Predictions that aging societies inevitably lead to catastrophic outcomes of dependency and decline are yesterday's stories.
Compared with the patients who were discharged, those who died had a significantly higher number of impaired CGA components (Table 2; Figure 1), including functional dependency, cognitive decline and polypharmacy.
Poor outcomes and high resource use are common in older people presenting to acute medical units who are discharged directly: in one UK series, 58% subsequently re-presented and 29% died over the next year 2; in another, 76% had one or more adverse outcomes (death institutionalisation, readmission, increase in dependency, or decline in mental wellbeing or quality of life) over three months.
Untreated or undertreated depression in older adults is a significant public health concern, associated with greater morbidity and dependency, functional decline, diminished quality of life, poor adherence to medical treatment, increased demands on family caregivers, increased use of healthcare services and death [ 2, 3, 5, 7- 9].
Against this background of capitalism's magic, the burgeoning welfare state has accompanied increases in dependency and a decline in social mobility.
The literature has documented that impaired activities in diabetic patients can cause substantial problems such as functional decline, dependency and physical disability [ 7, 22, 23].
For older adults without disability, it is well recognised that a fall or near-fall may be a key event that triggers a deteriorating illness trajectory, increased need and dependency and resultant decline in QOL [ 23].
Possibly, our inclusion and exclusion criteria were too severe, although it seems reasonable to assume that the risk for complications during WBV in subjects presenting severe levels of dependency or cognitive decline may be much higher than in the participants in our study.
In common with other Arab countries, it has favourable demographic trends, with a growing labour force and a declining dependency rate (children and pensioners as a share of the working-age population).
It is perfectly possible to have a free and vigorous debate without defaming anyone, as occurs often in Singapore.Chang Li Lin Press secretary to the prime minister SingaporeHaving fewer people worksSIR – It is time you abandoned the bugbear of the declining dependency ratio between the numbers of those working and those supported by them ("Quality time", May 31st).
