high levels of functioning as a requirement for ageing successfully, regardless of the circumstances the individual experiences; resilience models take into account the level of adversity being experienced by the individual. Individuals can demonstrate RES by having a more positive outcome than would be expected given their level of adversity. The incorporation of psychosocial constructs into SA models and the integration of SA and RES paradigms has important implications for research and for older adults themselves. Through the promotion of models of ageing that include psychosocial components and elements of adversity, greater generalizability to a broader population is possible with enhanced potential for research derived from these efforts to more positively influence individuals’ trajectories of ageing.

Revisionism in the Rationale for Population Policies

All three papers in this issue of Population Horizons look at population policies in low and middle income countries. Two of the papers focus on particular countries, Ethiopia (Hailemariam 2016) and Iran (Hosseini-Chavoshi et al 2016), where the governments have very different views and concerns about the direction of their current population trends. The third paper looks at the adoption of population policies across Sub-Saharan Africa (Sullivan Robinson 2016). As arguments and disputes in the recent past tell us, population policies may easily become contentious, especially when they are perceived as promoting social objectives in ways that may interfere with individual preferences or established cultural norms (Connelly 2008; May 2012). Although these controversies have most often flared up when governments have announced that they want to reduce the growth rate of the population by curtailing fertility, policy proposals that are intended to increase fertility may also provoke arguments along the same basic fault lines1: the relationship between the government’s aims and the justification for their intervention in this sphere of private life; and the implications or likely effects of specific policy measures for individual well-being. What links the papers in this issue of Population Horizons is their focus on the ways in which these issues play out in the context of current or recent policy debates in particular countries. There are major differences of course in the issues or challenges that policy-makers have to confront. How could this not be so, when the aim in Iran is to raise fertility because it is judged to be too low; and in Ethiopia and