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Ageing and Health
A Global Challenge for the 21st Century
Proceedings of a WHO Symposium, Kobe, 1013 November
1999, viii + 479 pages [E]
Sw.fr. 60./US $54.00; in developing countries: Sw.fr. 42.
Order no. 1930173
Records the proceedings of an international symposium convened to explore the challenges posed by rapidly ageing populations in all parts of the world. Contributions, which come from 36 countries and a large number of disciplines, cover the wide range of issues that need to be considered as policy-makers debate the best ways to cope with a vastly larger elderly population in the 21st century. Topics discussed range from methods of measuring healthy ageing, through trends in early retirement and the impact on social security costs, to the plight of illiterate widows in rural areas of Africa.
Noting the high costs of caring for disease and disability in the elderly, contributions give particular attention to innovative ways of helping the elderly retain their physical and mental abilities, maintain their independence, and thus maximize their contribution to society and economies. A special effort is also made to understand the unique consequences of ageing in the developing world, where resources for health care are scarce, systems of social support are deteriorating, and increasing urbanization may leave the rural elderly destitute. The burden of caring for AIDS orphans, which often falls on the elderly, is also assessed.
The report features 50 papers presented in eight main parts. The first two record the position papers and keynote addresses. These provide expert overviews of trends in ageing and corresponding patterns of morbidity and mortality, give projections to the year 2050, and discuss the implications for economies, social services, and health policies. Problems are considered separately for developed and developing countries, and a special effort is made to identify specific health and social policies requiring urgent reform. Papers in part three, on ageing, society, and health, consider changing patterns of disease and disability, discuss the impact of ageing on the workforce, review the roles of older women in ageing societies, and address the need to protect the rights of older persons.
Papers in part four focus on several demographic and social changes that affect the elderly. These include migration, changes in family structure and shifting roles of support, and the fate of the elderly in rural areas. Systems of support and care are described in part five, which draws on experiences with several social and voluntary systems, concluding that most elderly persons prefer to be cared for in their homes. Part six explores the impact of ageing populations on national economies and reports on various options for financing care.
Papers in the remaining two parts provide country reports on specific problems and ways of dealing with them, and offer brief descriptions of current research in both the clinical and basic sciences. The volume concludes with summaries of the main findings and recommendations of working groups on topics ranging from health policies and techniques for measuring healthy ageing to priorities for urgently needed research.
Report of a WHO Study Group
Technical Report Series, No. 835
1993, vi + 49 pages [C, E, F, R, S]
ISBN 92 4 120835 X
Sw.fr. 10.-/US $9.00; in developing countries: Sw.fr. 7.-
Order no. 1100835
Explores the large number of factors that influence both the health of aging workers and their performance on the job. Citing global demographic trends that point to an increasingly aged workforce, the report emphasizes specific measures that can help prevent a premature decline in work capacity and thus contribute to economic productivity. Fundamental questions considered include the nature of age-related changes in mental and physical abilities and the extent to which these changes are compatible with work demands. Factors that can help protect workers against disability are also considered.
The opening section reviews what is known about age-related changes that may impair performance and thus call for adjustments in either the workplace or the assignment of responsibilities and job tasks. Changes considered include a decline in muscular, cardiovascular, and respiratory functions and in vision and hearing. Readers are also reminded of certain areas in which older workers continue to perform at a very high level.
Other sections summarize data on the health problems of aging workers and discuss different working conditions of special concern to older workers. Stressful work environments, such as shiftwork and conditions of heat and cold, are considered in a separate section, which concentrates on differences in the adaptive capacity of younger and older workers. The remaining sections outline different health promotion strategies for aging workers and describe measures that can support work capacity as workers age.
Technical Report Series, No. 843
1994, v + 129 pages [C*, E, F, R, S]
ISBN 92 4 120843 0
Sw.fr. 22./US $19.80; in developing countries: Sw.fr. 15.40
Order no. 1100843
An expert technical assessment of the many factors that influence the risk of osteoporotic fracture in postmenopausal women and thus need to be considered when planning the most effective public health interventions. In view of growing awareness of the need to prevent and treat postmenopausal osteoporosis, the book aims to resolve several controversies concerning the usefulness of screening programmes, the appropriate target populations, the most effective methods for predicting fracture risk, techniques for assessment, and the comparative effectiveness of currently available preventive and therapeutic interventions.
