Population Aging and Urbanization in Europe

Cities are seeing a rise in ageing populations. In the European Union (EU), 75 percent of residents live in urban areas. As urban populations continue to rise, more and more people will grow into old age. For instance, the over age 65 group makes up 20-27 percent of the population in cities inside Portugal, Italy, and Spain. Since population aging will influence health, social exchanges, and well-being of older adults, hundreds of cities are designing urban environments to foster active and healthy aging.


Urbanization affects many areas including the health and well-being of society. As a result, many sectors are collaborating to keep populations engaged and healthy. Adapting cities to demographic trends accommodates residents, allowing for independent living and participation in society. The European Commission estimates that over 75 percent of housing in the EU is not suitable for independent living. Other aspects of physical environments including adequate sidewalks, transportation, and functional green spaces can increase physical activity and improve mobility, which reduces the risk and effects of chronic disease. Social issues, such as employment discrimination, negative stereotypes, and ageism, also play a role in the health of aging populations. It is important to involve older adults’ perspectives on urban planning to identify issues and barriers which prevent participation in society.

To help cities adjust to demographic trends and support healthy ageing, the World Health Organization (WHO) created a Global Network of Age Friendly Cities and Communities and Affiliated Programs, as well as a guide for policy and action in fostering age-friendly urban environments. Over 300 cities in 33 countries are currently involved in the Global Network, including 19 Member States in the European Region. The WHO guide advises on eight areas¹ considered the most influential, which also reflect the UN Principles for Older Persons. Through the work of the European Innovation Partnership on Healthy and Active Ageing (which has a dedicated Action Group on Innovation for age friendly buildings, cities and environments) the European Commission has published a guide on innovation for aging, with examples from 12 countries in Europe.

EuroHealthNet’s Healthy Ageing website also highlights examples of initiatives and key resources on healthy and active aging throughout the European Union. Arup, Help Age International, Intel, and Systematica have produced an overview² of aging in 10 European cities with comparative data on both urbanization and aging. AGE Platform Europe published a guide³ aimed at helping European cities to use the Urban Agenda to become more age-friendly and as a repository of innovative solutions for age-friendly environments. These networks and initiatives encourage cities to be health-promoting environments as they adjust to population aging, and share innovative ideas, experiences, and lessons learned along the way.

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By 2020, more than 50 percent of the global population over 60 years old will be living in urban areas. Planning now can stimulate active and healthy aging both for current and future generations.

1. The WHO guide addresses: outdoor spaces and buildings; transportation; housing; social participation; respect and social inclusion; civic participation and employment; communication and information; and community support and health services.
2. The ”Shaping Ageing Cities” publication examines: society; mobility; built and digital environments; politics; planning; and aging.
3. The AGE Platform Europe guide addresses the eight areas in the WHO guide as well as eight themes corresponding to the Urban Agenda: inclusion of migrants and refugees; jobs and skills in the local economy; urban poverty; housing; air quality; urban mobility; digital transition; and innovative and responsible public procurement.

Carrie Peterson covers Europe for Global Health Aging. She is a Gerontologist and Consultant in eHealth and Innovation.

Europe: How to Tackle the Lack of Support and Accessibility for the Influenza Vaccine

Every year, millions of people become infected with the influenza virus. In the U.S., it is recommended that anyone over the age of six months be vaccinated against influenza (flu). The World Health Organization (WHO) has come up with “six priority groups” that are strongly encouraged to get vaccinated. These groups include pregnant women, health care workers, small children (ages six months to two years), people with chronic medical conditions, and the elderly.

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According to WHO Europe, “90 percent of deaths related to seasonal influenza occur among those 65 and older.” Elderly who are infected with the influenza virus experience more severe symptoms, have a longer recovery time, and are hospitalized more often and longer. Compared to the U.S., there is an overall lack of support for the influenza vaccine in Europe. This is a result of missing data on the effectiveness and feasibility of the vaccine as well as lack of money.

