Aging and the Aged
Aging and the Aged
Aging is the process of growing older, a process that includes physical changes and, sometimes, mental changes. "The aged" refers to elderly people, those who have reached an advanced age.
The concept of aging and the aged has changed, as record numbers of people around the world are living longer, a trend expected to continue throughout the twenty-first century and beyond.
The word "elderly" used to refer to an older person, generally someone age 65 or older. At the beginning of the twentieth century, 65 was considered an advanced age. The life expectancy for a baby born in 1900 was 51 years for a girl and 48 years for a boy. That year, approximately one in 25 Americans was over 65.
By the 1930s, legislation set older adults apart from the rest of American society. Social Security laws declared that people had to retire from work by age 65. The ruling affected about 7.5 million people during the 1930s.
At the end of the twentieth century, the older population had increased 10 times since 1900. In 2000, approximately 35 million people age 65 and older accounted for 13% of America's population, according to Older Americans 2000: Key Indicators of Well-Being, a 2000 report from the Federal Interagency Forum on Aging Related Statistics. According to the report, by 2030 70 million Americans will be 65 or older.
Since the late twentieth century, the age group growing fastest in many countries has been the "very old" or the "oldest old." Opinions vary about the age classification for this group. The United States federal government defines this group as people 85 and older. The United Nations (U.N.) classifies people 80 and older in this demographic group.
|Commonly used instruments for geriatric patients|
|Instrument||Administered by||Answered by||Score range (poor-good)|
|Source: Abrams, W.B., et al., eds. Merck Manual of Geriatrics. 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories, 1995.|
|Folstein mini mental state||Interviewer||Subject||0-30|
|Katz activities of daily living||Interviewer||Proxy||0-6|
|Lawton instrumental activities of daily living||Interviewer, self-administered||Proxy or subject||9-27|
|Tinetti balance & gait evaluation||Interviewer, self-administered||Subject||0-28|
|Yesavage geriatric depression scale||Interviewer, self-administered||Subject||15-30|
The oldest age group includes the rapidly increasing number of centenarians, people age 100 or older. In the United States, the number of centenarians is projected to grow from about 60,000 in 2000 to some 2 million by the middle of the twenty-first century.
The demographic revolution
Advances in areas such as health care, medicines like antibiotics, and nutrition during the twentieth century mean that more people are living longer. An American baby born at the turn of the twenty-first century is expected to live nearly 30 years longer than one born a century earlier, according to Older Americans 2000.
The increase in life expectancy during the late twentieth century is believed to be as high or higher than any increase from recorded time until 1900. In many countries, one out of 10 people was 60 or older in 2000, according to The Ageing of the World's Population, a 2000 report from the U.N. Division for Social Policy and Development. The ratio of people over 60 was projected to change to one out of five in 2050 and one out of three in 2150, according to the report.
At the same time that more people are living longer, people around the world are having fewer children. The lower birth rate is attributed to the availability of family planning methods. The combination of a growing older population and a declining birth rate has produced a demographic revolution that the U.N. predicts will continue into subsequent centuries.
These demographic trends affect what the U.N. calls the "old-age dependency balance," the relationship between the number of people age 65 and older and the number of working people age 15 to 64.
Traditionally in the United States, younger workers have supported older people through wage deductions for programs such as Social Security. During the first half of the twenty-first century, the U.N. estimated that the old-age dependency ratio will double in more developed areas and triple in less developed areas.
With a smaller pool of workers, organizations around the world are studying methods to ease the dependency burden. One method of accomplishing this is to help older adults remain healthy and independent for as long as possible. Not only does this benefit the aging person, but health care costs are also reduced.
The demographic revolution has political, social, and economic significance. Of primary concern is how to provide health care for the growing number of older people, especially those 85 and older. Generally, the oldest old need more health services than younger people.
The aging process
It used to be thought that as people aged, their bodies became "worn out" over time and then they died. As the body deteriorates, a person may experience signs of aging, resulting in the need for dentures or the presence of a chronic disease. Although methods of prolonging life are well-known, opinions vary about why people age.
