CONTROLLING AGING: WHAT WOULD/COULD/SHOULD HAPPEN?
Presider:
Kenneth Kaloustian, Ph.D., Chair of
Biomedical Sciences, Quinnipiac College
Other presenters:
Donald J. Mulcare, Ph.D., Director
of Gerontology Programs, Gerontology Center, University of Massachusetts
Dartmouth
Augustine G. DiGiovanna, Ph.D.,
Professor of Biology, Salisbury University, Salisbury, MD.
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Symposium Outline and Page Index
1. Questionnaire
about controlling aging: what would/could/should happen?
2.a.
Information presented
Demographics
projections
Graphs
Tables
Potential
methods for changing aging, ML, XL and improving quality of life
Diet
Exercise
Better
diagnosis
Pharmacy
Surgery
Supplements
Caloric
restriction (CR)
Hormones
Genetics
2.b.
Possible consequences from altering mean longevity, maximum longevity, or both;
Quality
of life
Increased
mean longevity
Increased
maximum longevity
Changes
in demographics
Statistics
Possible
societal impact
US
2.c.
Possible conclusions.
3.
The relevance of offering this type of discussion in gerontology programs.
4. Additional summaries, notes, and bibliographies.
Hormones and Aging
Genes and Aging
Bibliography
International
view
CONTROLLING AGING: WHAT WOULD/COULD/SHOULD HAPPEN?
1. Questionnaire about controlling aging: what would/could/should happen?
To investigate knowledge of and opinions regarding how human aging could or should be controlled.
2.a. Information for us to present
- How the US Census makes population
projections. List the criteria used and the cohort method for population
projections.
Methodology and Assumptions for the Population
Projections of the United States: 1999 to 2100
https://www.census.gov/population/www/documentation/twps0038/twps0038.html
Projections
of the Size and Composition of the U.S. Population: 2014 to 2060
https://www.census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf
- The US Census
makes three different projections; lowest, middle, and highest. The lowest and
highest are the OUTSIDE LIMITS of what is "possible" given their
minimum and maximum values used in their equations. The middle values are their
"best guess" based on their assumptions, including that expected the
MLs are in the 80s, and there is no mention of XLs. Given these assumptions and
if MLs or XLs are increased, then the US Census highest projections should be
considered extremely conservative if not unrealistically low.
- (1) Making projections is a complex process.
- (2) Some of the important data and equations are in the US Census Bureau
computer and are not accessible by the public.
- (3) One cannot simply change one number, such as ML, and get answers because
each assumption, such as ML, is developed for each small segment of the
population (e.g., age, race, national origin, sex), so there are a multitude (a
matrix) of numbers used for each year's projections, and the entire matrix
changes for each year. The matrix includes assumptions for things like birth
rates for different types for females (e.g., age, race), death rates for people
of different ages and for different family sizes and different economic status,
and more. We are not able to see easily what might happen in real numbers if ML
or XL were to change or if death rates for people of different age groups were
to change.
- US projections are now available to the year 2100. Since many people being born now can expect to live almost that long.
- Many other projections other than total population { e.g., geographic distributions, sex ratios, MLs, age distributions and pyramids, available care facilities, health status, diseases, care expenses} are available from the US Census Bureau..
- Note that projections change as years pass due to changing conditions and assumptions.
Potential methods for changing aging, ML and XL and improving quality of life
"Intercompensating mortality factors"; i.e., if the major causes of aging and diseases are reduced or eliminated, they will be replaced with other factors so it is futile to try to increase ML or XL significantly.
Why many people would not, even if they could!
- Affordability
- Your Money
or Your Life
- The Cost
Of Life Extension
- Retirement
Planning Is Tough Enough
- Outliving
One's Pension
- Work Until
You Drop?
- Diet, Exercise Ignored
- Obesity & Diabetes
- Sci/Fi Vision of Extreme Old Age
- Science Vs. Snake Oil
- Conspiracy Theory
- Following The Wrong Advice
Diet
- good nutrition
is known the prevent many diseases and to correct many others (e.g.,
atherosclerosis, heart attacks, strokes, diabetes mellitus, osteoporosis,
intestinal diseases (e.g., constipation, diverticulosis, cancer)
- the diet for a
healthy older person is the same as the diet for a young adult except for
adjustments in caloric intake to compensate for the usual age-related decreases
in energy demands (e.g., muscle mass, physical activity)
Exercise
- exercise is
known the prevent many diseases and to correct many others (e.g.,
atherosclerosis, heart attacks, strokes, diabetes mellitus, osteoporosis,
intestinal diseases (e.g., constipation, diverticulosis)
- types of
exercises needed for a healthy older person are the same as those for a young
adult except for modifications in speed, strength, and coordination to
compensate for the usual age-related changes in the skeletal, muscle, and
nervous systems.