A large part of the report is devoted to a review of the advantages and limitations of three candidate methods for predicting future fracture risk: assessment of bone mass, assessment of bone loss, and clinical assessment of risk factors. Information on non-invasive physical techniques for bone mass assessment is especially detailed. A section devoted to the risks and benefits of intervention evaluates the efficacy and safety of hormone replacement therapy, using estrogens alone or estrogens combined with progestogens, and other currently available interventions, including the use of calcium, calcitonins, and bisphosphonates. Particular attention is given to the assessment of evidence that estrogen replacement therapy might increase the risk of certain cancers and decrease the risk of morbidity and mortality from cardiovascular disease. The final section reaches several important conclusions about the aims and design of screening programmes.
Drugs for the Elderly
WHO Regional Publications, European Series, No. 71
1997, x + 145 pages [E]
ISBN 92 890 1335 4
Sw.fr. 32.-/US $28.80; in developing countries: Sw.fr. 22.40
Order no. 1310071
The second revised edition of a popular practical guide to the prescribing of drugs for the elderly. Designed to promote a more rational use of drugs, the book emphasizes the many physical and mental conditions associated with aging that must be considered when evaluating symptoms and selecting the most appropriate drug, dose, and formulation.
The first part of the guide introduces the basic principles of good prescribing practices for elderly patients with the goal of making physicians more aware of when and how standard prescribing practices must be altered for this age group. A discussion of the problems surrounding drug therapy in the elderly is followed by an explanation of the ways in which the aging process can affect drug action. A chapter on choosing the right preparations alerts prescribers to the many problems with formulations and containers, such as childproof lids that are difficult to open and tablets that are too large for the elderly to swallow, that may reduce patient compliance and compromise therapeutic efficacy. The first part concludes with a chapter on adverse drug reactions in the elderly, which includes a tabular presentation of drugs known to have potentially severe or unusual side effects in the elderly.
The main part consists of detailed monographs for each of 41 categories of drugs frequently prescribed to elderly patients. Each monograph includes concise information on indications and prescribing rules, classes of drug preparations, drug-related symptoms, and possible alternative therapies. An index of drug names, with reference to those appearing in the WHO Model List of Essential Drugs, concludes the book.
Epidemiology and Prevention of Cardiovascular Diseases in Elderly People
Report of a WHO Study Group
Technical Report Series, No. 853
1995, v + 67 pages [E, F, S*]
ISBN 92 4 120853 8
Sw.fr. 14.-/US $12.60; in developing countries: Sw.fr. 9.80
Order no. 1100853
A state-of-the-art review of what is currently known about the epidemiology of cardiovascular diseases in elderly people and the possibilities for prevention. Noting that little attention has been given to the problem of cardiovascular diseases in this age group, the report aims to highlight opportunities for prevention while also underscoring the medical, social, and economic implications of increased longevity and the corresponding increase in the prevalence of cardiovascular disease. Both population-based approaches to prevention and strategies for reaching high-risk individuals are considered. Areas where knowledge is weak and research is urgently needed are also indicated.
The report has six main sections. The first, on demographic trends, summarizes key characteristics of the elderly population in various parts of the world, discusses the current and projected size of the elderly population, and describes changes in life expectancy over the past four years. A profile of cardiovascular diseases in the elderly is provided in the second section, which includes information on the global burden of cardiovascular diseases, trends in mortality rates and possible explanations, the most important cardiovascular diseases affecting the elderly, and eight principal risk factors. The third and most extensive section reviews health policy options for the prevention of cardiovascular diseases in elderly people and discusses their relative cost-effectiveness. Emphasis is placed on lifestyle approaches and on the medical management of risk factors. The remaining sections discuss opportunities for rehabilitation and establish guidelines for the development of health policies aimed at the prevention of cardiovascular disease in the elderly.