A range of factors is thought to contribute to aging, either alone or in combination. For example, a healthy person whose parents led long lives could expect to live many years. The probability of a long life would be increased if the population receives adequate health care, and modifies unhealthy lifestyle behaviors.
FACTORS AFFECTING THE AGING PROCESS. Factors that affect the aging process include:
- Heredity. A person whose parents and grandparents lived to an advanced age could expect to live longer. On the other hand, a person could inherit the susceptibility to a disease that shortens life. In addition, stress affects health, and the ability to cope with stress is also believed to be inherited.
- Senescence. Theories about aging focus on the reason cells stop dividing and age. Some scientists believe that cells begin to age when a person is fully grown. Others theorize that excess DNA accumulates and obstructs cell activity. Another theory is based on the effect of chemical compounds called free radicals on the system. The compounds located in the body and the environment can accelerate conditions such as heart attacks and diabetes.
- Physiology. The collective functioning of the body's components affects how long a person lives.
- Biology. Traditionally, women live longer than men. Scientists believe this is due to the female sex hormones.
- Lifestyle. The choices a person makes when younger can affect health later in life. A person who smoked cigarettes, took drugs, did not eat nutritionally, or failed to get enough exercise or sleep may suffer poor health years later. For example, smoking is attributed to numerous conditions ranging from cancer to gum diseases.
- Psychological factors. Feelings of self-confidence are linked to a longer life. Conversely, low self-esteem and negative attitudes about being old may impair health. This can lead to feelings of depression and loneliness.
PHYSICAL SIGNS OF AGING. How a person ages varies, however, the aging process includes some general characteristics such as:
- Lowering of the basal metabolism (the rate of energy production in the body cells). People may tire more easily and be more sensitive to changes in the weather.
- Reduction of strength, endurance, and ability.
- Change in eyesight. People who wear glasses may experience presbyopia, a form of farsightedness. Bifocals or reading glasses allow the person to read print that appears too small. Other aging people who never needed corrective lenses may need to wear eyeglasses. Some older people may be diagnosed with eye conditions such as glaucoma and cataracts.
- Change in hearing. Generally, older people have more difficulty hearing high tones but can hear low tones. A hearing aid may be prescribed.
- Dental changes. Gums may recede, and this can lead to tooth decay. Lack of proper oral hygiene earlier in life may result in the removal of all or some of the natural teeth. Dentures may be required.
- Osteoporosis (a condition characterized by reduced bone density and brittle bones). This condition, more common in women, can lead to bone fractures.
- Muscle strength and body tone may diminish.
- Organ function may slow down.
- As skin ages, cells hold less water, and there is less fat tissue. Skin becomes dry and wrinkled.
- Hair loses its pigment (color) and turns white or gray.
- Sexual desire and ability may decrease. Drugs such as Viagra allow men to perform, and products such as lubricants can help women.
- Reproduction. Aging men can still father children. After menopause, women are usually unable to bear children.
- The senses of taste, touch, and smell may diminish over time.
MENTAL SIGNS OF AGING. Generally, age has little effect on the mind. While it is true that older people do not learn as quickly, once something is learned, the information is retained more accurately. However, the brain like the body, must be exercised. That exercise can take the form of learning something new. However, most adults, not just the aging, may experience anxiety about returning to classes. People who teach adults effectively make their students feel welcome. They also realize that adults remember more of what is relevant to them.
As people advance in age, they may experience memory loss. This is frequently treatable. In addition, a stimulated mind is thought to help avoid the memory loss that has been associated with aging. Emotional health can affect physical health, with conditions such stress, loneliness, and depression leading to illness in people of all ages.
DEMENTIA AND ALZHEIMER'S DISEASE. One-third or more people age 85 and older have moderate or severe memory impairment. Memory loss can be a symptom of Alzheimer's disease, a progressive condition that is not reversible. Before more was known about Alzheimer's, the disease was thought to be a natural symptom of aging. It is still not easy to diagnose and can be mistaken for dementia. Although many of those diagnosed with Alzheimer's are older than 65, the disease also affects people in their 40s and 50s.
AGE-RELATED HEALTH CONDITIONS. Advanced age doesn't cause disease in itself, but the possibility that some chronic conditions will develop increases as a person ages. These conditions include arthritis and other musculoskeletal disorders that could affect mobility.