- Use it or lose
it.
- Use it to improve
it.
Better diagnosis
- better diagnoses are known the prevent many diseases and
to help correct many others (e.g., atherosclerosis, heart attacks, strokes,
diabetes mellitus, osteoporosis, intestinal diseases (e.g., constipation,
diverticulosis, cancers)
- diagnoses for elders is more complicated because of
altered signs and symptoms and because of the higher presence of multiple
diseases in each person.
Pharmacy
- new and better medications and herbal substances are
known that prevent many diseases and to help correct many others (e.g.,
atherosclerosis, heart attacks, strokes, osteoporosis, intestinal diseases
(e.g., constipation, diverticulosis, cancers, cosmetic surgery)
Replacement Cells and Organs
-
tissue transplants and organ transplants are known the prevent some diseases
and to help correct others (e.g., brain cells for parkinsonism, pancreatic
islet cells for diabetics, bone marrow for leukemia and for marrow- destroying
diseases and treatments, hearts, livers, skin graphs, skeletal joints,
arteries, hearts, inner ears for hearing, cosmetic prostheses)
- new and better
surgical procedures are known the prevent many diseases and to help correct
many others (e.g., atherosclerosis, heart attacks, strokes, osteoporosis,
intestinal diseases (e.g., constipation, diverticulosis, cancers, cosmetic
surgery)
- robotics, prosthetics replacement
organs hips, knees, skin, blood, hearts, bones
- immune system modifications
- cell
implants
- organ
transplants and replacement (e.g., human donors, animal donors, organ
"cloning)
- implants
for the brain (e.g., dopamine, acetylcholine, embryo brain parts)
Vitamins and minerals
- except for vitamin E, supplements help only by augmenting a poor diet or
compensating for a disease condition (e.g., intestinal, kidney)
- vitamin E serves and an antioxidant, which seems to help prevent
atherosclerosis, heart attacks, and strokes
Herbal remedies
- inconclusive
- placebo effect
Antioxidants (synthetic, organic)
- antioxidants other than vitamin E reduce certain age changes in animal
experiments but have not been shown consistently to increase ML or XL
- oxidants are necessary as useful entities (e.g., neuronal signals, hormonal
signals, WBC and immune defense responses).
- there is inadequate knowledge about which FRs are dangerous and how to
specify antioxidant therapy
Caloric restriction (CR)
- definition in
humans vs ad lib
- CR is know to
increase ML and reduce diseases in many animals including monkeys (e.g.,
cancers, diabetes mellitus)
- compliance with
CR may be difficult. Note preponderance of overweight and obesity now.
- would it be
possible to use anti-appetite drugs to suppress hunger (possible abuse)
- CR may have
adverse effects on quality of life (e.g., constant hunger, limited energy
expenditures (e.g., work, recreation), poor concentration, altered behaviors
and personality traits, poorer healing, reduced tolerance of and recovery from
serious illness (i.e., lower body reserves)
- For detailed notes
click here.
- hormone supplements have been shown to slow or reverse some age changes and
some diseases. However, research shows significant adverse side effects. Hormone
supplementation is not yet known to alter ML or XL. Some hormones (e.g.,
melatonin, DHEA) are not regulated in any way (e.g., production, availability,
doses)
- GH
improves muscle and bone and skin but may promote diabetes mellitus and cancers.
Exercise helps maintain GH levels and also promotes all the benefits of GH
supplements without the drawbacks.
-
Melatonin is a potent antioxidant but also affects biorhythms (e.g.,
sleep:wakefulness), including rhythms of other hormones (e.g., ADH,
glucocorticoids). Some sources of melatonin are contaminated with toxic
materials and are unregulated.
- The
normal functions of DHEA are unknown. DHEA may reduce some diseases, but
results are inconclusive and controversial. DHEA supplementation produces
dangerous by-products.
