This major demographic shift in population will undoubtedly place both social and health care demands on governments that will have major financial implications. Although the life expectancy has risen dramatically, of concern is that the main health burdens for older people have shifted now from communicable diseases to primarily non-communicable diseases. These non-communicable diseases include chronic diseases such as heart disease, stroke, lung disease, cancer and diabetes. Even in the poorest countries the biggest killers are heart disease, stroke and chronic lung disease. As well for the older adult group, the greatest causes of disability are visual impairment, dementia, hearing loss and osteoarthritis.2
In a comparison of the prevalence of chronic disease and disability among men and women aged 50-74 in the US, England and Europe, it is surprising to note that the US has the highest prevalence in both the chronic diseases listed as well as disability (Table 2).6
Table 2. Prevalence of Chronic Disease and Disability among Men and Women Aged 50 to 74 years in the United States, England and Europe: HRS, United States, 2004; ELSA, England, 2004; and SHARE, Europe, 2004.