Older Adults

Older Adults

THE LONGEVITY REVOLUTION

As of the early twenty-first century, the United States was on the threshold of a longevity revolution. Richard J. Hodes (1943), the director of the National Institute on Aging, recognized this revolution when he observed in Director's Page (February 16, 2008, http://www.nia.nih.gov/AboutNIA/DirectorsPages/) that life expectancy has nearly doubled over the last century, and today there are 35 million Americans age 65 and older. What has fueled this new era of long life is a combination of better sanitation (safe drinking water, food, and disposal of waste), improved medical care, and reduced mortality rates for infants, children, and young adults.

In 1900 life expectancy in the United States was 47.3 years at birth; by 1970 it had increased to 70.8 years. (See Table 10.1.) By 2004 the National Center for Health Statistics projected that life expectancy for those born in that year was 77.8 years. Those who were sixty-five years old in 2004 could expect to live 18.7 more years, with women living an average of 20 more years and men 17.1 more years. In 2004 white men and women had longer life expectancies at age sixty-five than African-American men and women: 18.7 more years versus 17.1 more years.

AGING AMERICANS

According to the U.S. Census Bureau, 35.1 million (12.4%) of the U.S. population were aged sixty-five years and older in 2000. (See Table 10.2.) Those aged sixty-five years and older are projected to account for 20.7% of the population, or 86.8 million people, in 2050. Furthermore, 38.3 million (18.5%) men and 48.4 million (22.7%) women will be over sixty-five.

Who are the older Americans? Table 10.3 shows the characteristics of this group in 1990, 2000, 2005, and 2006. Nearly one-third (29.9%) of both men and women in this age group were widowed in 2006. Breaking down this statistic by gender reveals the longevity gap between men and women: 42.4% of women were widowed, whereas only 13.1% of men were.

Table 10.3 also shows that a greater percentage of people aged sixty-five and older continued to work past this typical retirement age in 2006 (15%) than did people in 1990 (11.5%), 2000 (12.4%), and 2005 (14.5%). One-fifth (19.8%) of the sixty-five-and-over men were still working, whereas only one-tenth (11.4%) of women in this age group were still employed in 2006. Over these years, many of those aged sixty-five and older have pulled themselves above the poverty level. In 1990, 11.4% of those sixty-five and older lived below the poverty level, whereas in 2006, 10.1% did so. Nonetheless, more older women (12.3%) than older men (7.3%) lived below the poverty level in 2006.

Baby Boomers

The first children born during the postWorld War II baby boom (19461964) will be turning sixty-five in 2011. Baby boomers, the largest single generation in U.S. history, will help swell the sixty-five and older population to approximately 54.6 million in 2020. (See Table 10.2.)

The Oldest Demographic

Americans aged eighty-five and older account for the most rapidly growing age group in the population. Predictions vary as to how fast this oldest old segment of the population is increasing. The Census Bureau's prediction is that there will be approximately 20.9 million people aged eighty-five and older by 2050. (See Table 10.2.) However, if life spans continue to increase, the Census Bureau may have to revise its calculation for this portion of the general population.

TABLE 10.1
Life expectancy at birth, at 65 years of age, and at 75 years of age, by race and sex, selected years, 19002004

[Data are based on death certificates]
All races White Black or African Americana
Specified age and year Both sexes Male Female Both sexes Male Female Both sexes Male Female
Data not available.
a Data shown for 19001960 are for the nonwhite population.
b Death registration area only. The death registration area increased from 10 states and the District of Columbia (DC) in 1900 to the coterminous United States in 1933.
c Includes deaths of persons who were not residents of the 50 states and DC.
Notes: Populations for computing life expectancy for 19911999 are 1990-based postcensal estimates of U.S. resident population. In 1997, life table methodology was revised to construct complete life tables by single years of age that extend to age 100 (Anderson RN. Method for constructing complete annual U.S. life tables. National Center for Health Statistics. Vital Health Stat 2(129). 1999). Previously, abridged life tables were constructed for 5-year age groups ending with 85 years and over. Life table values for 2000 and later years were computed using a slight modification of the new life table method due to a change in the age detail of populations received from the U.S. Census Bureau. In 2003, seven states reported multiple-race data. In 2004, 15 states reported multiple-race data. The multiple-race data for these states were bridged to the single-race categories of the 1977 Office of Management and Budget Standards for comparability with other states. Data for additional years are available.
SOURCE: Table 27. Life Expectancy at Birth, at 65 Years of Age, and at 75 Years of Age, by Race and Sex: United States, Selected Years 19002004, in Health, United States, 2007. With Chartbook on Trends in the Health of Americans, Centers for Disease Control and Prevention, National Center for Health Statistics, November 2007, http://www.cdc.gov/nchs/data/hus/hus07.pdf (accessed January 30, 2008)
At birth Remaining life expectancy in years
1900b,c 47.3 46.3 48.3 47.6 46.6 48.7 33.0 32.5 33.5
1950c 68.2 65.6 71.1 69.1 66.5 72.2 60.8 59.1 62.9
1960c 69.7 66.6 73.1 70.6 67.4 74.1 63.6 61.1 66.3
1970 70.8 67.1 74.7 71.7 68.0 75.6 64.1 60.0 68.3
1980 73.7 70.0 77.4 74.4 70.7 78.1 68.1 63.8 72.5
1990 75.4 71.8 78.8 76.1 72.7 79.4 69.1 64.5 73.6
1995 75.8 72.5 78.9 76.5 73.4 79.6 69.6 65.2 73.9
1996 76.1 73.1 79.1 76.8 73.9 79.7 70.2 66.1 74.2
1997 76.5 73.6 79.4 77.1 74.3 79.9 71.1 67.2 74.7
1998 76.7 73.8 79.5 77.3 74.5 80.0 71.3 67.6 74.8
1999 76.7 73.9 79.4 77.3 74.6 79.9 71.4 67.8 74.7
2000 77.0 74.3 79.7 77.6 74.9 80.1 71.9 68.3 75.2
2001 77.2 74.4 79.8 77.7 75.0 80.2 72.2 68.6 75.5
2002 77.3 74.5 79.9 77.7 75.1 80.3 72.3 68.8 75.6
2003 77.5 74.8 80.1 78.0 75.3 80.5 72.7 69.0 76.1
2004 77.8 75.2 80.4 78.3 75.7 80.8 73.1 69.5 76.3
At 65 years
1950c 13.9 12.8 15.0 12.8 15.1 13.9 12.9 14.9
1960c 14.3 12.8 15.8 14.4 12.9 15.9 13.9 12.7 15.1
1970 15.2 13.1 17.0 15.2 13.1 17.1 14.2 12.5 15.7
1980 16.4 14.1 18.3 16.5 14.2 18.4 15.1 13.0 16.8
1990 17.2 15.1 18.9 17.3 15.2 19.1 15.4 13.2 17.2
1995 17.4 15.6 18.9 17.6 15.7 19.1 15.6 13.6 17.1
1996 17.5 15.7 19.0 17.6 15.8 19.1 15.8 13.9 17.2
1997 17.7 15.9 19.2 17.8 16.0 19.3 16.1 14.2 17.6
1998 17.8 16.0 19.2 17.8 16.1 19.3 16.1 14.3 17.4
1999 17.7 16.1 19.1 17.8 16.1 19.2 16.0 14.3 17.3
2000 18.0 16.2 19.3 18.0 16.3 19.4 16.2 14.2 17.7
2001 18.1 16.4 19.4 18.2 16.5 19.5 16.4 14.4 17.9
2002 18.2 16.6 19.5 18.2 16.6 19.5 16.6 14.6 18.0
2003 18.4 16.8 19.8 18.5 16.9 19.8 17.0 14.9 18.5
2004 18.7 17.1 20.0 18.7 17.2 20.0 17.1 15.2 18.6
At 75 years
1980 10.4 8.8 11.5 10.4 8.8 11.5 9.7 8.3 10.7
1990 10.9 9.4 12.0 11.0 9.4 12.0 10.2 8.6 11.2
1995 11.0 9.7 11.9 11.1 9.7 12.0 10.2 8.8 11.1
1996 11.1 9.8 12.0 11.1 9.8 12.0 10.3 9.0 11.2
1997 11.2 9.9 12.1 11.2 9.9 12.1 10.7 9.3 11.5
1998 11.3 10.0 12.2 11.3 10.0 12.2 10.5 9.2 11.3
1999 11.2 10.0 12.1 11.2 10.0 12.1 10.4 9.2 11.1
2000 11.4 10.1 12.3 11.4 10.1 12.3 10.7 9.2 11.6
2001 11.5 10.2 12.4 11.5 10.2 12.3 10.8 9.3 11.7
2002 11.5 10.3 12.4 11.5 10.3 12.3 10.9 9.5 11.7
2003 11.8 10.5 12.6 11.7 10.5 12.6 11.4 9.8 12.4
2004 11.9 10.7 12.8 11.9 10.7 12.8 11.4 9.9 12.2
TABLE 10.2
Population and projected population, by age and sex, selected years, 200050