-
Estrogen reduces some age changes (e.g., bone loss, memory loss) and some
diseases (e.g., atherosclerosis, heart attacks, strokes, Alzheimer's) but has
adverse side effects for some women (e.g., cancers, blood clots)
- (e.g., gene therapy, transgenes
from non-humans, man-made genes, telomerase)
- genetic engineering works in animals
(e.g., selective breeding, altering genes, "designer" genes from
humans, synthetic genes, transgenes from non- humans,))
- additional effects while
altering ML and XL are not well studied or documented
- correct congenital defects
- correct late life defects
- enhance vitality.
2.b. Possible consequences from altering mean longevity, maximum longevity, or both;
Should we? Is It Worth The Cost?
- Species
Approach applied to humans (Ethical Cost)
- Health
Resources Needed Elsewhere
- No
Guarantee That Later Years Would Be Better
- Harvard
Study: (East Boston) 47% of >85 Apparent SDAT
There Is More To Life That This?
- Spiritual
Dimension
- Patrick
Henry
There are different criteria used to establish quality of life.
- physical independence, medical status,
economic status, social status and situation, life satisfaction, self-efficacy,
self-determination
Increased mean longevity
- with or without increasing quality of later life
Increased maximum longevity
- with or without increasing quality of later life
Changes in demographics
Graphs of demographics
Projected
U.S. Population - 2000-2100
The range between
the highest and lowest series is the 95% confidence interval.
Populations
of Elders - 1900-2050
The changes
in the numbers of elders and the percentages of elders at 65+ and at 85+.
Elders as Percent
of Population - 2000-2100 (Middle Series)
The changes in elders as percentages of the total population.
Projected
Life Expectancies at Birth - 1995-2050 (Table)
The 95%
confidence intervals and average life expectancies of women and of men.
Projected Life
Expectancies at Birth - 2000-2100 (Table)
The 95%
confidence intervals and average life expectancies of women and of men.
Projected
Life Expectancies at Age 65 - 1995-2050
The 95%
confidence intervals and average life expectancies of women and of men age 65.
Age Pyramids (Slow
download)
The age
distributions at different years.
Survival Curves
1999-2100
The present
and projected survival curves based on middle series.
Projected Percent
Female Elders 65+ - 2000-2100
The
changes in women as a percentage of the population of elders 65+.
Projected
Number of Females and Males 65 - 2000-2100
The changes
in numbers of elderly women and men.
Population
Ages 25-64 by State - 1995-2025 (Table)
The present
and projected changes in the distribution of young adults among states. Compare
the differences in the present and projected numbers and proportions of elders
among states.
Population
Ages 65+ by State - 1995-2025 (Table)
The present
and projected changes in the distribution of elders 65+ among states. Compare
the differences in the present and projected numbers and proportions of elders
among states.
Tables of demographics (Slow
download for tables)
Projected Life
Expectancies at Birth - 1995-2050 - All Series
(Graph)
Projected Life
Expectancies at Birth - 2000 to 2100 (Graph)
Population Ages
24-64 by State - 1995-2025 (Graph)
Population Ages
65+ by State
Updated
changes in demographics
Topics
Demographics
and Populations Statistics
Health
Births,
Mortality, Deaths
International
data and statistics
Diverse
topics
Demographics and Populations Statistics
Population Projections of the United States by Age, Sex, Race, and
Hispanic Origin: 1995 to 2050
https://www.census.gov/prod/1/pop/p25-1130.pdf
An Aging Nation: The Older Population in the United States
https://www.census.gov/library/publications/2014/demo/p25-1140.html
2014 National Population Projections Tables
https://www.census.gov/data/tables/2014/demo/popproj/2014-summary-tables.html
Census Data & Population Estimates
https://www.acl.gov/aging-and-disability-in-america/data-and-research/census-data-population-estimates
The Nation's Median Age Continues to Rise
https://www.census.gov/library/visualizations/2017/comm/median-age.html
Millennials Outnumber Baby Boomers and Are Far More Diverse,
Census Bureau Reports
https://www.census.gov/newsroom/press-releases/2015/cb15-113.html
The Nation’s Older Population Is Still Growing, Census Bureau Reports
https://www.census.gov/newsroom/press-releases/2017/cb17-100.html
News
Releases by Year: This page displays the most recent
news releases published by the U.S. Census Bureau.