Health Care for the Elderly
A Manual for Primary Health Care Workers
edited by G. Hafez and K. Bagchi
WHO Regional Publications, Eastern Mediterranean Series, No. 10
1994, 57 pages [E]
ISBN 92 9021 186 5
Sw.fr. 9.-/US $8.10; in developing countries: Sw.fr. 6.30
Order no. 1440010
An illustrated guide to the health needs and basic care of the elderly in Eastern Mediterranean countries, where ageing of the population is a comparatively new trend. The manual is designed for use during a simple training course for primary health care workers.
Information is presented in seven self-contained modules. The first provides tips and advice on effective teaching using problem-based methods. The remaining modules outline the training needed to help primary health care workers perform a number of simple tasks, such as collecting information about the elderly in a community, recognizing the signs of common disorders and disabilities, helping to prevent accidents and injuries, and knowing when a patient must be referred to a doctor. Information on nutritional needs in the elderly, and the foods to choose or avoid, is also provided. Numerous drawings, model forms, and boxed points to remember are used to illustrate the many simple yet vital things primary health care workers can do to prevent or manage the special health problems of the elderly.
Health, Lifestyles and Services for the Elderly
edited by W.E. Waters, E. Heikkinen and A.S.
Public Health in Europe, No. 29
1989, xx + 222 pages [E]
ISBN 92 890 1165 3
Sw.fr. 20.-/US $18.00; in developing countries: Sw.fr. 14.-
Order no. 1320029
A detailed comparative analysis of data generated by an international study designed to assess the health, functional ability, and quality of life of the elderly and to evaluate their use of health and social services. Data from the study, which was carried out in 15 European centres, are submitted to sophisticated statistical and epidemiological analysis in order to yield conclusions useful in the improvement of services and in the design of further research on aging.
Chapters assess data on the ability to perform selected activities of daily living and consider interrelations between social activity and life satisfaction. Findings lend support to the assumption that socially active people are more satisfied with their lives than those whose personal contacts are more limited. Other chapters point out differences in the utilization of services, identify factors that may explain these differences, and consider the determinants of physical dependence. Risk factors for physical dependence are identified as poor housing conditions, low education, low social activity, and low physical activity.
Midlife and Older Women in Latin America and the Caribbean
PAHO 1989, x + 424 pages [E, S from PAHO]
ISBN 92 75 12021 8
Sw.fr. 50.-/US $45.00; in developing countries: Sw.fr. 35.-
Order no. 1630002
A multi-authored study of the special health and social problems faced by older women living in Latin America and the Caribbean. As the book points out, their problems of poverty, bad health, and social isolation deserve special attention, not only because more women than men survive to old age, but also because they reach that vulnerable stage of life having already faced a lifetime of difficulties and discrimination related to their sex.
The first half of the book consists of a background paper prepared expressly for the Consulting Group Meeting on Midlife and Older Women, co-sponsored by PAHO and the American Association of Retired Persons. The paper, which provides a comprehensive summary of the situation in the entire Region of the Americas, draws a portrait of a group of women diverse in social and cultural background but united by problems inherent to being female and middle-aged or elderly in male-dominated and youth-oriented societies. The paper also focuses on the one problem which unites women from all these societies: the traditional focus on health problems of women in their reproductive years and the tremendous lack of attention given to health problems of elderly women. Other papers explore the condition of older women in specific countries from the perspectives of health, social and psychological well-being, and economic status.
"The authors of this powerful and moving book
call for urgent attention to be paid to the suffering and deprivation of middle-aged and
older women born to a lifetime of subordination. Through the work of PAHO, the care of the
elderly is at last being forced on the political agendas of Latin American
- The Lancet
Quality Health Care for the Elderly
A Manual for Instructors for Nurses and Other Health Workers
Western Pacific Education in Action Series, No. 6
1995, 256 pages [E]
ISBN 92 9061 136 7
Sw.fr. 22.-/US $19.80; in developing countries: Sw.fr. 15.40
Order no. 1500006
A manual providing a basic training course, for student nurses and other health workers, in the quality health care of the elderly. Intended for use in Western Pacific countries, the manual aims to meet the great need for formal care of the elderly in a part of the world where traditional family care has weakened and few health workers possess the necessary skills.
