[MUSIC] My name is Michel Oris, and today I'm in charge of speaking about aging as a global challenge. Aging can be basically defined as an increase in the proportion of elderly within a given population. We can use a threshold of 60 or 65 but it does not change the trends. At the level of the world, we observed in 1980 a population of elderly around 378 million of person, and no, 30 years after this number has doubled and we reach a 768 millions of elderly. And the United Nations, as you can see on this figure expecting we will reach in 2050, a number of 2 billion. Of course, this increase seems completely dramatic but in fact, this is also because the world population, as a world, will continue to increase. If we look at the proportion of elderly, we will reach in 2015 something like 15 to 18%. You can consider that it is a lot or you can consider that more than 80% of the population is younger, it's up to you, basically. Whether that we look at the absolute numbers or at the proportion, it reminds that aging and especially the increase of the oldest old is associated with non-communicable disease. With disability, with cognitive impairments, much more that if we look at the epidemiological situation among the young people or adults. So definitely, aging is a health challenge. Moreover, aging is also a global health challenge. In common view we tend to believe that aging is a problem for the wealthy western societies. But as you can see with the blue color on this figure, in fact the motor of the dynamics of aging in the world population is located in the south. This progression of the number or proportion of elderly is explained by the demographic transition. Historically speaking we can isolate four phases. Initially during thousands of years the fate of humanity was characterized by a very high level of mortality and also very high level of fertility with, moreover, a very important infant and child mortality. In turn, when start the demographic transition, it is in the western world in the 18th century with the decrease of mortality while the number of children per woman is remaining high. And it implies, obviously, a population explosion that is one of the explanation why Europeans dominated the world in the 19th century. Precisely at the end of the 19th century, we enter into second phase of the transition with the decline of fertility. And by the mid of the 20th century we reached the last phase, we come back to an equilibrium between birth and deaths but at a low level, low mortality, low. However, this equilibrium is not completely true because in the population structure, this is the phase of aging, of the grown, of the elderly population. In 1971, Jerry Abdel Omran, an Egyptian scientist, associated to the demographic transition a complementary model, the one of the epidemiological transition. For him, we started initially with a period characterized by huge epidemics and many fermines. And then mortality declined because we moved to our era of receding pandemics. And, in a third phase we move to the degenerative and man-made disease. The degenerative diseases are cardiovascular disease, cancers, that kinds of things. While man-made disease are typically a kind of cancers associated to lifestyle like smoking. And more recently, Jay Olshansky and Brian Ault added a fourth phase, the stage of delayed degenerative disease. Delayed because we are living longer and longer, expectancy of life is higher and higher. So in the western world it's quite obvious that we went across to four phases, both from a demographic transition point of view and an epidemiologic transition point of view. In pursuit, it's more complicated, indeed the mortality decline started in developing countries just after the second World War, and it was extremely brutal, extremely rampant. So we observed a population explosion, an explosion of mouths to feed in the poorest countries of the world. However, from the 1970s, fertility also declined progressively. First in Latin America and in Asia, and more recently also in Sub Sahara and Africa. But if we look at the epidemiological transition, the situation is extremely different in the north and in the south. In the North we clearly face the age of delayed degenerative disease, and also emerging infections like AIDS. However in the country if you did, just example of a country like India, they have to first all together and in the same time, they have to face the age of receding pandemics of degenerative and man-made disease. And with the aging process, also delay the degenerative disease. For us, we went from one to the other and we adapted to social policies and sanitary system. The poorest country of the world or the emerging country, have to adapt everything in the same time and it's extremely complicated. Maybe also much more costly at what they can do. So, if we come back now to western world, the oldest part of the world population, we first took competing hypotheses about the relation between aging and health. The most recent hypotheses that you can see illustrated here on that slide, as a very mediatic echo it's the idea of pandemic of cognitive impairment associated with the increase of the so called oldest old, the people aged 80 and more. There is a huge, hot debate between the specialists about the true territory of this pandemic and we can not solve this debate today. However I believe it is extremely important to keep a critical mind, just to give an illustration, recently the Swiss Federal Statistical Office made an announcement that dementia became the third causes of death in Switzerland, and that the number of deaths attributed to dementia doubled during the last years. However, the federal office also observed that dementia is much more diagnosed now than a few years ago so to some extent, this increase is not a fact. And at the same time when you look at the numbers, you observe that dementia is the cause of 7% of the death in Switzerland. What means that more than 90% of the people who are dying are dying of something else. So just keeping a critical approach of the type of disease. The second hypotheses has been confirmed in all the western world and it seems also in the. Developed by James Fries, a Professor of Medicine of Stanford University, this is the idea that we live longer because we remain in a good health situation during a longer period of life. Of course, at some moment health problems happen but later and later in life thought that they tend to be concentrated into very old age, close from the age of death, from the end of life. And indeed, this is what we can observe on this figure, which is the survivor curve around 2000, in the Lemanic area. In that region at the time, you need to wait until 78 before to observe that the of the woman of that. But then between 78 and 92, half of the women are dying. So we see that mortality is delayed, and delayed, and delayed. But at some moment, you have a frail population, massively frail, who is dying in a very short period of time. And this observation of frailty is also documented at the more human individual level by research in gerontology. Here you have an illustration of the main hazards of a survey led by Christian Lalive d'Epinay and Dario Spini. From the mid 1990s until the early 2000, they followed each year people aged 80 and more. You have here a simple typology. I, means independent, you are age 80 and more but you can run your everyday life independently. D means that you are dependent, to continue to live you need the help of someone. And F mean frail. Indeed research go beyond the dichotomy between independency and dependency and to isolate an internal status where you are affected in some dimension, but you are not in a situation of handicap. Where you have some difficulties to do the task of you everyday life, but you are still able to do that alone. And if you look at that, you see that among the oldest old, in Geneva and Valais, 15% remain independent until the end of their life. You have only 5% of people who are moving from independency to dependency brutally in one step. And this is because of cardiovascular disease, normally. And in between, you have the highest proportion of person who are moving from independency to frailty and dependency, but most of them are remaining frail and finish their life avoiding dependency. In common view, we believe that huge majority of the oldest old are finishing their life in an institution, in a dependency, in fact there are 45%. It's a large minority but a minority. So with that kind of research we completely change the vision of aging at an individual level. We see at which point we have individual variation. We have not a transition from a third to a fourth age, it really depends on the individual live course. Moreover, these results have very important policy implications because all and policy system is oriented to take care of the dependent, of the people in the situation of dependencey. If we could act on the frail people to increase the well-being, and postpone, and delay the age of chronic infirmity and dependency, we will make tremendous progress from a humanistic perspective and also from a financial one, since this is so important for the political leaders now. So to sum up, to mercer, to read of mercer of the efficiency of social and sanitary policy, is not an increase in longevity, is the well-being among the elderly. And the elderly cannot be isolated from the rest of the population, they belong to the society, like anybody else. And for them like for the young and for the others, well being is, to use the word of another Amartya Sen, the real freedom to live the life you value. Thank you. [MUSIC]