https://www.census.gov/newsroom/press-releases/by-year.html
Health
Health, United States, 2016
https://www.cdc.gov/nchs/hus/index.htm
- (for previous years, see (https://www.cdc.gov/nchs/hus/previous.htm)
Health Information for Older Adults
https://www.cdc.gov/aging/aginginfo/index.htm
National Center for Health Statistics
National Center for Health Statistics: Diseases and Conditions
https://www.cdc.gov/nchs/fastats/diseases-and-conditions.htm
Percent of U.S. Adults 55 and Over with Chronic Conditions: National Center for Health Statistics:
https://www.cdc.gov/nchs/health_policy/adult_chronic_conditions.htm
Overweight
& Obesity
https://www.cdc.gov/obesity/index.html
Births, Mortality, Deaths
Deaths: Final Data for 2014 : Life expectancy, mortality statistics, causes
of death
https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_04.pdf
National
Vital Statistics System
https://www.cdc.gov/nchs/nvss/index.htm
International data and statistics
International Programs Data
https://www.census.gov/population/international/data/
U.S.
and World Population Clock
https://www.census.gov/popclock/
Diverse topics
National Institute on Aging: Many types of data and information on aging and elders.
https://www.nia.nih.gov/
American FactFinder – from the US Census Bureau
https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml
“American FactFinder provides access to data about the United States, Puerto
Rico and the Island Areas. The data in American FactFinder come from several
censuses and surveys.”
National Archive of Computerized Data on Aging (NACDA)
https://www.icpsr.umich.edu/icpsrweb/NACDA/search.jsp
Search
for any variable or select:
I.
Demographic characteristics of older adults
II.
Social characteristics of older adults
III.
Economic characteristics of older adults
IV.
Psychological characteristics, mental health, and
well-being of older adults
V.
Physical health and functioning of older adults
VI.
Health care needs, utilization, and financing for older
adults
CDC Newsroom Releases: 2017 News Releases
https://www.cdc.gov/media/archives.htm
CDC Newsroom Archives: for years before 2017
https://www.cdc.gov/media/archives.htm
Changes in demographics (Web Sites in
original presentation)
Web Sites for demographic data
and graphs
One
of the most complete sources with very diverse types of data, table, and
wonderful graphs is "65+ in the United States" at
https://www.census.gov:80/prod/1/pop/p23-190/p23-190.html (Broken Link)
Other good
ones are at
https://www.acl.gov//AoARoot/Aging_Statistics/Profile/index.aspx (Broken Link)
https://www.acl.gov//AoARoot/Aging_Statistics/index.aspx (Broken Link)
https://www.census.gov/prod/1/pop/p25-1130.pdf
Population Projections of the United States by Age, Sex, Race,
and Hispanic Origin: 1995 to 2050
https://www.census.gov/population/www/projections/popproj.html (Broken Link)
https://www.cdc.gov/nchs/data/hus/hus05.pdf
(especially page xiii and page 70)
Life Tables
https://www.census.gov:80/population/www/projections/natdet-D5.html (Broken Link)
Statistics
- size of U.S. population
https://www.census.gov/prod/1/pop/p25-1130/ (Broken
Link)
https://www.census.gov/population/www/projections/natsum-T3.html (Broken Link)
https://www.census.gov/population/projections/nation/summary/np-t1.txt
(Broken Link)
https://www.census.gov/population/www/projections/natsum.html (Broken Link)
https://www.census.gov/population/www/projections/natdet-D1A.html (Broken Link)
- size of global population
https://www.census.gov/population/international/
or https://www.census.gov/ipc/www/
- age distributions and age pyramids
https://www.census.gov/population/www/projections/natchart.html (Broken Link)
- geographic distribution of elders
https://www.census.gov/population/www/socdemo/age.html#elderly (Broken Link)
- health status of population
https://www.cdc.gov/nchs/agingact.htm (Broken
Link)
https://www.cdc.gov/nchs/hus/index.htm
- Health, United States, 2016
(for previous years, see (https://www.cdc.gov/nchs/hus/previous.htm)
try this -
https://www.census.gov/population/www/socdemo/related_sites.html
(Broken Link)
Possible
societal impact from demographic
changes (i.e., changes in groups)
See the US Census Bureau and the AOA sites above and in the
bibliography for projections about economy, social status (e.g., men/women
ratios, living arrangements, nursing homes, institutionalization, health care
costs).
Note the projections about HMOs and the cost
of health care, Social Security, prescription drugs.
Medical
Increases in certain diseases
Cataracts
Dementias
Alzheimer's
Cancers
?????