In 2013, the flu vaccine was only 62 percent effective. For the elderly and frail, the vaccine is even less effective. The main reason for the ineffectiveness is that the influenza vaccine only responds to certain circulating viral strains. Also, the responsiveness of the vaccine depends on “the seroconversion in the individual” after vaccination. Anytime a vaccine (antigen) enters the blood, antibodies are created by the immune system to fight off the disease that a person is immunized for. A reduced seroconversion can lead to a reduced effectiveness of the vaccine.

Although the flu vaccine is less effective in the elderly, it is still recommended that older adults get vaccinated because “some protection is better than none,” and immunization can lead to decreased recovery time and severity of illness. In addition, hospital admissions and the death rate related to influenza are reduced, which lessen the burden of a health care system in any country. Therefore by 2014-2015, 94 percent of countries in the WHO European Region recommend that at least 75 percent of the elderly population should get vaccinated. However, only the Netherlands were able to reach this goal.

How can we increase the uptake levels of the influenza vaccine? Dr. Caroline Brown, Programme Manager for Influenza at WHO/Europe, highlights that we need to “estimate the burden of influenza, assess the costs and benefits of influenza vaccination programs,” and still maintain and improve the vaccination programs we have. Making a vaccine easy to access and afford is key as well. In Europe, vaccines can only be given by doctors and vaccine programs do not always exist, which causes a lack of accessibility to vaccines. Some countries offer free vaccines while other countries require residents to pay for them. It is important to improve the public’s perception of the influence of vaccines, which will happen once there is more data about the effectiveness of vaccines. Researchers are also eager to find a more effective vaccine; a vaccine that could possibly be effective for a longer period of time and be given in higher doses as a recent study shows. This could increase the protection for influenza especially among the elderly.

If the vaccine is not as effective among the elderly, we need to take another approach. In order to protect the elderly in nursing homes, let us reduce outbreaks and mortality rates as well as advising all health care workers to get vaccinated, which ultimately leads to herd immunity.

Martina Lesperance is a Health Educator and Screening Technician at Catapult Health.

An Invisible Epidemic: Substance Abuse Among Baby Boomers in Europe

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Substance abuse among the elderly is a real problem. In Europe, it was reported that the number of people over the age of 65 with a problem of drug abuse will double between 2001 and 2020. These substances include legal medication, tobacco, alcohol, illegal drugs, prescription drugs, as well as over-the counter medicine. One of the reasons why there is an increase of substance abuse among today’s elderly, also called Baby Boomers, is because they have a more tolerant attitude towards drugs, which in the 1960’s, were acceptable for recreational use. Other reasons are mostly related to emotional and psychosocial issues that result from dealing with difficult life changes or situations. These life situations may be caused by a death of a friend or family member, retirement, loneliness, depression, and even homelessness. The elderly use drugs to compensate for the loneliness and social isolation they may experience. However, being intoxicated definitely hinders them to take part in social events and gatherings, which could improve their mental state. It seems to be a cycle that a drug user may not get out of without help.

Most reports and research about substance abuse are focused on the younger generation although with an increase of aging population worldwide, drug abuse among the elderly has become more of a problem and is often referred to as a hidden or “invisible epidemic”. Why is this a public health issue we need to fix? Drug abuse not only affects the mental state of a person but can also lead to physical harm. Alcohol and illegal drug abuse are among the top ten risk factors for premature death and health problems. It is also reported that the mortality rate of older drug users is significantly higher compared to young drug users.

After a long-term drug abuse, one may experience memory loss, social isolation, weight loss, and pain. Older people who are drug users are intoxicated and more likely to suffer falls and serious injuries. Especially after a fall, their mental and physical health will decline rapidly. In most cases, substance abuse of older adults who live at home alone will go undetected because they are able to hide it from their family as well as their physician. Physicians are often not able to differentiate between the symptoms of substance use and symptoms of aging. This is why the elderly rarely get referred to a Substance Abuse Specialist so they can receive the help they need. It is important to raise awareness of substance abuse among the older generation. We need to educate physicians, nurses, as well as our family members on how to recognize symptoms or behaviors of substance abuse. In addition, treatments and interventions have to be tailored to the needs of older drug users.

Martina Lesperance is a Health Educator and Screening Technician in El Paso, Texas.