[In thousands except as indicated. As of July 1. Resident population.]
Population or percent, sex, and age 2000 2010 2020 2030 2040 2050
SOURCE: Table 2a. Projected Population of the United States, by Age and Sex: 2000 to 2050, in U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin, U.S. Census Bureau, March 18, 2004, http://www.census.gov/ipc/www/usinterimproj/natprojtab02a.pdf (accessed February 2, 2008)
Population
Total
Total 282,125 308,936 335,805 363,584 391,946 419,854
04 19,218 21,426 22,932 24,272 26,299 28,080
519 61,331 61,810 65,955 70,832 75,326 81,067
2044 104,075 104,444 108,632 114,747 121,659 130,897
4564 62,440 81,012 83,653 82,280 88,611 93,104
6584 30,794 34,120 47,363 61,850 64,640 65,844
85+ 4,267 6,123 7,269 9,603 15,409 20,861
Male
Total 138,411 151,815 165,093 178,563 192,405 206,477
04 9,831 10,947 11,716 12,399 13,437 14,348
519 31,454 31,622 33,704 36,199 38,496 41,435
2044 52,294 52,732 54,966 58,000 61,450 66,152
4564 30,381 39,502 40,966 40,622 43,961 46,214
6584 13,212 15,069 21,337 28,003 29,488 30,579
85+ 1,240 1,942 2,403 3,340 5,573 7,749
Female
Total 143,713 157,121 170,711 185,022 199,540 213,377
04 9,387 10,479 11,216 11,873 12,863 13,732
519 29,877 30,187 32,251 34,633 36,831 39,632
2044 51,781 51,711 53,666 56,747 60,209 64,745
4564 32,059 41,510 42,687 41,658 44,650 46,891
6584 17,582 19,051 26,026 33,848 35,152 35,265
85+ 3,028 4,182 4,866 6,263 9,836 13,112
Percent of total
Total
Total 100.0 100.0 100.0 100.0 100.0 100.0
04 6.8 6.9 6.8 6.7 6.7 6.7
519 21.7 20.0 19.6 19.5 19.2 19.3
2044 36.9 33.8 32.3 31.6 31.0 31.2
4564 22.1 26.2 24.9 22.6 22.6 22.2
6584 10.9 11.0 14.1 17.0 16.5 15.7
85+ 1.5 2.0 2.2 2.6 3.9 5.0
Male
Total 100.0 100.0 100.0 100.0 100.0 100.0
04 7.1 7.2 7.1 6.9 7.0 6.9
519 22.7 20.8 20.4 20.3 20.0 20.1
2044 37.8 34.7 33.3 32.5 31.9 32.0
4564 21.9 26.0 24.8 22.7 22.8 22.4
6584 9.5 9.9 12.9 15.7 15.3 14.8
85+ 0.9 1.3 1.5 1.9 2.9 3.8
Female
Total 100.0 100.0 100.0 100.0 100.0 100.0
04 6.5 6.7 6.6 6.4 6.4 6.4
519 20.8 19.2 18.9 18.7 18.5 18.6
2044 36.0 32.9 31.4 30.7 30.2 30.3
4564 22.3 26.4 25.0 22.5 22.4 22.0
6584 12.2 12.1 15.2 18.3 17.6 16.5
85+ 2.1 2.7 2.9 3.4 4.9 6.1

LEADING CAUSES OF DEATH AMONG THE ELDERLY

Six out of ten (59.8%) people aged sixty-five and older who died in 2004 were the victims of diseases of the heart, cancer (malignant neoplasms), or stroke (cerebrovascular diseases). (See Table 10.4.)

Coronary Heart Disease

Coronary heart disease (CHD) is the leading cause of death in the United States and remains the leading cause of death among older Americans. Eight out of ten (81.8%; 533,302 out of 652,029) people who died of CHD in 2004 were aged sixty-five years and older. (See Table 10.4.) This figure is up from 1980, when a slightly lower percentage of those aged sixty-five and older died of CHD (78.3%; 595,406 out of 760,132). This shift is because more young people aged one to fourteen years and twenty-five to forty-four years died of CHD in 1980 than in 2004. In fact, fewer people in the sixty-five-years-and-older age group died from CHD in 2004 than in

TABLE 10.3
Characteristics of persons age 65 and older, by sex, selected years, 19902006

[As of March, except as noted]
Total Male Female
Characteristic 1990 2000 2005 2006 1990 2000 2005 2006 1990 2000 2005 2006
a Represents those who completed 1 to 3 years of high school.
b Represents those who completed 4 years of high school.
c Represents those who completed 1 to 3 years of college.
d Represents those who completed 4 years of college or more.
e Annual averages of monthly figures.
f Poverty status based on income in preceding year.
Notes: 29.6 represents 29,600,000. Covers civilian noninstitutional population. Excludes members of Armed Forces except those living off post or with their families on post. Data for 1990 are based on 1980 census population controls; 2000 data based on 1990 census population controls; beginning 2005, data based on 2000 census population controls and an expanded sample of households. Based on Current Population Survey.
SOURCE: Table 34. Persons 65 Years Old and overCharacteristics by Sex: 1990 to 2006, in Statistical Abstract of the United States: 2008, U.S. Census Bureau, 2007, http://www.census.gov/compendia/statab/tables/08s0034.pdf (accessed March 15, 2008)
Total (million) 29.6 32.6 35.2 35.5 12.3 13.9 15.1 15.2 17.2 18.7 20.0 20.3
Percent distribution
Marital status
Never married 4.6 3.9 4.1 3.6 4.2 4.2 4.4 3.8 4.9 3.6 3.9 3.6
Married 56.1 57.2 57.7 57.8 76.5 75.2 74.9 75.0 41.4 43.8 44.7 44.9
Spouse present 54.1 54.6 54.8 54.7 74.2 72.6 71.7 71.9 39.7 41.3 42.0 41.9
Spouse absent 2.0 2.6 2.9 3.0 2.3 2.6 3.2 3.1 1.7 2.5 2.7 3.0
Widowed 34.2 32.1 30.3 29.9 14.2 14.4 13.7 13.1 48.6 45.3 42.9 42.4
Divorced 5.0 6.7 7.9 8.7 5.0 6.1 7.0 8.1 5.1 7.2 8.5 9.1
Educational attainment
Less than ninth grade 28.5 16.7 13.4 13.0 30.0 17.8 13.2 13.0 27.5 15.9 13.5 12.9
Completed 9th to 12th grade, but no
high school diploma 16.1a 13.8 12.7 11.9 15.7a 12.7 11.9 11.0 16.4a 14.7 13.3 12.5
High school graduate 32.9b 35.9 36.3 36.7 29.0b 30.4 31.6 32.9 35.6b 39.9 39.9 39.5
Some college or associate's degree 10.9c 18.0 18.7 19.0 10.8c 17.8 18.4 17.4 11.0c 18.2 19.0 20.2
Bachelor's or advanced degree 11.6d 15.6 18.9 19.5 14.5d 21.4 24.9 25.6 9.5d 11.4 14.3 14.9
Labor force participatione
Employed 11.5 12.4 14.5 15.0 15.9 16.9 19.1 19.8 8.4 9.1 11.1 11.4
Unemployed 0.4 0.4 0.5 0.4 0.5 0.6 0.7 0.6 0.3 0.3 0.4 0.3
Not in labor force 88.1 87.2 84.9 84.6 83.6 82.5 80.2 79.7 91.3 90.6 88.5 88.3
Percent below poverty levelf 11.4 9.7 9.8 10.1 7.8 6.9 7.0 7.3 13.9 11.8 11.9 12.3

1980, even though the numbers of deaths from all causes in this group rose from 1.3 million in 1980 to nearly 1.8 million in 2004. Nonetheless, CHD is still the leading cause of death among older Americans.

The risk of dying from heart disease increases as a person ages. The death rate from CHD in 2004 for those aged seventy-five to eighty-four was 1,506.3 deaths per 100,000 population, almost three times the rate for those aged sixty-five to seventy-four (541.6 per 100,000). (See Table 10.5.) For those aged eighty-five and older, the death rate rose sharply to 4,895.9 deaths per 100,000 populationnine times the rate for those aged sixty-five to seventy-four. In 2004 females had a lower incidence of death from heart disease than did males at all ages, except for ages one to fourteen. At those ages the risk for both sexes was approximately the same.

In the sixty-five-and-older age group the death rate for males from heart disease has been consistently higher than the death rate for females of the same age group regardless of the race. For example, the death rate from heart disease for African-American males aged sixty-five to seventy-four years was 1,096.6 per 100,000 population in 2004, whereas the death rate from heart disease for African-American females was 656.5. (See Table 10.5.) In another example, the death rate from heart disease for Hispanic males aged sixty-five to seventy-four years was 572.2 per 100,000 population in 2004, whereas the death rate from heart disease for Hispanic females was 305.5.

Since the 1950s deaths from heart disease have consistently declined. (See Table 10.5.) Several factors account for this decrease, including better control of hypertension (high blood pressure) and cholesterol levels in the blood. Changes in lifestyle, such as the inclusion of physical exercise and a healthy diet, help decrease the incidence of heart disease. The expanding use of trained mobile emergency personnel (paramedics) in most urban areas has also contributed to the decrease, and the widespread use of cardiopulmonary resuscitation and new drugs have increased the likelihood of surviving an initial heart attack.

