Background: A practical and up-to-date consensus among experts is paramount to further improve patient care in actinic keratosis (AK).Objectives: To develop a structured consensus statement on the diagnosis, classification, and practical management of AK based on up-to-date information.Methods: A systematic review of AK clinical guidelines was conducted. This informed the preparation of a 3-round Delphi procedure followed by a consensus meeting, which combined the opinions of 16 clinical experts from 13 countries, to construct a structured consensus statement and a treatment algorithm positioning daylight photodynamic therapy (dl-PDT) among other AK treatment options.Results: The systematic review found deficiencies in current guidelines with respect to new AK treatments such as ingenol mebutate and dl-PDT. The Delphi panel established consensus statements across definition, diagnosis, classification, and management of AK. While the diagnosis of AK essentially rests on the nature of lesions, treatment decisions are based on several clinical and nonclinical patient factors and diverse environmental attributes. Participants agreed on ranked treatment preferences for the management of AK and on classifying AK in 3 clinical situations: isolated AK lesions requiring lesion-directed treatment, multiple lesions within a small field, and multiple lesions within a large field, both requiring specific treatment approaches. Different AK treatment options were discussed for each clinical situation.Conclusions: The results provide practical recommendations for the treatment of AK, which are readily transferable to clinical practice, and incorporate the physician’s clinical judgement. The structured consensus statement positioned dl-PDT as a valuable option for patients with multiple AKs in small or large fields.

The United Nations’ 2022 World Population Prospects suggests the global population will reach 10 billion people in 2058 and will peak in 2086. Aggregated data do not account for regional and age-group realities, which draw a more pressing picture. We analyze the World Population Prospects 2022 data according to age groups and regions and show that population peaks are going to occur sooner in some regions of the world than others, and the working-age population will peak on average 10 to 20 years before the overall population peaks. Africa is the only world region expected to continue to experience significant population growth. The population will be increasingly made up of larger proportions of older ages than younger, thereby shifting the dependency ratio. Reflections on the implications of an aging and shrinking population on policy regarding fertility, aging, migration, urban planning and economic development are needed. The challenge is not to be left for future generations to face; it is happening tomorrow.

Ageing is often depicted negatively, but we challenge passive views, suggesting that an “active ageing” agenda requires rethinking economy, urban form and societal responses. We present demographic trends in ageing, migration and urbanization across global regions. Building from psychological theories of ageing regarding disengagement and continuity, we argue for an adjustment response at the societal level to address needed structural changes in economy, social policy and regional planning. These adjustments should prioritize well-being and purpose over economic growth; social policy that links household, informal and formal care and new approaches to urban and regional planning that remake cities for all ages. Ageing requires new paradigms. These societal adjustments will permit new approaches that could build a more inclusive world.

Despite the demographic aging of Latin America, the uptake of the WHO’s Age-Friendly Cities Framework remains extremely low, with the notable exceptions of Chile, Mexico and Brazil. We argue for a broader human ecological framework, which focuses on the macro, meso and micro levels, to better address the context, challenges and opportunities for age-friendly cities in the Latin American region. The WHO’s age-friendly city domains are primarily at the meso (community) scale, with a focus on built environment, services and participation. We call for more attention to be paid to the macro policy scale to address concerns regarding migration, demography and social policy context. More attention also should be given to the micro scale to recognize the critical role of family and informal care supports. It is possible that the WHO domains are the result of a design bias, with Global North settings in mind for their development. We find the domains of UNICEF’s Child-Friendly Cities Initiative, which give more attention to the realities of the Global South, helpful to broaden the WHO’s Age-Friendly Cities Framework.