However, the prevalence of arthritis and other chronic diseases like hypertension, heart disease, cancer, diabetes, and stroke varies by ethnicity in the United States. Furthermore, an ongoing healthy lifestyle can help prevent illness and disease later in life. For an older adult, that lifestyle should include exercise, a proper diet to avoid malnutrition, and vaccinations such as flu shots.
Retirement brings many changes to aging people. After working throughout their lives, they may want to relax and get into a routine of sitting and watching television. They may experience a loss of identity after defining themselves by their work for so many years.
The aging lifestyle
After retirement, it is crucial to overall health for a person to find hobbies, social activities, or interests that challenge both mind and body. Most cities in the United States have senior centers that offer lunch programs where people can socialize. Center classes range from line dancing to journal writing. In addition, volunteer opportunities for older adults include serving with law enforcement and as tutors. Many older people remain socially active through contact with friends, family, and neighbors. In addition, more older people are physically active.
Agism and activism
For centuries, cultures including the Native Americans, Samoans, and Chinese honored the older members of their societies. These people respected their elders for their wisdom and experience. However, negative attitudes about the aged date back to ancient times. The Greek philosopher Socrates cited his age as one reason that he planned to commit suicide by taking hemlock. He was 70 years old.
Furthermore, some primitive societies regarded the aged and ailing as burdens. In some situations, people were murdered or given assistance in committing suicide. Assisted suicide was the subject of much debate during the late twentieth century and remains an issue in the twenty-first century, with people divided about whether or not a person has the right to choose to die.
|Leading causes of death in persons 65 and older|
|Cause of death||Number of deaths||Percentage of all deaths in those ≥ 65 years old|
|Source: National Center for Health Statistics, 1993.|
|Malignant neoplasms, including neoplasms of lymphatic and hematopoietic tissues||345,387||22.4|
|Chronic obstructive pulmonary disease and associated conditions||72,755||4.7|
|Pneumonia and influenza||70,485||4.6|
|Accidents and adverse effects||26,213||1.7|
|Motor vehicle accidents||7,210||0.5|
|All other accidents and adverse effects||17,306||1.2|
|Nephritis, nephrotic syndrome, and nephrosis||17,306||1.1|
|All other causes||222,048||14.4|
Health issues are just one factor for those who view older people as a burden to society. Negative stereotypes about the aged include the view that they are useless because they don't work and therefore don't contribute to society. This prejudice against older people is known as agism, sometimes spelled "ageism." This negative attitude can be traced in part to the fact that older people are visual reminders of aging and death. In addition, during the second half of the twentieth century, the media celebrated youth as a valued commodity. The appearance of an older person was seen as a rarity, as when Renee Russo appeared in the 1999 movie, The Thomas Crown Affair. Much was made of the fact that she was in her 40s.
Older people took a stand during the 1970s. Maggie Kuhn founded the Gray Panthers, a group that continues to fight agism. The American Association of Retired Persons campaigned and continues to advocate for older people. Both groups champion older adults as vital people with much to contribute to society.
The older population of the late twentieth century now includes Baby Boomers. The first Boomers turned 50 in the late 90s, and this group is expected to vigorously campaign for the rights of the aging and the aged.
Furthermore, with mandatory retirement abolished, people in their 90s and 100s worked at jobs that they enjoyed in 2000, according to the New York Times. However, that same year, agism surfaced after the U.S. presidential election. Disputed election results in Florida led to jokes on TV and the Internet about the incompetence of older voters.
While older people may share a chronological age, they vary according to their ethnic heritage, economic status, interests, and education. Some are healthy and active; others are frail and not as active. According to Older Americans 2000, the ethnic make-up of people age 65 and older in 2000 was 84% non-Hispanic white, 8% non-Hispanic black, 6% Hispanic, 2% non-Hispanic Asian and Pacific Islander, and less than 1% American Indian and Alaska native. Population percentages are predicted to change by the year 2050 to 64% non-Hispanic white, 16% Hispanic, 12% non-Hispanic black, 7% non-Hispanic Asian and Pacific Islander, and less than 1% American Indian and Alaska native.