Until the 1990s almost all research on heart disease focused on white, middle-aged males. Researchers, physicians, and public health officials agree that more research and prevention efforts should be directed toward

TABLE 10.4
Leading causes of death and numbers of deaths, by age, 1980 and 2004
[Data are based on death certificates]
1980 2004
Age and rank order Cause of death Deaths Cause of death Deaths
Under 1 year
All causes 45,526 All causes 27,936
1 Congenital anomalies 9,220 Congenital malformations, deformations and chromosomal abnormalities 5,622
2 Sudden infant death syndrome 5,510 Disorders related to short gestation and low birth weight, not elsewhere classified 4,642
3 Respiratory distress syndrome 4,989 Sudden infant death syndrome 2,246
4 Disorders relating to short gestation and unspecified low birthweight 3,648 Newborn affected by maternal complications of pregnancy 1,715
5 New born affected by maternal complications of pregnancy 1,572 Unintentional injuries 1,052
6 Intrauterine hypoxia and birth asphyxia 1,497 Newborn affected by complications of placenta, cord and membranes 1,042
7 Unintentional injuries 1,166 Respiratory distress of newborn 875
8 Birth trauma 1,058 Bacterial sepsis of newborn 827
9 Pneumonia and influenza 1,012 Neonatal hemorrhage 616
10 New born affected by complications of placenta, cord, and membranes 985 Diseases of circulatory system 593
14 years
All causes 8,187 All causes 4,785
1 Unintentional injuries 3,313 Unintentional injuries 1,641
2 Congenital anomalies 1,026 Congenital malformations, deformations and chromosomal abnormalities 569
3 Malignant neoplasms 573 Malignant neoplasms 399
4 Diseases of heart 338 Homicide 377
5 Homicide 319 Diseases of heart 187
6 Pneumonia and influenza 267 Influenza and pneumonia 119
7 Meningitis 223 Septicemia 84
8 Meningococcal infection 110 Certain conditions originating in the perinatal period 61
9 Certain conditions originating in the perinatal period 84 In situ neoplasms, benign neoplasms and neoplasms of uncertain or unknown behavior 53
10 Septicemia 71 Chronic lower respiratory diseases 48
514 years
All causes 10,689 All causes 6,834
1 Unintentional injuries 5,224 Unintentional injuries 2,666
2 Malignant neoplasms 1,497 Malignant neoplasms 1,019
3 Congenital anomalies 561 Congenital malformations, deformations and chromosomal abnormalities 389
4 Homicide 415 Homicide 329
5 Diseases of heart 330 Suicide 285
6 Pneumonia and influenza 194 Diseases of heart 245
7 Suicide 142 Chronic lower respiratory diseases 120
8 Benign neoplasms 104 In situ neoplasms, benign neoplasms and neoplasms of uncertain or unknown behavior 84
9 Cerebrovascular diseases 95 Influenza and pneumonia 82
10 Chronic obstructive pulmonary diseases 85 Cerebrovascular diseases 77
1524 years
All causes 49,027 All causes 33,421
1 Unintentional injuries 26,206 Unintentional injuries 15,449
2 Homicide 6,537 Homicide 5,085
3 Suicide 5,239 Suicide 4,316
4 Malignant neoplasms 2,683 Malignant neoplasms 1,709
5 Diseases of heart 1,223 Diseases of heart 1,038
6 Congenital anomalies 600 Congenital malformations, deformations and chromosomal abnormalities 483
7 Cerebrovascular diseases 418 Cerebrovascular diseases 211
8 Pneumonia and influenza 348 Human immunodeficiency virus (HIV) disease 191
9 Chronic obstructive pulmonary diseases 141 Influenza and pneumonia 185
10 Anemias 133 Chronic lower respiratory diseases 179

women, racial and ethnic minorities, and older adults. In Heart and Stroke Statistics2008 Update (2008, http://www.americanheart.org/downloadable/heart/1200082005246HS_Stats%202008.final.pdf), the American Heart Association notes that at age forty and older, 23% of women who have heart attacks die within the first year after the incident, compared to 18% of men.

The symptoms of heart attack can be significantly different for women than for men. Heart disease in

TABLE 10.4
Leading causes of death and numbers of deaths, by age, 1980 and 2004
[Data are based on death certificates]
1980 2004
Age and rank order Cause of death Deaths Cause of death Deaths
Category not applicable.
SOURCE: Table 32. Leading Causes of Death and Numbers of Deaths, by Age: United States, 1980 and 2004, in Health, United States, 2007. With Chartbook on Trends in the Health of Americans, Centers for Disease Control and Prevention, National Center for Health Statistics, November 2007, http://www.cdc.gov/nchs/data/hus/hus07.pdf (accessed January 30, 2008)
2544 years
All causes 108,658 All causes 126,230
1 Unintentional injuries 26,722 Unintentional injuries 29,503
2 Malignant neoplasms 17,551 Malignant neoplasms 18,356
3 Diseases of heart 14,513 Diseases of heart 16,088
4 Homicide 10,983 Suicide 11,712
5 Suicide 9,855 Homicide 7,479
6 Chronic liver disease and cirrhosis 4,782 Human immunodeficiency virus (HIV) disease 6,294
7 Cerebrovascular diseases 3,154 Chronic liver disease and cirrhosis 3,108
8 Diabetes mellitus 1,472 Cerebrovascular diseases 2,928
9 Pneumonia and influenza 1,467 Diabetes mellitus 2,625
10 Congenital anomalies 817 Influenza and pneumonia 1,194
4564 years
All causes 425,338 All causes 442,394
1 Diseases of heart 148,322 Malignant neoplasms 146,476
2 Malignant neoplasms 135,675 Diseases of heart 101,169
3 Cerebrovascular diseases 19,909 Unintentional injuries 26,593
4 Unintentional injuries 18,140 Diabetes mellitus 16,347
5 Chronic liver disease and cirrhosis 16,089 Cerebrovascular diseases 16,147
6 Chronic obstructive pulmonary diseases 11,514 Chronic lower respiratory diseases 15,265
7 Diabetes mellitus 7,977 Chronic liver disease and cirrhosis 14,065
8 Suicide 7,079 Suicide 10,917
9 Pneumonia and influenza 5,804 Nephritis, nephrotic syndrome and nephrosis 6,030
10 Homicide 4,019 Septicemia 5,996
65 years and over
All causes 1,341,848 All causes 1,755,669
1 Diseases of heart 595,406 Diseases of heart 533,302
2 Malignant neoplasms 258,389 Malignant neoplasms 385,847
3 Cerebrovascular diseases 146,417 Cerebrovascular diseases 130,538
4 Pneumonia and influenza 45,512 Chronic lower respiratory diseases 105,197
5 Chronic obstructive pulmonary diseases 43,587 Alzheimer's disease 65,313
6 Atherosclerosis 28,081 Diabetes mellitus 53,956
7 Diabetes mellitus 25,216 Influenza and pneumonia 52,760
8 Unintentional injuries 24,844 Nephritis, nephrotic syndrome and nephrosis 35,105
9 Nephritis, nephrotic syndrome, and nephrosis 12,968 Unintentional injuries 35,020
10 Chronic liver disease and cirrhosis 9,519 Septicemia 25,644

women is often due to coronary microvascular dysfunction, in which the small blood vessels of the heart do not dilate (widen) properly to supply sufficient blood to the heart muscle. This dysfunction may occur alone, or besides, blockages that reduce blood flow in the large coronary arteries as is often the case in men. Because of the differences in the sizes of the involved blood vessels, symptoms of a heart attack may differ between women and men. When the large vessels are blocked, symptoms may include pain, pressure, burning, aching, and tightness in the chest, along with shortness of breath, sweating, weakness, anxiety, and nausea. When small vessels are blocked, symptoms may be more subtle and may include discomfort spread over a wide chest area, exhaustion, depression, and shortness of breath. Nausea, back or jaw pain, shortness of breath, and chest pain may accompany these symptoms.

Cancer

Cancer (malignant neoplasms) is the second-leading cause of death among older adults. In 2004, 385,847 people sixty-five and older died of cancer. (See Table 10.4.) The risk of developing many types of cancers increases with age and varies by race and ethnicity. (See and Table 10.6 and Table 10.7.)

