Conclusion and Outlook

Epidemiology has been well established as an indispensable component of the disciplinary spectrum for aging research in recent years. Its contributions to aging research will continue to grow in the decades to come, mainly due to the contributions from recently and newly setup large-scale longitudinal studies. The largest benefits are to be expected from interdisciplinary approaches which keep determinants of health throughout the life span in mind. The unique contributions of this discipline to aging research may become even more fruitful, however, by taking the following aspects into account:

1. Strengthening interdisciplinarity

Given the high prevalence of multimorbidity at old age, the horizon of single clinical specialties, which are mostly focused on a single (group of) diagnosis, may often be much too narrow for epidemiological studies among the elderly. Simply addressing multiple different health outcomes separately does not overcome the problem. What is needed are integrative approaches with a particular emphasis on functional impairments. Also, development of new methods is required to adequately deal with multiple, complexly interrelated health outcomes. The rapidly emerging fields of molecular aging research and molecular genetics provide new opportunities for interdisciplinary cooperation in epidemiologic studies in which biological materials (such as blood samples) are collected and stored.

2. From epidemiology among the elderly to epidemiology in aging research

The etiology of chronic diseases and impairments among the elderly cannot be studied by restricting the focus to health outcomes and their determinants at old age. Major efforts are needed to incorporate measures of relevant determinants throughout the life span, starting from the genetic predisposition and intrauterine growth, and including factors that may act in childhood, adolescence or various parts of adulthood. Achievements to this end may again best be made by integrating expertise from such diverse fields as human genetics, prenatal and neonatal care, pediatrics, internal and family medicine, and developmental psychology (Kuh et al., 2003).

3. Large-scale longitudinal studies

Most of the study questions in epidemiologic aging research can best be answered by large-scale longitudinal (cohort) studies, on either a regional, national or international level. Although investments in such studies in terms of time and funds are comparably large in the beginning, this investment is often more than paid off after a few years of follow-up. International studies are confronted with more difficult logistics (e.g., for standardization and validation of instruments), but may often benefit from a wider range of possible health determinants and outcomes. A number of well-planned large-scale cohort studies have meanwhile been set up among older adults in different parts of the world. While they steadily provide a wealth of data, their contribution to aging research will further increase with each additional year of follow-up.

4. Epidemiology of medical and nursing care Apart from studying health outcomes, epidemiolo-gic methods can also be used and should be more widely used to study patterns of medical and nursing care and their determinants (e.g., Kliebsch et al., 1998; Ramroth et al., 2005). The epidemiology of medical and nursing care might prove particularly useful in the process of modernization of health and nursing care systems that is required to meet the challenges imposed by demographic aging and that is now ongoing in many countries around the world.

5. Translating epidemiologic study results into the practice of prevention

In the last 50 years, epidemiologic research has identified a large number of risk factors and preventive factors of multiple chronic diseases, yet the transfer of these findings into applied disease prevention has often remained unsatisfactory. For example, half a century after the deleterious health effects of smoking have been disclosed by carefully conducted epidemiologic studies, the global number of smokers and prevalence of smoking keep rising. A similar development appears to be seen for physical inactivity, which is likewise related to a large number of severe chronic diseases. Therefore, further development of epidemiology in aging research has to go along with research on how to more effectively translate epidemiologic study results into the practice of prevention. Preventive efforts again have to keep the entire life span in mind.

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