Background: Rapid political and economic changes have exerted a great influence on the health of the Lithuanian population, particularly on the most vulnerable layers such as older adults. The aim of this study was to assess mortality from major causes of death of older adults in the context of the socioeconomic transition and health reform in Lithuania. Methods: Information was gathered on deaths of older adults (aged 65 years and older) from 1991 to 2010 by examining death certificates held by the Lithuanian Department of Statistics. Overall mortality and mortality from cardiovascular diseases (CVD) and cancer were analyzed. Joinpoint analysis was used to identify the best-fitting points wherever a statistically significant change in mortality occurred. Results: Because of considerable variations in overall mortality throughout the two decades, average annual changes were not statistically significant for males; however, a decline of 0.81% was observed for females (p < 0.05). Mortality from CVD decreased and cancer mortality increased statistically significantly both for males and females. The most critical points for overall mortality occurred in 1993, when an increasing trend reversed to a decreasing one. The major decline was observed in mortality from CVD in males and females. After the period of growing mortality (2000-2007 for males and 2003-2006 for females), the trend reversed to the declining one, which was mainly determined by the positive changes in CVD and cancer mortality, particularly among females. Conclusion: A shift from a health care system based on inpatient services towards a system including preventive strategies and being opened to the modern medical achievements seems to have played an important role in the health improvement of the older adults. However, organization of geriatric care and development of the social system for active ageing is still challenging. A major priority is to persuade all of the different sectors to commit to the establishment and implementation of the national policy for health and social care among the older population.

Keywords:
Older adults, Mortality, Joinpoint, Lithuania, Socioeconomic transition
1.
Keep J: Last of Empires: A History of the Soviet Union 1945-1991. Oxford, Oxford University Press, 1995.
2.
United Nations Children's Fund. Crisis in Mortality, Health and Nutrition. Central and Eastern Europe in Transition. Public Policy and Social Conditions. Regional Monitoring Report No 2. Florence, UNISEF, 1994.
3.
Statistics of Lithuania. Statistical Yearbook of Lithuania 2011. Vilnius, 2011.
4.
Petrauskiene J, Lesauskaite V, Kalediene R: Inhabitants of Lithuania - an old population (in Lithuanian, English abstract). Medicina 1994;30:193-195.
5.
Kalediene R: Mortality from cardiovascular disease in Lithuania: time trends, age, period, and cohort effects. CVD Prevention 1999;2:205-211.
6.
Varnik A, Wasserman D, Eklund G: Suicides in the Baltic countries, 1968-90. Scand J Soc Med 1994;22:166-169.
7.
Kalediene R: Demographic, Social and Territorial Inequalities in Health of Lithuanian Population. Summary of the Research Report Presented for Habilitation. Kaunas, Kaunas University of Medicine, 2000.
8.
Kalediene R: Time trends in suicide mortality in Lithuania. Acta Psychiatr Scand 1999;99:419-422.
9.
Kalediene R, Starkuviene S, Petrauskiene J: Mortality from external causes in Lithuania: looking for critical points in time and place. Scand J Public Health 2004;32:374-380.
10.
Kim HJ, Fay MP, Feuer EJ, Midthune DN: Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 2000;19:335-351.
11.
Ries LA, Wingo PA, Miller DS, et al: The annual report to the nation on the status of cancer, 1973-1997, with special section on colorectal cancer. Cancer 2000;88:2398-2424.
12.
Lesauskaite V, Macijauskiene J: The need and necessity of geriatric care in the health care system of Lithuania (in Lithuanian, English abstract). Sveikatos Mokslai 2005;3:97-99.
13.
Lesauskaite V, Macijauskiene J, Rader E: Challenges and opportunities of health care for the aging community in Lithuania. Gerontology 2006;52:40-44.
14.
Ministry of Health of the Republic of Lithuania. Order No. 453 of the Minister of Health of the Republic of Lithuania of 18 October 1999. ‘Physician geriatrician. Rights, duties, competencies and responsibility (in Lithuanian). Official Gazette 1999;89:2633.
15.
Ministry of Health of the Republic of Lithuania. Order No. V-734 of the Minister of Health of the Republic of Lithuania of 30 August 2006. Physician geriatrician. Rights, duties, competencies and responsibility. Official Gazette 2006;95:3748.
16.