Regarding ethnicity, African-American males had the highest incidence of cancer of all types between 2000 and 2004 (663.7 per 100,000 population) and Native American and Alaskan Native females had the lowest incidence (282.4 per 100,000), followed closely by Asian-American and Pacific Islander females (285.8 per 100,000). (See Table 10.7.) African-American males also had the highest mortality rate from cancer between 2000 and 2004 at 321.8 deaths per 100,000 population. Asian-American and Pacific Islander females had the

TABLE 10.5
Death rates for diseases of the heart, by sex, race, Hispanic origin, and age, selected years, 19502004

[Data are based on death certificates]
Sex, race, Hispanic origin, and age 1950a,b 1960a,b 1970b 1980b 1990 2000c 2003 2004
All persons Deaths per 100,000 resident population
All ages, age-adjustedc 586.8 559.0 492.7 412.1 321.8 257.6 232.3 217.0
All ages, crude 355.5 369.0 362.0 336.0 289.5 252.6 235.6 222.2
Under 1 year 3.5 6.6 13.1 22.8 20.1 13.0 11.0 10.3
14 years 1.3 1.3 1.7 2.6 1.9 1.2 1.2 1.2
514 years 2.1 1.3 0.8 0.9 0.9 0.7 0.6 0.6
1524 years 6.8 4.0 3.0 2.9 2.5 2.6 2.7 2.5
2534 years 19.4 15.6 11.4 8.3 7.6 7.4 8.2 7.9
3544 years 86.4 74.6 66.7 44.6 31.4 29.2 30.7 29.3
4554 years 308.6 271.8 238.4 180.2 120.5 94.2 92.5 90.2
5564 years 808.1 737.9 652.3 494.1 367.3 261.2 233.2 218.8
6574 years 1,839.8 1,740.5 1,558.2 1,218.6 894.3 665.6 585.0 541.6
7584 years 4,310.1 4,089.4 3,683.8 2,993.1 2,295.7 1,780.3 1,611.1 1,506.3
85 years and over 9,150.6 9,317.8 7,891.3 7,777.1 6,739.9 5,926.1 5,278.4 4,895.9
Male
All ages, age-adjustedd 697.0 687.6 634.0 538.9 412.4 320.0 286.6 267.9
All ages, crude 423.4 439.5 422.5 368.6 297.6 249.8 235.0 222.8
Under 1 year 4.0 7.8 15.1 25.5 21.9 13.3 12.1 10.9
14 years 1.4 1.4 1.9 2.8 1.9 1.4 1.1 1.1
514 years 2.0 1.4 0.9 1.0 0.9 0.8 0.7 0.6
1524 years 6.8 4.2 3.7 3.7 3.1 3.2 3.4 3.2
2534 years 22.9 20.1 15.2 11.4 10.3 9.6 10.5 10.5
3544 years 118.4 112.7 103.2 68.7 48.1 41.4 42.8 40.9
4554 years 440.5 420.4 376.4 282.6 183.0 140.2 136.2 132.3
5564 years 1,104.5 1,066.9 987.2 746.8 537.3 371.7 331.7 312.8
6574 years 2,292.3 2,291.3 2,170.3 1,728.0 1,250.0 898.3 785.3 723.8
7584 years 4,825.0 4,742.4 4,534.8 3,834.3 2,968.2 2,248.1 2,030.3 1,893.6
85 years and over 9,659.8 9,788.9 8,426.2 8,752.7 7,418.4 6,430.0 5,621.5 5,239.3
Female
All ages, age-adjustedd 484.7 447.0 381.6 320.8 257.0 210.9 190.3 177.3
All ages, crude 288.4 300.6 304.5 305.1 281.8 255.3 236.2 221.6
Under 1 year 2.9 5.4 10.9 20.0 18.3 12.5 9.8 9.7
14 years 1.2 1.1 1.6 2.5 1.9 1.0 1.3 1.2
514 years 2.2 1.2 0.8 0.9 0.8 0.5 0.5 0.6
1524 years 6.7 3.7 2.3 2.1 1.8 2.1 2.1 1.7
2534 years 16.2 11.3 7.7 5.3 5.0 5.2 5.7 5.2
3544 years 55.1 38.2 32.2 21.4 15.1 17.2 18.6 17.7
4554 years 177.2 127.5 109.9 84.5 61.0 49.8 50.2 49.6
5564 years 510.0 429.4 351.6 272.1 215.7 159.3 141.9 131.5
6574 years 1,419.3 1,261.3 1,082.7 828.6 616.8 474.0 417.5 388.6
7584 years 3,872.0 3,582.7 3,120.8 2,497.0 1,893.8 1,475.1 1,331.1 1,245.6
85 years and over 8,796.1 9,016.8 7,591.8 7,350.5 6,478.1 5,720.9 5,126.7 4,741.5
White male e
All ages, age-adjustedd 700.2 694.5 640.2 539.6 409.2 316.7 282.9 264.6
All ages, crude 433.0 454.6 438.3 384.0 312.7 265.8 249.5 236.5
4554 years 423.6 413.2 365.7 269.8 170.6 130.7 125.3 122.2
5564 years 1,081.7 1,056.0 979.3 730.6 516.7 351.8 313.2 294.4
6574 years 2,308.3 2,297.9 2,177.2 1,729.7 1,230.5 877.8 761.1 703.2
7584 years 4,907.3 4,839.9 4,617.6 3,883.2 2,983.4 2,247.0 2,030.1 1,897.1
85 years and over 9,950.5 10,135.8 8,818.0 8,958.0 7,558.7 6,560.8 5,747.2 5,348.4
Black or African American male e
All ages, age-adjustedd 639.4 615.2 607.3 561.4 485.4 392.5 364.3 342.1
All ages, crude 346.2 330.6 330.3 301.0 256.8 211.1 206.0 196.7
4554 years 622.5 514.0 512.8 433.4 328.9 247.2 248.1 240.0
5564 years 1,433.1 1,236.8 1,135.4 987.2 824.0 631.2 580.9 560.2
6574 years 2,139.1 2,281.4 2,237.8 1,847.2 1,632.9 1,268.8 1,195.5 1,096.6
7584 yearsf 4,106.1 3,533.6 3,783.4 3,578.8 3,107.1 2,597.6 2,426.6 2,235.5
85 years and over 6,037.9 5,367.6 6,819.5 6,479.6 5,633.5 4,850.3 4,637.3

lowest cancer death rate during this period at 96.7 deaths per 100,000 population.

Regarding age, the older people become, the higher their probability of developing invasive cancers. For example, the older a man gets, the more likely he is to develop prostate cancer. The chance of dying from prostate cancer also rises with age. The American Cancer Society reports in Cancer Facts & Figures 2008 (2008, http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf) that about 64% of men newly diagnosed with prostate cancer are older than sixty-five. The probability of developing prostate cancer is 1 in 10,553 for men who are younger than forty; 1 in 39 for forty- to

TABLE 10.5
Death rates for diseases of the heart, by sex, race, Hispanic origin, and age, selected years, 19502004

[Data are based on death certificates]
Sex, race, Hispanic origin, and age 1950a,b 1960a,b 1970b 1980b 1990 2000c 2003 2004
Deaths per 100,000 resident population
American Indian or Alaska Native male e
All ages, age-adjustedd 320.5 264.1 222.2 203.2 182.7
All ages, crude 130.6 108.0 90.1 98.5 91.4
4554 years 238.1 173.8 108.5 116.7 94.1
5564 years 496.3 411.0 285.0 293.5 260.7
6574 years 1,009.4 839.1 748.2 655.6 590.0
7584 years 2,062.2 1,788.8 1,655.7 1,309.9 1,252.1
85 years and over 4,413.7 3,860.3 3,318.3 3,266.5 2,812.6
Asian or Pacific Islander male e
All ages, age-adjustedd 220.7 286.9 185.5 158.3 146.5
All ages, crude 119.8 88.7 90.6 86.3 81.4
4554 years 112.0 70.4 61.1 62.7 56.6
5564 years 306.7 226.1 182.6 152.9 138.9
6574 years 852.4 623.5 482.5 398.3 347.7
7584 years 2,010.9 1,642.2 1,354.7 1,145.1 1,047.0
85 years and over 5,923.0 4,617.8 4,154.2 3,524.6 3,416.7
Hispanic or Latino male e,g
All ages, age-adjustedd 270.0 238.2 206.8 193.9
All ages, crude 91.0 74.7 72.2 70.2
4554 years 116.4 84.3 79.6 77.6
5564 years 363.0 264.8 235.6 224.6
6574 years 829.9 684.8 625.0 572.2
7584 years 1,971.3 1,733.2 1,543.5 1,489.0
85 years and over 4,711.9 4,897.5 3,874.5 3,496.8
White, not Hispanic or Latino male g
All ages, age-adjustedd 413.6 319.9 286.9 268.7
All ages, crude 336.5 297.5 282.9 269.1
4554 years 172.8 134.3 129.8 126.9
5564 years 521.3 356.3 317.7 298.8
74 years 1,243.4 885.1 767.3 709.5
7584 years 3,007.7 2,261.9 2,049.9 1,915.1
85 years and over 7,663.4 6,606.6 5,821.0 5,430.9
White female e
All ages, age-adjustedd 478.0 441.7 376.7 315.9 250.9 205.6 185.4 172.9
All ages, crude 289.4 306.5 313.8 319.2 298.4 274.5 253.8 238.3
4554 years 141.9 103.4 91.4 71.2 50.2 40.9 41.1 40.7
5564 years 460.2 383.0 317.7 248.1 192.4 141.3 125.2 117.2
6574 years 1,400.9 1,229.8 1,044.0 796.7 583.6 445.2 392.0 365.4
7584 years 3,925.2 3,629.7 3,143.5 2,493.6 1,874.3 1,452.4 1,315.2 1,229.1
85 years and over 9,084.7 9,280.8 7,839.9 7,501.6 6,563.4 5,801.4 5,193.6 4,810.4
Black or African American female e
All ages, age-adjustedd 536.9 488.9 435.6 378.6 327.5 277.6 253.8 236.5
All ages, crude 287.6 268.5 261.0 249.7 237.0 212.6 200.0 188.3
4554 years 525.3 360.7 290.9 202.4 155.3 125.0 124.1 121.2
5564 years 1,210.2 952.3 710.5 530.1 442.0 332.8 304.7 276.0
6574 years 1,659.4 1,680.5 1,553.2 1,210.3 1,017.5 815.2 712.0 656.5
84 years6 3,499.3 2,926.9 2,964.1 2,707.2 2,250.9 1,913.1 1,699.6 1,622.9
85 years and over 5,650.0 5,003.8 5,796.5 5,766.1 5,298.7 4,976.5 4,534.7
American Indian or Alaska Native female e
All ages, age-adjustedd 175.4 153.1 143.6 127.5 119.9
All ages, crude 80.3 77.5 71.9 75.9 73.6
4554 years 65.2 62.0 40.2 45.4 49.5
5564 years 193.5 197.0 149.4 153.4 116.9
6574 years 577.2 492.8 391.8 390.3 317.4
7584 years 1,364.3 1,050.3 1,044.1 950.3 894.1
85 years and over 2,893.3 2,868.7 3,146.3 2,284.1 2,449.1