The course concentrates on information that should be incorporated into the daily clinical practice of health care facilities. Only the most common problems of aging are included. Details range from advice on how to create safe environments and prevent accidents, through examples of exercises that help train the bladder and prevent incontinence, to instructions for developing a plan of care for patients with Alzheimer's disease. Throughout, culturally specific photographs and advice, such as on the use of herbal medicine, help enhance the local relevance of this well-planned teaching tool. The course is divided into twelve modules. Each provides student readings, individual written exercises, topics for group discussion, case studies and other learning activities. Examples of multiple-choice questions for use in examinations are included for teachers.
Regional Strategy for Health Care of the Elderly in the Eastern Mediterranean Region 1992-2001
WHO Regional Office for the Eastern Mediterranean
Regional Advisory Panel on Health Care of the Elderly
1994, 22 pages [E]
ISBN 92 9021 188 1
Sw.fr. 6.-/US $5.40; in developing countries: Sw.fr. 4.20
Order no. 1440009
Outlines a forward-looking regional strategy for health care of the elderly in Eastern Mediterranean countries - a part of the world where a rapidly ageing population has created new and urgent challenges for health services. The strategy, which covers the decade from 1992 to 2001, describes specific country and intercountry activities designed to assist the development of programmes for the health care of elderly populations.
Women, Aging and Health
Achieving Health Across the Life Span
prepared by R. Bonita for the Third Meeting of the
Global Commission on Women's Health
1996, iii + 55 pages [E]
Sw.fr. 12.-/US $10.80; in developing countries: Sw.fr. 8.40
Sets out a conceptual framework, supported by specific lines of action, that can guide efforts to improve the health of aging women in developed and developing countries alike. Global in its approach, the report identifies certain health needs shared by all aging women, discusses their determinants, and then shows how these needs can be met through cost-effective strategies. Throughout the report, numerous facts, figures, and practical examples are used to illustrate both the great scope for improving the health of aging women and the feasibility of twenty-two precise strategies for action.
The most extensive section identifies health priorities for aging women in three main areas: major preventable causes of morbidity and mortality, major chronic disabling conditions, and mental health. Conditions discussed include cardiovascular diseases and cancers of the lung, cervix, and breast; trachoma, tuberculosis, and tropical diseases; musculoskeletal conditions, osteoporosis, urinary incontinence, and sensory impairment; and depression and dementia. Noting that many of these conditions are caused by the same factors, the report stresses the need for broad, population-based strategies that address common causes.
The determinants of older women's health are considered in the final section, which assesses the economic, social, cultural, and political factors which influence health and affect the quality of women's life as they age.
World Atlas of Ageing
WHO Centre for Health Development, Kobe, Japan
1998, 138 pages [E]
Sw.fr. 32./US $28.80; in developing countries: Sw.fr. 22.40
Order no. 1930150
A collection of 64 colour maps, supported by statistical tables, charts, and explanatory text, portraying global trends in ageing for the years 1975, 1997, and 2025. As current trends are likely to have wide-ranging economic and social consequences in the 21st century, the atlas also presents selected socioeconomic statistics on the aged dependency ratio and the labour force, old-age security systems, expenditure on medical treatment of the elderly, and the impact of economic forces on the health of the elderly.
The atlas has three parts. The first uses charts, graphs, and tables to discuss key dimensions of global ageing. These include the evolution of ageing in the world, population growth and fertility, life expectancy and mortality, the typology of the age structure, demographic dimensions of ageing, and economic and social consequences.
These dimensions are graphically depicted in the maps, which form part two. To facilitate evaluation of the pace of ageing, variables are presented for the years 1975, 1997, and 2025. Apart from indicating the spatial distribution of ageing, these maps illustrate both the clear heterogeneity of the ageing process throughout the world and the especially rapid pace of ageing in the developing world, where more and more countries are moving from high mortality and high fertility to low mortality and low fertility.
Part three presents country-specific statistical tables indicating population, by age group, for the years 1975, 1997, 2025 and 2050, and the proportion of population, by age group, for the same years.