The report indicated that older Americans in 2000 were better educated than older people in 1950. The higher education level "positively" influenced health and socio-economic status.
People age 85 and older are the most likely to live in nursing homes. About three-fourths of nursing home residents are women, which reflects their predominance in the population.
A NATIONAL MODEL. Government, the medical community, and numerous organizations are studying issues associated with the ever-increasing aging population. An overview of the issues facing the aging and the aged is demonstrated by the scope of the activities of the U.S. Department of Health and Human Services (HHS) in 2000. Programs and projects included research on the aging process, aging and disease, Alzheimer's, and the relationship between the aging and society. Other HHS activities included a seniors nutrition program, and services and studies related to care at home and long-term care facilities.
Globally, the average lifespan increased by 20 years during the last half of the twentieth century, according to the U.N. At the end of the century, a 60-year-old woman living in a developed region could expect to live 22 years longer. A man that age could expect to live 18 years longer. In a less developed region, a woman who reaches age 60 could expect to live 16 years longer, while a 60-year-old man in that area could expect to live 14 years longer.
A sampling of other international trends includes:
- People age 60 and older accounted for one in five Europeans and one in 20 Africans in 2000. In developing countries, the growth of the aging population is more rapid than in developed countries. Therefore, developing countries have less time to adjust to the expansion of their aging populations.
- In developing countries, older people continue to work. In Zimbabwe, 82% of men and 70% of women age 60 and older worked during the year 2000. Some non-wage earners worked at home caring for children, worked on farms, or did other household projects that allowed other relatives to work for pay.
- More than 25% of people age 75 and older live in China and India.
- In many Asian and African countries, more than half of women age 60 and older are widowed. Only 10-20% of men in that age group outlived their spouses.
- Women outlive men almost everywhere. At age 60, there are 99 men for every 100 women. By age 90, there are only 69 men for every 100 women.
A EUROPEAN MODEL. Concern about promoting health and preventing illness led the European Commission to start the Megapoles Project in 1997. Part of the project involved looking at the elderly in the capital cities of Amsterdam, Athens, Brussels, Copenhagen, Dublin, Helsinki, Lisbon, London, Madrid, Oslo, Stockholm, and Vienna. The review, "Growing Old in Metropolitan Areas" (GOMA), found three major issues in those cities:
- Prevention of social isolation and loneliness. The goals include promoting individual self-confidence that would lead to a more positive perception by others.
- Early detection of dementia, Alzheimer's disease, and the implementation of a project to provide individual competence. The project involves the elderly, their relatives, and caregivers.
- Providing a safer environment that protects older people from accidental falls, road traffic, and "firm vigilance" towards violence directed at the elderly.
A 2001 report on GOMA included examples of successes. Cities such as Vienna have day centers that offer therapeutic and health promotion services. Stockholm has a special bus with wheelchair ramps that transports seniors to their destinations after morning rush hour. Furthermore, programs in London reach out to older people who may feel isolated for various reasons, for example, a lack of language skills. Intergenerational projects can serve three groups targeted by Megapoles Project: the elderly, the disadvantaged, and youth and young families. For example, one facility serves as a day center for the elderly and a kindergarten. Young and old interacted and socialized.
Another London project linked older people to social services through their milkman. This was aimed at people who didn't leave their homes. Isolation can lead to impaired mobility and cognitive skills, so the milkman "casually" checks in daily and may encourage visits from social service workers. This delivery person calls for help if milk isn't taken indoors.
Furthermore, senior centers in Madrid and Helsinki provide information about topics such as health, nutrition, exercise, and home safety.
IMPLICATIONS ACROSS BORDERS. The GOMA report acknowledged that not all senior projects can be exported to other cities. And for those living in the United States, most programs are recognizable. Handicapped-accessible public transportation is required by law. National, state, and city agencies are concerned with the elderly. Senior centers in many cities offer health programs, physical activities, and classes.
The GOMA report maintained that dialog throughout the world about the aged and implementation of programs for this group are crucial. The goal of dialog and programs is to help the aged feel secure, socially integrated, and mentally healthy. Not only do these dialogs and programs benefit the aging population, they provide some relief to health providers and caregiving institutions.