fifty-nine-year-olds; and 1 in 15 for men aged sixty to sixty-nine. (See Table 10.6.) The odds rise to one in seven for men aged seventy and older.

Stroke

Stroke (cerebrovascular disease) is the third-leading cause of death and the principal cause of serious disability among older adults. In 2004, 130,538 people aged sixty-five and older died of a stroke. (See Table 10.4.) The death rate from stroke increases markedly with age. In 2004 the death rate from stroke for those aged sixty-five to seventy-four was 107.8 deaths per 100,000. (See Table 10.8.) This rate more than tripled for each successive decade of age after that, to 386.2 deaths from stroke

TABLE 10.5
Death rates for diseases of the heart, by sex, race, Hispanic origin, and age, selected years, 19502004

[Data are based on death certificates]
Sex, race, Hispanic origin, and age 1950a,b 1960a,b 1970b 1980b 1990 2000c 2003 2004
Data not available.
a Includes deaths of persons who were not residents of the 50 states and the District of Columbia.
b Underlying cause of death was coded according to the Sixth Revision of the International Classification of Diseases (ICD) in 1950, Seventh Revision in I960, Eighth Revision in 1970, and Ninth Revision in 19801998.
c Starting with 1999 data, cause of death is coded according to ICD-10.
d Age-adjusted rates are calculated using the year 2000 standard population. Prior to 2003, age-adjusted rates were calculated using standard million proportions based on rounded population numbers. Starting with 2003 data, unrounded population numbers are used to calculate age-adjusted rates.
e The race groups, white, black, Asian or Pacific Islander, and American Indian or Alaska Native, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Death rates for the American Indian or Alaska Native and Asian or Pacific Islander populations are known to be underestimated.
f In 1950, rate is for the age group 75 years and over.
g Prior to 1997, excludes data from states lacking an Hispanic-origin item on the death certificate.
Notes: Starting with Health, United States, 2003, rates for 19911999 were revised using intercensal population estimates based on the 2000 census. Rates for 2000 were revised based on 2000 census counts. Rates for 2001 and later years were computed using 2000-based postcensal estimates. Census and Population Estimates. For the period 19801998, diseases of heart was coded using ICD-9 codes that are most nearly comparable with diseases of heart codes in the 113 cause list for ICD-10. Age groups were selected to minimize the presentation of unstable age-specific death rates based on small numbers of deaths and for consistency among comparison groups. In 2003, seven states reported multiple-race data. In 2004, 15 states reported multiple-race data. The multiple-race data for these states were bridged to the single-race categories of the 1977 Office of Management and Budget standards for comparability with other states. Data for additional years are available.
SOURCE: Table 36. Death Rates for Diseases of Heart, by Sex, Race, Hispanic Origin, and Age: United States, Selected Years 19502004, in Health, United States, 2007. With Chartbook on Trends in the Health of Americans, Centers for Disease Control and Prevention, National Center for Health Statistics, November 2007, http://www.cdc.gov/nchs/data/hus/hus07.pdf (accessed January 30, 2008)
Deaths per 100,000 resident population
Asian or Pacific Islander female e
All ages, age-adjustedd 132.3 149.2 115.7 104.2 96.1
All ages, crude 57.0 62.0 65.0 68.2 65.1
4554 years 28.6 17.5 15.9 14.8 13.7
5564 years 92.9 99.0 68.8 60.3 50.7
6574 years 313.3 323.9 229.6 207.2 205.6
7584 years 1,053.2 1,130.9 866.2 769.7 697.4
85 years and over 3,211.0 4,161.2 3,367.2 3,020.0 2,817.1
Hispanic or Latino female e,g
All ages, age-adjustedd 177.2 163.7 145.8 130.0
All ages, crude 79.4 71.5 69.6 64.1
4554 years 43.5 28.2 27.0 27.0
5564 years 153.2 111.2 102.1 93.1
6574 years 460.4 366.3 330.6 305.5
7584 years 1,259.7 1,169.4 1,067.0 962.7
85 years and over 4,440.3 4,605.8 3,962.5 3,421.2
White, not Hispanic or Latino female g
All ages, age-adjustedd 252.6 206.8 187.1 175.1
All ages, crude 320.0 304.9 285.1 269.1
4554 years 50.2 41.9 42.4 42.2
5564 years 193.6 142.9 126.6 118.9
6574 years 584.7 448.5 394.8 368.6
7584 years 1,890.2 1,458.9 1,324.0 1,241.2
85 years and over 6,615.2 5,822.7 5,232.2 4,862.4

per 100,000 for those aged seventy-five to eighty-four, and 1,245.9 deaths per 100,000 population for those aged eighty-five and older.

Men aged sixty-five to seventy-four years and seventy-five to eighty-four years were more likely to have suffered a stroke in 2004 than females (121.1 versus 96.6 per 100,000 population, and 402.9 versus 374.9 per 100,000, respectively). (See Table 10.8.) However, in the eighty-five-years-and-older age group, women were more likely than men to have suffered a stroke (1,303.4 versus 1,118.1 per 100,000 population). This pattern was consistent from 1960 to 2004 for all ethnicities and generally for each ethnicity.

Stroke and Alzheimer's disease are two primary causes of dementia. Death rates from stroke have declined dramatically since the 1950s. (See Table 10.8.) Regardless, stroke leaves approximately one-third of the survivors with severe disabilities, and they require continued care.

DEMENTIA

Older people with cognitive (mental) problems were once labeled senile, which had a derogatory connotation and meant an elderly person who was cognitively impaired. Researchers have found that physical disorders can cause progressive deterioration of cognitive and neurological functions. In the twenty-first century these disorders produce symptoms that are collectively known as dementia. Symptoms of dementia include loss of language functions, inability to think abstractly, inability to

Text has been suppressed due to author restrictions

care for oneself, personality change, emotional instability, and loss of a sense of time or place.

Dementia has become a serious health problem in developed countries, including the United States, because older adults are living longer than ever before. One indicator of diminished cognitive functioning in older adults is memory loss. Table 10.9 shows the percentage of people aged sixty-five and older with moderate to severe memory impairment. For each age shown, a higher percentage of men than of women show memory impairment. Nevertheless, in 2002 about one-third of men and women aged eighty-five and older exhibited memory impairment.

Alzheimer's Disease

Alzheimer's disease (AD) is the single most common cause of dementia. It is a progressive, degenerative disease that attacks the brain and results in severely impaired memory, thinking, and behavior. First described in 1906 by the German neuropathologist Alois Alzheimer (18641915), the disorder may strike people in their forties and fifties, but most victims are over age sixty-five.

Alzheimer's autopsy of a severely demented fifty-five-year-old woman revealed deposits of neuritic plaques and neurofibrillary tangles. The latter characteristic, the presence of twisted and tangled fibers in the brain cells, is the anatomical hallmark of the disease.

SYMPTOMS. The onset of dementia in AD is gradual, and the decline of cognitive function progresses over time. Mild or early AD is not easily distinguishable from the characteristics of normal agingmild episodes of forgetfulness and disorientation. Gradually, the AD patient may experience confusion; language problems, such as trouble finding words; impaired judgment; disorientation in place and time; and changes in mood, behavior, and personality. The speed with which these changes occur varies, but eventually the disease leaves patients unable to care for themselves.

In the terminal stages of AD, patients require care twenty-four hours a day. They no longer recognize family members and need help with simple daily activities, such as eating, dressing, bathing, and using the toilet. Eventually, they may become incontinent, blind, and unable to communicate. The course of the disease varies widelysome patients die within a few years of diagnosis, whereas others live as long as twenty-five years.

PREVALENCE. In 2004, 65,313 deaths from AD were reported for those aged sixty-five and older. (See Table 10.4.) In that year AD was the fifth-leading cause of death in the sixty-five-and-older age group, whereas in 1980, AD was not even in the top-ten leading causes of death for this group. Figure 10.1 shows that the number of deaths from AD had increased 44.7% between 2000 and 2005, whereas the percentage change in numbers of deaths from heart disease, breast cancer, prostate cancer, and stroke had all decreased.

