Health and Mortality among Elderly Populations

By Graziella Caselli; Alan D. Lopez | Go to book overview

5 Comparative Mortality Trends among Older Persons in Developed Countries
GEORGE C. MYERS
5.1. Introduction
The so-called theory of epidemiologic transition provides a basic framework for examining major historical patterns in the decline of mortality to its unprecedentedly low levels in the world's developed countries. The original formulations of the framework ( Omran, 1971, 1982), emphasized transition in overall patterns of mortality, through three stages, from high to low infant mortality levels, from communicable to non-communicable diseases, and from the increasing advantage to females over males. Relatively little attention was given explicitly in the original formulations to reductions in mortality among older persons. Beginning in the 1970s, however, demographers became increasingly aware that mortality declines at the older ages were not only possible, but were actually occurring with significant force so as to affect overall mortality and the population ageing process ( Myers, 1978; UN, 1982). In subsequent periods, it has often been demonstrated that mortality declines at advanced ages account for the main increases in life expectancy and ageing population structures that are occurring in better developed countries (e.g. Prestonet al., 1989; Horiuchi, 1991).A fourth phase of epidemiological transition in mortality and related health and disease states has been identified, which calls attention to changes that are underway in many low mortality countries ( Olshansky and Ault, 1986; Myers and Manton, 1987; Rogers and Hackenberg, 1987). This development has important implications not only for understanding current mortality patterns, but also for forecasting future mortality trends, health and disability statuses, and health-care service requirements. Among the characteristic features of this new phase are
1. the continuation of slow and often fluctuating overall mortality declines, which are increasingly concentrated in the later ages of life;
2. stability and even signs of some lowering in life expectancy differentials between men and women in a few countries;
3. variable patterns of both positive and negative change for different causes of death, including some of the major chronic diseases;

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