The prevalence of chronic conditions is expected to increase dramatically as a result of global population aging over the next several decades. It is estimated that the number of persons aged 60 and over worldwide will increase from 550 million in 1996 to 1.2 billion in 2025 (National Institute on Aging, 1996). In at least 50 industrialized countries in Europe, North America, and Asia, 15% or more of the population is in this age group, and in most countries, the rate of growth of the elderly population exceeds that of the population as a whole
(National Institute on Aging, 1996). Moreover, the number of elderly persons in developing countries is increasing more rapidly than in developed countries, and by 2020 will account for 70% of the world's population aged 60 and over (Roca & Amaducci, 1991). Worldwide prevalence projections for diabetes illustrate the impact of population aging on the burden of chronic diseases. The number of persons aged 65 and over with diabetes is estimated to increase from about 54 million in the year 2000 to 105 million by 2025. This latter figure represents 35% of all cases among adults aged 20 and over, and the majority (58%) of older adults with diabetes in 2025 will be in developing countries (King, Aubert, & Herman, 1998).
The extension in life expectancy underlying population aging has been the result of decreased infant and maternal mortality and delayed mortality among persons aged 65 and over due to improvements in nutrition, sanitation, control of communicable diseases, and medical services (Miles & Brody, 1994). Developing countries are currently undergoing various stages of the "epidemiologic transition," that is, the shift in the major causes of morbidity and mortality from infectious and parasitic diseases to chronic diseases (Omram, 1971) that typically occurred in industrialized countries from the 19th century onward (Levison, Hastings, & Harrison, 1981; Rogers & Hackenberg, 1987; Wolleswinkel-Van den Bosch, Looman, Poppel, & Mackenbach, 1997). Modernization has also spread risk factors for many chronic diseases of aging through the "nutrition transition" to a Westernized high-fat, low-fiber diet (Popkin, 1994), increased seden-tarism, obesity, and smoking, that contribute to the growing epidemics of these diseases in developing regions of the world (Bovet, 1995; Pearson, 1996, 1999).
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