In Prevalence of Dementia in the United States: The Aging, Demographics, and Memory Study (Neuroepidemiology, vol. 29, nos. 12, 2007), Brenda L. Plassman et al. use data from the University of Michigan's Health

Text has been suppressed due to author restrictions

and Retirement Study to determine the prevalence of AD and other dementias in the United States. Table 10.10 shows some of the results from this study. Nearly 5% of all individuals aged seventy-one to seventy-nine suffered from a dementia of some type in 2002. Of these 5%, 2.3% suffered from AD and 0.9% suffered from vascular dementia, which is the second-most common form of dementia after AD. It is caused by problems with the

TABLE 10.8
Death rates for cerebrovascular diseases, by sex, race, Hispanic origin, and age, selected years, 19502004

[Data are based on death certificates]
Sex, race, Hispanic origin, and age 1950a,b 1960a,b 1970b 1980b 1990 2000c 2003 2004
All persons Deaths per 100,000 resident population
All ages, age-adjustedd 180.7 177.9 147.7 96.2 65.3 60.9 53.5 50.0
All ages, crude 104.0 108.0 101.9 75.0 57.8 59.6 54.2 51.1
Under 1 year 5.1 4.1 5.0 4.4 3.8 3.3 2.5 3.1
14 years 0.9 0.8 1.0 0.5 0.3 0.3 0.3 0.3
514 years 0.5 0.7 0.7 0.3 0.2 0.2 0.2 0.2
1524 years 1.6 1.8 1.6 1.0 0.6 0.5 0.5 0.5
2534 years 4.2 4.7 4.5 2.6 2.2 1.5 1.5 1.4
3544 years 18.7 14.7 15.6 8.5 6.4 5.8 5.5 5.4
4554 years 70.4 49.2 41.6 25.2 18.7 16.0 15.0 14.9
5564 years 194.2 147.3 115.8 65.1 47.9 41.0 35.6 34.3
6574 years 554.7 469.2 384.1 219.0 144.2 128.6 112.9 107.8
7584 years 1,499.6 1,491.3 1,254.2 786.9 498.0 461.3 410.7 386.2
85 years and over 2,990.1 3,680.5 3,014.3 2,283.7 1,628.9 1,589.2 1,370.1 1,245.9
Male
All ages, age-adjustedd 186.4 186.1 157.4 102.2 68.5 62.4 54.1 50.4
All ages, crude 102.5 104.5 94.5 63.4 46.7 46.9 42.9 40.7
Under 1 year 6.4 5.0 5.8 5.0 4.4 3.8 2.8 3.4
14 years 1.1 0.9 1.2 0.4 0.3 * 0.3 0.3
514 years 0.5 0.7 0.8 0.3 0.2 0.2 0.2 0.2
1524 years 1.8 1.9 1.8 1.1 0.7 0.5 0.5 0.5
2534 years 4.2 4.5 4.4 2.6 2.1 1.5 1.6 1.4
3544 years 17.5 14.6 15.7 8.7 6.8 5.8 5.8 5.6
4554 years 67.9 52.2 44.4 27.2 20.5 17.5 16.7 16.7
5564 years 205.2 163.8 138.7 74.6 54.3 47.2 40.8 39.5
6574 years 589.6 530.7 449.5 258.6 166.6 145.0 127.8 121.1
7584 years 1,543.6 1,555.9 1,361.6 866.3 551.1 490.8 431.4 402.9
85 years and over 3,048.6 3,643.1 2,895.2 2,193.6 1,528.5 1,484.3 1,236.0 1,118.1
Female
All ages, age-adjustedd 175.8 170.7 140.0 91.7 62.6 59.1 52.3 48.9
All ages, crude 105.6 111.4 109.0 85.9 68.4 71.8 65.1 61.2
Under 1 year 3.7 3.2 4.0 3.8 3.1 2.7 2.2 2.8
14 years 0.7 0.7 0.7 0.5 0.3 0.4 0.3 *
514 years 0.4 0.6 0.6 0.3 0.2 0.2 0.1 0.2
1524 years 1.5 1.6 1.4 0.8 0.6 0.5 0.5 0.5
2534 years 4.3 4.9 4.7 2.6 2.2 1.5 1.4 1.4
3544 years 19.9 14.8 15.6 8.4 6.1 5.7 5.3 5.1
4554 years 72.9 46.3 39.0 23.3 17.0 14.5 13.4 13.1
5564 years 183.1 131.8 95.3 56.8 42.2 35.3 30.9 29.5
6574 years 522.1 415.7 333.3 188.7 126.7 115.1 100.5 96.6
7584 years 1,462.2 1,441.1 1,183.1 740.1 466.2 442.1 396.8 374.9
85 years and over 2,949.4 3,704.4 3,081.0 2,323.1 1,667.6 1,632.0 1,429.4 1,303.4
White male e
All ages, age-adjustedd 182.1 181.6 153.7 98.7 65.5 59.8 51.7 48.1
All ages, crude 100.5 102.7 93.5 63.1 46.9 48.4 44.2 41.8
4554 years 53.7 40.9 35.6 21.7 15.4 13.6 12.9 12.8
5564 years 182.2 139.0 119.9 64.0 45.7 39.7 33.3 32.4
6574 years 569.7 501.0 420.0 239.8 152.9 133.8 117.3 110.8
7584 years 1,556.3 1,564.8 1,361.6 852.7 539.2 480.0 422.4 393.7
85 years and over 3,127.1 3,734.8 3,018.1 2,230.8 1,545.4 1,490.7 1,247.0 1,129.3
Black or African American male e
All ages, age-adjustedd 228.8 238.5 206.4 142.0 102.2 89.6 79.5 74.9
All ages, crude 122.0 122.9 108.8 73.0 53.0 46.1 43.2 41.5
4554 years 211.9 166.1 136.1 82.1 68.4 49.5 46.9 44.8
5564 years 522.8 439.9 343.4 189.7 141.7 115.4 112.1 107.4
6574 years 783.6 899.2 780.1 472.3 326.9 268.5 237.4 235.2
7584 yearsf 1,504.9 1,475.2 1,445.7 1,066.3 721.5 659.2 588.9 551.0
85 years and over 2,700.0 1,963.1 1,873.2 1,421.5 1,458.8 1,180.3 1,061.0

supply of blood to the brain, such as when a person suffers a stroke, has chronic high blood pressure, or has diabetes.

Plassman et al. note that the prevalence of dementias increased dramatically in those aged eighty to eighty-nine from those aged seventy-one to seventy-nine. The prevalence of any dementia increased fivefold to nearly 24.2%. Dementias more than tripled in males (from 5.3% to 17.7%), but increased nearly sixfold in females (from 4.8% to 27.9%). Likewise, the prevalence of AD increased dramatically from those in their seventies to those in their eighties. In men, the prevalence increased from 2.3% to 12.3%, and in women from 2.3% to 21.3%.

TABLE 10.8
Death rates for cerebrovascular diseases, by sex, race, Hispanic origin, and age, selected years, 19502004