Ministry of Health of the Republic of Lithuania. Order No. V89 of the Minister of Health of the Republic of Lithuania of 10 February 2003. On the program for the development of geriatric care and health care in Lithuania in 2003-2007 (in Lithuanian).
17.
Government of the Republic of Lithuania. National strategy for overcoming consequences of aging population 2005-2013 (in Lithuanian). Official Gazette 2004;95:3501.
18.
Ministry of Health of the Republic of Lithuania. Order No.V117 of the Minister of Health of the Republic of Lithuania of 10 February 2011. On the approval of special requirements and basic costs for delivering services of geriatric services (in Lithuanian). Official Gazette 2011;19:934.
19.
Kalediene R: The Assessment of Health of Lithuanian Population on the Basis of Mortality Statistics (Lithuanian, summary in English). Kaunas, Kaunas Medical Academy, 1992.
20.
Zatonski WA, Jha P: The health transformation in Eastern Europe after 1990: a second look. Warszava, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, 2000.
21.
Ford ES, Ajani UA, Croft JB, et al: Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. N Engl J Med 2007;356:2388-2398.
22.
Pratala R, Helakorpi S, Sipila N, et al (eds): Social Determinants of Health Behaviours. Finbalt Health Monitor 1998-2008. Tampere, National Institute for Health and Welfare, 2011.
23.
World Health Organization: NCD Country Profiles, 2011. http://www.who.int/nmh/countries/ltu_en.pdf (accessed Feb. 21, 2012).
24.
Baubiniene AV, Eviltis EA: Arterial hypertension and its control in therapeutic districts of various polyclinics of the Lithuanian S.S.R (in Russian). Kardiologiia 1986;26:72-76.
25.
Reklaitiene R, Tamosiunas A, Virviciute D, Baceviciene M, Luksiene D: Trends in prevalence, awareness, treatment, and control of hypertension, and the risk of mortality among middle-aged Lithuanian urban population in 1983-2009. BMC Cardiovasc Disord 2012;12:68.
26.
Jatoi I, Miller AB: Why is breast cancer mortality declining? Lancet Oncol 2003;4:251-254.
27.
Karin-Kos HE, de Vries E, Soerjomartam I, et al: Recent trends of cancer in Europe: a combined approach of incidence, survival and mortality by 17 cancer sites since the 1990s. Eur J Cancer 2008;44:1345-1389.
28.
Bosetti C, Bertuccio P, Levi F, et al: Cancer mortality in the European Union, 1970-2003, with a joinpoint analysis. Ann Oncol 2008;19:631-640.
29.
La Vecchia C, Bosetti C, Lucchini F, et al: Cancer mortality in Europe, 2000-2004, and an overview of trends since 1975. Ann Oncol 2010;21:1323-1360.
30.
Cook MB, McGlynn, Devesa SS, et al: Sex disparities in cancer mortality and survival. Cancer Epidiomol Biomarkers Prev 2011;20:1629-1637.
31.
Soares JJF, Barros H, Torres-Gonzales F, Ioannidi-Kapolou E, Lamura G, et al: Abuse and Health among Elderly in Europe. Kaunas, Lithuanian University of Health Sciences Press, 2010.
32.
Berkman LF: Assessing the physical health effects of social networks and social support. Ann Rev Public Health 1984;5:413-432.
33.
Tomaka J, Thompson S, Palacios R: The relations of social isolation, loneliness, and social support to disease outcomes among the elderly. J Aging Health 2006;18:359-384.
34.
Adomaitiene R, Vozbutas S, Juozulynas A, Alekna V, Prapiestis J: The national social system of active ageing policy in the context of theory of structural functionalism (in Lithuanian). Gerontologija 2007;8:7-16.
35.
Ministry of Social Welfare and Labor. Report on Implementation of National Strategy for Overcoming Consequences of Aging Population in 2005-2013. http://www.lrv.lt/Posed_medz/2011/110427/12.pdf (accessed at Feb. 17, 2012).
36.
Lash TL, Fox MP, Buist DS, Wei F, Field TS, Frost FJ, Geiger AM, Quinn VP, Yood MU, Silliman RA: Mammography surveillance and mortality in older breast cancer survivors. J Clin Oncol 2007;25:3001-3006.
© 2012 S. Karger AG, Basel
2012
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