Ecological
Pollution
Erosion
Effects on habitat
Increases in endangered and extinct species
Loss of wilderness
Loss of species diversity (altered evolution and lowered survivability)
Alterations in human environments (e.g., drinking water, insecticides and
herbicides, antibiotic resistance, urban sprawl, aesthetic quality)
Social
Maintaining and transferring culture
Family structure
- multiple generation families
- "sandwich generations"
Care giver burdens
Institutionalization
Racial and ethic shifts
Psychological
There Is More To Life That This?
- Spiritual Dimension
- Patrick Henry
Economic
- Who will afford necessary techniques (e.g., diet vs supplement vs surgery)
- Prioritization of medical research funds
- Who should pay for necessary techniques
- Aging of the "rich"
- Health care costs
- Personal resources
- Medicare/medicaid
- HMOs
- Available health care workers and facilities
- Costs for research
- Costs for treatments and care
- Education
- Work force and employment
- Competition for employment
- Retirement plans and pensions
- Poverty
Political
- Elections
- Public policy
- Legislation
- Budget re-allocations
Ethical
- Means vs ends?
- Returns vs investments?
- Contributions by elders
- Effects on younger generations and future generations
- Quality vs quantity of life
- Ecological and environmental responsibilities
- Care giver burden on family and friends
There Is More To Life That This?
- Spiritual dimension
- Patrick Henry
Note the current difficulties with the federal and state governments and with
families and friends dealing with problems related to the elderly.
International
- Global conditions
- International politics
- These derive from Item 2.
- Some believe that work toward increasing ML
and XL will have negligible effects on total population sizes and small effects
on the size of elder populations because new or unrecognized age-related
problems will only replace ones that we may be able to solve in the near future
(e.g., increases in cancers, genetic limitations).
3. The relevance of offering this type of discussion
in gerontology programs.
1. Show students ethical
implications of altering ML or XL.
2. Shows interdisciplinary aspects and therefore need for interdisciplinary
education for gerontology students. Wouldn't this be a great class discussion
in any gerontology course regardless of its special focus (e.g., sociology,
psychology, economics, biology, philosophy, etc.).
3. Provide opportunities for students to progress up Bloom's
categories (i.e., knowledge, {name, define, list, describe}; comprehension
{explain, interpret, predict, summarize}; application {apply, modify,
construct}; analysis {show how or why something relates or works}; synthesis {design
an experiment or study, make predictions, use data to support a position};
evaluation {compare and contrast, decide, select the best})
4. Allows students with different backgrounds, value
systems, and backgrounds to contribute and to appreciate the contributions and
perspectives of others.
5. Contributes to more expansive thinking by faculty
teaching courses.
6. Shows need for VERY long range thinking about outcomes
from short range changes (e.g., "small" increase in ML and how that
could make MAJOR differences within one's lifetime and certainly within the
lifetimes of ones children - many college-age folks plan to have children
within a few years of their graduation.)
7. Show students opportunities for and importance of
continued research.
8. Show students importance of being educated about
gerontology to be educated citizens and career professionals prepared to
address inevitable questions about altering aging and its outcomes.
4. Summaries, notes, and bibliographies with current references about what would/could/should
happen regarding controlling human aging.
Books and articles:
(no author): "Births, Marriages,
Divorces, and Deaths for November 1996." Monthly Vital Statistics Report,
U.S. Department of Health and Human Services 45(11) May 15 (1997).
(no author): "Births, Marriages,
Divorces, and Deaths for November 1997." Monthly Vital Statistics Report,
U.S. Department of Health and Human Services, 4(12) July 28 (1998).
(no author): "Historical Statistics of
the United States: Colonial Times to 1970: Part 1." U.S. Department of
Commerce, September (1975).
(no author): "Resident Population of the
United States: Estimates, by Age and Sex." U.S. Bureau of the Census,
August 28 (1998).
(no author): "Sixty-five Plus in the
United States." U.S. Census Bureau: the Official Statistics Economics and
Statistics Administration, U.S. Department of Commerce, May (1995).
(no author): "Statistical Abstract of
the United States 1997." The National Data Book, 117th Edition, U.S.
Department of Commerce, October (1997).
(no author): "Trends in the Health of
Older Americans: United States, 1994." Vital and Health Statistics, U.S.
Department of Health and Human Services, Series 3: Analytic and Epidemiological
Studies No. 30, DHHS Publication No. (PHS) 95-1414 April (1995).