[Data are based on death certificates]
Sex, race, Hispanic origin, and age 1950a,b 1960a,b 1970b 1980b 1990 2000c 2003 2004
Deaths per 100,000 resident population
American Indian or Alaska Native male e
All ages, age-adjustedd 66.4 44.3 46.1 34.9 35.0
All ages, crude 23.1 16.0 16.8 15.6 15.6
4554 years * * 13.3 15.5 14.0
5564 years 72.0 39.8 48.6 30.7 29.9
6574 years 170.5 120.3 144.7 101.4 109.4
7584 years 523.9 325.9 373.3 280.7 312.0
85 years and over 1,384.7 949.8 834.9 596.9 559.5
Asian or Pacific Islander male e
All ages, age-adjustedd 71.4 59.1 58.0 48.5 44.2
All ages, crude 28.7 23.3 27.2 26.0 24.3
4554 years 17.0 15.6 15.0 14.7 19.2
5564 years 59.9 51.8 49.3 42.2 36.8
6574 years 197.9 167.9 135.6 128.3 102.6
7584 years 619.5 483.9 438.7 355.7 350.8
85 years and over 1,399.0 1,196.6 1,415.6 1,093.0 969.0
Hispanic or Latino male e,g
All ages, age-adjustedd 46.5 50.5 43.0 41.5
All ages, crude 15.6 15.8 14.9 15.0
4554 years 20.0 18.1 18.1 17.5
5564 years 49.2 48.8 43.5 42.9
6574 years 126.4 136.1 113.9 114.4
7584 years 356.6 392.9 337.1 323.3
85 years and over 866.3 1,029.9 837.4 778.9
White, not Hispanic or Latino male g
All ages, age-adjustedd 66.3 59.9 51.9 48.2
All ages, crude 50.6 53.9 49.7 47.0
4554 years 14.9 13.0 12.1 12.1
5564 years 45.1 38.7 32.1 31.1
6574 years 154.5 133.1 116.9 110.0
7584 years 547.3 482.3 426.0 396.9
85 years and over 1,578.7 1,505.9 1,264.2 1,145.3
White female e
All ages, age-adjustedd 169.7 165.0 135.5 89.0 60.3 57.3 50.5 47.2
All ages, crude 103.3 110.1 109.8 88.6 71.6 76.9 69.5 65.3
4554 years 55.0 33.8 30.5 18.6 13.5 11.2 10.0 10.1
5564 years 156.9 103.0 78.1 48.6 35.8 30.2 25.8 25.1
6574 years 498.1 383.3 303.2 172.5 116.1 107.3 92.1 89.0
7584 years 1,471.3 1,444.7 1,176.8 728.8 456.5 434.2 389.9 366.8
85 years and over 3,017.9 3,795.7 3,167.6 2,362.7 1,685.9 1,646.7 1,442.1 1,315.7
Black or African American female e
All ages, age-adjustedd 238.4 232.5 189.3 119.6 84.0 76.2 69.8 65.5
All ages, crude 128.3 127.7 112.2 77.8 60.7 58.3 54.8 51.9
4554 years 248.9 166.2 119.4 61.8 44.1 38.1 36.0 33.9
5564 years 567.7 452.0 272.4 138.4 96.9 76.4 71.8 65.0
6574 years 754.4 830.5 673.5 361.7 236.7 190.9 175.3 166.8
7584 yearsf 1,496.7 1,413.1 1,338.3 917.5 595.0 549.2 498.3 489.5
85 years and over 2,578.9 2,210.5 1,891.6 1,495.2 1,556.5 1,414.2 1,270.7
American Indian or Alaska Native female e
All ages, age-adjustedd 51.2 38.4 43.7 34.2 35.1
All ages, crude 22.0 19.3 21.5 19.9 21.3
4554 years * * 14.4 14.6 10.
5564 years * 40.7 37.9 26.0 24.5
6574 years 128.3 100.5 79.5 94.8 110.9
7584 years 404.2 282.0 391.1 304.7 258.8
85 years and over 1,095.5 776.2 931.5 569.1 710.1

The prevalence of AD in those ninety years and older declined to 9.7%7.1% in men and 11.5% in women. This decline is due to deaths of those with AD.

Table 10.11 shows national estimates of the number of individuals with AD or any dementia (including AD). In 2002 approximately 2.4 million people seventy-one years and older were living with AD. About 3.4 million had dementias of some type.

DEPRESSION

According to Dan G. Blazer, in Depression in Late Life: Review and Commentary (Journals of

TABLE 10.8
Death rates for cerebrovascular diseases, by sex, race, Hispanic origin, and age, selected years, 19502004
[Data are based on death certificates]
Data not available.
* Rates based on fewer than 20 deaths are considered unreliable and are not shown.
a Includes deaths of persons who were not residents of the 50 states and the District of Columbia.
b Underlying cause of death was coded according to the Sixth Revision of the International Classification of Diseases (ICD) in 1950, Seventh Revision in 1960, Eighth Revision in 1970, and Ninth Revision in 19801998.
c Starting with 1999 data, cause of death is coded according to ICD-10.
d Age-adjusted rates are calculated using the year 2000 standard population. Prior to 2003, age-adjusted rates were calculated using standard million proportions based on rounded population numbers. Starting with 2003 data, unrounded population numbers are used to calculate age-adjusted rates.
e The race groups, white, black, Asian or Pacific Islander, and American Indian or Alaska Native, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Death rates for the American Indian or Alaska Native and Asian or Pacific Islander populations are known to be underestimated.
f In 1950, rate is for the age group 75 years and over.
g Prior to 1997, excludes data from states lacking an Hispanic-origin item on the death certificate.
Notes: Starting with Health, United States, 2003, rates for 19911999 were revised using intercensal population estimates based on the 2000 census. Rates for 2000 were revised based on 2000 census counts. Rates for 2001 and later years were computed using 2000-based postcensal estimates. For the period 19801998, cerebrovascular diseases was coded using ICD-9 codes that are most nearly comparable with cerebrovascular diseases codes in the 113 cause list for ICD-10. Age groups were selected to minimize the presentation of unstable age-specific death rates based on small numbers of deaths and for consistency among comparison groups. In 2003, seven states reported multiple-race data. In 2004, 15 states reported multiple-race data. The multiple-race data for these states were bridged to the single-race categories of the 1977 Office of Management and Budget standards for comparability with other states. Data for additional years are available.
SOURCE: Table 37. Death Rates for Cerebrovascular Diseases, by Sex, Race, Hispanic Origin, and Age: United States, Selected Years 19502004, in Health, United States, 2007. With Chartbook on Trends in the Health of Americans, Centers for Disease Control and Prevention, National Center for Health Statistics, November 2007, http://www.cdc.gov/nchs/data/hus/hus07.pdf (accessed January 30, 2008)
Deaths per 100,000 resident population
Asian or Pacific Islander female e
All ages, age-adjustedd 60.8 54.9 49.1 42.6 38.9
All ages, crude 26.4 24.3 28.7 28.8 27.0
4554 years 20.3 19.7 13.3 12.6 10.5
5564 years 43.7 42.1 33.3 30.8 28.1
6574 years 136.1 124.0 102.8 95.6 78.1
7584 years 446.6 396.6 386.0 330.2 312.5
85 years and over 1,545.2 1,395.0 1,246.6 1,042.4 979.9
Hispanic or Latino female e,g
All ages, age-adjustedd 43.7 43.0 38.1 35.4
All ages, crude 20.1 19.4 18.6 17.9
4554 years 15.2 12.4 11.7 11.8
5564 years 38.5 31.9 27.8 27.7
6574 years 102.6 95.2 86.0 83.0
7584 years 308.5 311.3 302.8 272.2
85 years and over 1,055.3 1,108.9 902.3 830.4
White, not Hispanic or Latino female g
All ages, age-adjustedd 61.0 57.6 50.8 47.7
All ages, crude 77.2 85.5 78.2 73.7
4554 years 13.2 10.9 9.7 9.8
5564 years 35.7 29.9 25.5 24.7
6574 years 116.9 107.6 92.1 89.0
7584 years 461.9 438.3 393.6 371.6
85 years and over 1,714.7 1,661.6 1,461.3 1,335.1
TABLE 10.9
Percentage of people age 65 and over with moderate or severe memory impairment, by age and sex, 2002
Both sexes Men Women
SOURCE: Percentage of People Age 65 and over with Moderate or Severe Memory Impairment, by Age Group and Sex, 2002, in Older Americans Update 2006: Key Indicators of Well-Being, Federal Interagency Forum on Aging-Related Statistics, 2006, http://agingstats.gov/agingstatsdotnet/Main_Site/Data/2006_Documents/Health_Status.pdf (accessed March 16, 2008)
Percent
65 and over 12.7 14.9 11.2
6569 5.1 7.8 3.1
7074 8.2 10.9 6.1
7579 13.6 17.2 11.2
8084 18.8 21.8 17.0
85 and over 32.1 33.9 31.2

Gerontology, vol. 58, no. 3, 2003), a review of depression in late life, it is difficult to get a definitive answer to the question of how many adults aged sixty-five and older suffer from depression. Blazer's review reveals a range of 9% to 16% of people aged sixty-five and older to have clinically significant depressive symptoms. Other studies show an overall estimate of the prevalence of major depression in those aged sixty-five and older to vary from 0.15% to 2%, and an overall estimate of the prevalence of minor depression to be 12.9%. The National Institute of Mental Health notes in Older Adults: Depression and Suicide Facts (May 7, 2008, http://www.nimh.nih.gov/health/publications/older-adults-depression-and-suicide-facts.shtml) that estimates of major depression in older people

living in the community range from less than 1 percent to about 5 percent, but rises to 13.5 percent in those who require home healthcare and to 11.5 percent in elderly hospital patients.

Family members and health-care professionals often fail to recognize depression among the elderly. Older people usually suffer from comorbidity (the presence of more than one chronic illness at one time), so depression may be masked by the symptoms of other disorders. In addition, older adults suffering from depression may mistakenly think that their depression is simply a reaction to an illness or loss, or is a consequence of aging. Many sufferers fail to divulge their depression because of the stigma associated with mental illness.

Suicide

According to the National Institute of Mental Health, in Older Adults, depression is commonly associated with suicide in older people. Most suicidal older adults, up to 75%, visit their primary care physician during the month before ending their life. However, their depression apparently had not been accurately diagnosed or effectively treated.

TABLE 10.11
Number of persons with dementia or Alzheimer's Disease, by age, 2002
Age All dementia Alzheimer's disease
SOURCE: Adapted from B.L. Plassman et al., Table 3. National Estimates of the Number of Individuals with Dementia or AD, in Prevalence of Dementia in the United States: The Aging, Demographics, and Memory Study, Neuroepidemiology, vol. 29, no. 12, 2007, http://content.karger.com/ProdukteDB/produkte.asp?doi=109998 (accessed February 3, 2008). Reprinted with permission of S. Karger AG Basel.
7179 years 712,000 332,000
8089 years 1,996,000 1,493,000
90 years 699,000 556,000
Total 3,407,000 2,381,000

Depression is especially common in nursing homes. Richard N. Jones, Edward R. Marcantonio, and Terry Rabinowitz determine in Prevalence and Correlates of Recognized Depression in U.S. Nursing Homes (Journal of the American Geriatric Society, vol. 51, no. 10, October 2003) that at least 20% of nursing home residents suffer from clinical depression. The researchers believe this may be an underrepresentation of the magnitude of the problem. They note that depression in long-term care settings such as nursing homes is often unrecognized. In addition, when depression is recognized it is often undertreated, treated inadequately, or treated inappropriately.

