title: Mortality of older adults in the context of socioeconomic transition and health reform in Lithuania.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Health Management, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Ramune
authors.initials: R
authors.lastname: Kalediene
authors.forename: Jurate
authors.initials: J
authors.lastname: Macijauskiene
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D005260:Female; D018166:Health Care Reform / Q000639:trends*; D006291:Health Policy; D006801:Humans; D008097:Lithuania / Q000453:epidemiology; D008297:Male; D009026:Mortality / Q000639:trends*; D009369:Neoplasms / Q000401:mortality; D012959:Socioeconomic Factors