Arking R: "Biology of Aging:
Observations and Principles." Prentice Hall, Englewood Cliffs, NJ (1999).
Austad SN: "Why We Age: What Science Is
Discovering about the Body's Journey Through Life." John Wiley & Sons,
Inc., NY (1997).
Carter WR: A Means to an End: The Biological
Basis of Aging and Death." Oxford University Press, NY (1999)
Comfort A: The Biology of Senescence.(Third
Edition),New York:Elsevier (1979).
DiGiovanna AG: "Human Aging:
Biological Perspectives." McGraw-Hill, NY (2000).
Diplock AT: "Will the 'good fairies'
please prove to us that vitamin E lessens human degenerative disease?."
Free Radic Res (1997) Nov;27(5):511-532.
Gardner P, Rosenberg HM: "Leading Causes
of Death by Age, Sex, Race, and Hispanic Origin: United States, 1992."
Vital and Health Statistics Series 20: Data on Mortality, No. 29 U.S.
Department of Health and Human Services DHHS Publication No. (PHS) 96-1857 June
(1996).
Hayflick L: "How and Why We Age."
Ballantine Books, NY (1994).
Kilama: WL: HEALTH CHALLENGES EARLY IN
TWENTY FIRST CENTURY SUB-SAHARAN AFRICA, LECTURE DELIVERED AT THE 19TH
AFRICAN HEALTH SCIENCES CONGRESS INCORPORATING THE 16TH AJSC, NIMR, TANZANIA
ARUSHA 15 APRIL (1998)
Klemera P, Doubal S: "Human mortality at
very advanced age might be constant." Mechanisms of Ageing and Development
(1997) Nov;98(2):167-176.
Kurian GT: "Datapedia of the United
States 1790-2000 America Year by Year" Bernan Press, Lanham, MD (1994).
Lane MA, Ingram DJ, Roth GS: "Beyond the
rodent model: calorie restriction in rhesus monkeys." Age (1997) 20:39-50.
Lundh U, Nolan M: "Aging and quality of
life. 1: Towards a better understanding." British Journal of Nursing
(1996) Nov 14;5(20):1248-1251.
O'Boyle CA : "Measuring the quality of
later life." Philos Trans R Soc Lond B Biol Sci. (1997) Dec 29;352(1363)
1871-9.
Olshansky SJ, Carnes BA: "Ever since
Gompertz." Demography (1997) Feb;34(1):1-15.
Pickle LW, Mungiole M, Jones GK, White AA:
"Atlas of United States Mortality." U.S. Department of Health and
Human Services, DHHS Publication No. (PHS) 97-1015 December (1996).
Rowe JW, Kahn RL: "Successful
aging." Gerontologist (1997) Aug;37(4):433-440.
Rowe JW, Kahn RL: "Successful
Aging." Pantheon Books, NY (1998).
Thurman JE, Mooradian AD: "Vitamin
supplementation therapy in the elderly." Drugs and Aging (1997)
Dec;11(6):433-449.
Vita AJ, Terry RB, Hubert HB, Fries JF:
"Aging, health risks, and cumulative disability." New England Journal
of Medicine (1998) Apr 9;338(15):1035-1041.
Ward JA: "Should antioxidant vitamins be
routinely recommended for older people?." Drugs and Aging (1998)
Mar;12(3):169-175.
Weindruch R, Walford, RL: "The
retardation of aging and disease by dietary restriction." Charles C.
Thomas, Springfield, IL, (1998).
Weindruch R: "Caloric restriction and
aging." Scientific American (1996) Jan 46-52.
Wickens A: The Causes of Aging.
Amsterdam: Harwood Academic Publishers (1998).
Internet sites:
65+ in the United States - U.S. Census
Bureau
https://www.census.gov/prod/1/pop/p23-190/p23-190.html
Administration on Aging
https://pr.aoa.dhhs.gov/aoa/stats/statpage.html
Statistics pages
Centers for Disease Control and
Prevention (CDC)
https://www.cdc.gov/epo/prevent.htm
Prevention and cost estimates of diseases
National Center for Health Statistics
https://www.cdc.gov/nchs/
U.S. Census Bureau
https://www.census.gov/
International statistics - U.S. Census
Bureau
https://www.census.gov/ipc/www/
Mortality statistics - National Center for
Health Statistics
https://www.cdc.gov/nchs/about/major/dvs/mortdata.htm
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