Feeling lonely, abandoned, or suffering financial woes, many depressed nursing home residents end their life by nonviolent means such as by starving themselves, failing to take prescribed medication, or ingesting large amounts of drugs. This type of suicide, as a result of depression, is different from that committed by the terminally ill who, not wishing to prolong the dying process, refuse life-sustaining medical treatment.

TABLE 10.10
Percentages of persons with dementia, Alzheimer's Disease and vascular dementia, by age, 2002
All dementia Alzheimer's disease Vascular dementia
Age Combined Male Female Combined Male Female Combined Male Female
SOURCE: Adapted from B.L. Plassman et al., Table 2. National Prevalence of Dementia, AD and VaD, by Age Categories, in Prevalence of Dementia in the United States: The Aging, Demographics, and Memory Study, Neuroepidemiology, vol. 29, no. 12, 2007, http://content.karger.com/ProdukteDB/produkte.asp?doi=109998 (accessed February 3, 2008). Reprinted with permission of S. Karger AG Basel.
7179 years 4.97 5.25 4.76 2.32 2.30 2.33 0.98 1.27 0.76
8089 years 24.19 17.68 27.84 18.10 12.33 21.34 4.09 3.58 4.38
90 years 37.36 44.59 34.69 29.70 33.89 28.15 6.19 8.14 5.46
Total 13.93 11.14 15.74 9.74 7.05 11.48 2.43 2.34 2.48
TABLE 10.12
Sex ratio for population 25 years and over by age, 2000 and 2030
[Men per 100 women]
2000 2030
Country 25 to 54 years 55 to 64 years 65 to 69 years 70 to 74 years 75 to 79 years 80 years and over 25 to 54 years 55 to 64 years 65 to 69 years 70 to 74 years 75 to 79 years 80 years and over
SOURCE: Adapted from Kevin Kinsella and Victoria A. Velkoff, Table 6. Sex Ratio for Population 25 Years and over by Age: 2000 and 2030, in An Aging World: 2001, U.S. Census Bureau, November 2001, http://www.census.gov/prod/2001pubs/p95-01-1.pdf (accessed February 3, 2008)
United States 98 91 85 79 72 52 98 92 89 86 81 64

In the United States the suicide rate generally increases with age. In 2004 the oldest old (eighty-five years and older) accounted for the second-highest rate at 16.4 suicides per 100,000 people. (See Table 6.1 in Chapter 6.) Those aged forty-five to fifty-four had a slightly higher rate at 16.6 per 100,000.

Men have a higher suicide rate than women. Men aged eighty-five years and older had the highest suicide rate of 45 per 100,000, whereas the rate among women was 3.6 suicides per 100,000 people. (See Table 6.1.)

By race, white men eighty-five years and older had the highest suicide rate in 2004 at 48.4 suicides per 100,000 people. (See Table 6.1.) In contrast, African-American men of this age had a suicide rate of fifteen. One generally held theory about the high rates of suicide among aged white men is that they have traditionally been in positions of power and thus have great difficulty adjusting to a life they may consider useless or diminished.

OLDER WOMEN

Women Live Longer Than Men

In the United States the life expectancy in 2004 for females born in that year was 5.2 years more than for males80.4 years and 75.2 years, respectively. (See Table 10.1.) In 2000 there were eighty-five men aged sixty-five to sixty-nine for every one hundred women in the same age span. As both sexes age, the gap widens. For those aged eighty and older, there were only fifty-two men for every one hundred women. (See Table 10.12.) The U.S. Census Bureau (2007, http://www.census.gov/popest/national/asrh/NC-EST2007/NC-EST2007-02.xls) finds that in 2007 more than two-thirds of all people aged eighty-five years and older were womenapproximately 3.7 million women, compared to approximately 1.8 million men.

Elderly Women Have More Chronic Diseases Than Do Elderly Men

Older women are more likely than men of the same age to suffer from chronic conditions, such as arthritis, osteoporosis and related bone fractures, AD, and incontinence. Women are also more likely to have more than one chronic disorder at a time (comorbidity). Arnold Mitnitski et al. note in Relative Fitness and Frailty of Elderly Men and Women in Developed Countries and Their Relationship with Mortality (Journal of the American Geriatric Society, vol. 53, no. 12, 2005) that women, at any given age, are frailer than men, even though they have a lower mortality rate.

GERIATRICS

Geriatrics is the medical subspecialty concerned with the prevention and treatment of diseases in the elderly. In 1909 Ignatz L. Nascher (18631944) coined the term geriatrics from the Greek geras (old age) and iatrikos (physician). Geriatricians are physicians trained in internal medicine or family practice who obtain additional training and certification in the diagnosis and treatment of older adults. The Eastern Virginia Medical School's Glennan Center (November 7, 2007, http://www.evms.edu/services/geriatrics-glennan.html) explains that geriatricians rely on the findings of researchers and gerontologists (nonphysician professionals who conduct scientific studies of aging and older adults) to help older adults maintain the highest possible degree of function and independence and avoid unnecessary and costly institutionalization.

Gerontology was unheard of before the nineteenth century, when most people died at an early age. Those who reached old age accepted their deteriorating health as a part of aging. In the early twentieth century gerontology was born when scientists began to investigate the pathological changes that accompany the aging process.

Even though many developed countries have recognized the need for more geriatrics education, the United States continues to lag in offering geriatrics courses in its medical schools. In ACGME Requirements for Geriatrics Medicine Curricula in Medical Specialties: Progress Made and Progress Needed (Academic Medicine, vol. 80, no. 3, March 2005), Elizabeth J. Bragg and Gregg A. Warshaw state that as of 2003 only 30% of the ninety-one nonpediatric accredited medical specialties offered in U.S. medical schools had specific geriatrics training

requirements. Among those with specific requirements, curriculum expectations were considered modest by the Association of Directors of Geriatric Academic Programs' (ADGAP) team at the University of Cincinnati School of Medicine's Institute for Health Policy and Health Services Research.

Gregg A. Warshaw et al. report in The Development of Academic Geriatric Medicine: Progress toward Preparing the Nation's Physicians to Care for an Aging Population (Journal of the American Geriatrics Society, vol. 55, no. 12, December 2007) both positive and negative news on the topic: From 2001 to 2005, more fellows and faculty [in geriatrics] have been recruited and trained, and some academic programs have emerged with strong education, research, and clinical initiatives. Medical student exposure to geriatrics curriculum has increased, although few academic geriatricians are pursuing research careers, and the number of practicing geriatricians is declining. An expanded investment in training the physician workforce to care for older adults will be required to ensure adequate care for aging Americans.

Decline in Numbers of Geriatricians in the United States

The ADGAP also reports that a tremendous shortage of physicians specializing in geriatrics exists, including those in the field of psychiatry known as geropsychiatrists. In Fellows in Geriatric Medicine and Geriatric Psychiatry Programs (Training and Practice Update, vol. 5, no. 2, October 2007), the ADGAP estimates that in 2007 there were only 7,128 active certified geriatricians practicing in the United States and 1,596 certified geriatric psychiatrists.

In Geriatricians and Geriatric Psychiatrists (Training and Practice Update, vol. 1, no. 2, May 2003), the ADGAP notes that Medicare, the primary payer for most clinical services provided by geriatricians, reduced the average reimbursement to physicians by 5.4% in 2002. The ADGAP suggests that the growing gap between Medicare reimbursement and the actual costs of delivering medical care may affect the willingness of physicians to continue focusing their careers in geriatric medicine and geriatric psychiatry. The ADGAP explains in Fellows in Geriatric Medicine and Geriatric Psychiatry Programs that the low Medicare reimbursement rates leave community-based geriatricians with much lower salaries than physicians in other fields.

The Geriatric Care Act was introduced in 2003, which would help improve payment for geriatricians. This bill never became law, but two other related bills were pending as of May 2008. The Geriatric Assessment and Chronic Care Coordination Act of 2007 has the goal of providing financial incentives within Medicare to encourage the coordination of care for patients having multiple medical conditions and to bring down medical costs and increase the quality of care. The Caring for an Aging America Act of 2008 has the goal of providing federal funding to attract and retain trained health-care professionals and direct-care workers in the field of geriatrics.

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"Older Adults." Death and Dying: End-of-Life Controversies. 2009. Encyclopedia.com. 28 Jun. 2016 <http://www.encyclopedia.com>.

"Older Adults." Death and Dying: End-of-Life Controversies. 2009. Encyclopedia.com. (June 28, 2016). http://www.encyclopedia.com/doc/1G2-3232300016.html

"Older Adults." Death and Dying: End-of-Life Controversies. 2009. Retrieved June 28, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3232300016.html