In 1965 the federal government created Medicare, a health insurance program for people age 65 and older. In 1999, Medicare spending totaled $181 million for the 39 million older and disabled people enrolled in the program.
The cost of health care for the aging population is among the issues that will be debated throughout the twenty-first century as the old-age dependency burden shifts to fewer younger people. This could lead to further discussion of health care rationing, i.e. whether the decision to provide some health care should be limited because of a person's advanced age. This issue was discussed in an article titled "Does Ageism Affect Health Care Rationing?" (found on the Novartis Foundation web site 〈www.healthandage.com〉). The author cited an incident described in a 1998 issue of the medical journal, the Lancet. Both articles concerned an 88-year-old woman who stopped breathing three minutes after admission to a hospital emergency room. At issue was whether the woman should be revived since the admitting physician thought she would die anyway. The doctor revived the woman, who was still doing well several years later.
The Novartis Foundation writer pointed out that rationing wouldn't have been an issue with a younger patient. The writer maintained that age should not be an issue when determining whether to provide health care. The author warned that this issue is complex. In some cases, a patient may face a lingering death.
Debate will continue about euthanasia, mercy killing, and the right-to-die. Opponents of these procedures fear that patients may be pressured to end their lives. In some cases, this pressure may be based on rising health care costs.
Such debates will affect some members of the medical profession as they are faced with patients and families needing guidance. In addition, the shift to an ever-growing older population will affect health care in the twenty-first century.
On a more positive note, strategies to delay illness later in life benefit the elderly and help keep costs down. For example, delaying the onset of Alzheimer's disease by five years would cut its incidence in half and result in a saving of $50 billion annually in the United States.
This preventive treatment should focus on patients of all ages. The healthcare team should emphasize to patients that aging is an ongoing process, so that lifelong preventive measures such as diet and exercise are the best tools for long-term health.
Treating the older patient
For the older patient, the goal of treatment is to help a patient remain physically, mentally, and socially active for as long as possible. To achieve this goal:
- Patients above the age of 60 should have an annual comprehensive health assessment.
- Vitamins and inoculations are important.
- Patients should be advised that calcium from sources such as milk and dairy products is crucial for fighting osteoporosis and keeping teeth and bones strong.
- Diet should maintain the recommended body weight, so that a patient is not overweight or too thin. A low-fat diet is recommended because aging results in a lessening of fat-digesting enzymes.
- Patients should be reminded that regular exercise produces benefits that include well-being, good circulation, and good respiration. Exercise helps a person maintain coordination and mobility. Even if a person is in a wheelchair or bed, exercise will produce beneficial results.
- Early treatment to help prevent or lessen a risk of conditions such as cataracts or glaucoma.
Since the aging population is growing and continues to increase, all health care professionals and staffs should receive geriatric training. The demographic trend also creates a demand for people with expertise in gerontology and geriatrics. Other career opportunities include work in long-term care facilities, health education for the aged, and home health care.
In addition, working with the aged prompts people in the nursing and allied health fields to take a look at their lives and those of their relatives. In doing so, they can make adjustments so that they can attempt to live long and healthy lives.
Chronic disease— A condition lasting a long time.
Cognitive— Able to know or perceive.
Geriatrics— The branch of medicine concerned with the prevention, diagnosis, and treatment of conditions in aging people and the aged.
Gerontology— The study of the aging process and conditions associated with this process.
Gillick, Muriel R. Lifelines: Living Longer, Growing Frail, Taking Heart. New York: W.W. Norton and Co., 2001.
Honn Qualls, Sara, and Norman Abeles, eds. Psychology and the Aging Revolution: How We Adapt to Longer Life. Washington, D.C.: American Psychological Association, 2000.
Powell, Douglas H. The Nine Myths of Aging: Maximizing the Quality of Later Life. Thorndike, ME: Thorndike Press, 1998.
Safford, Florence, and George I. Krell, eds. Gerontology for Health Professionals: A Practice Guide. Washington, D.C.: National Association of Social Workers, 1997.
Wei, Jeanne Y., and Sue Levkoff. Aging Well: The Complete Guide to Physical and Emotional Health. New York: Wiley, 2000.
Martin, Douglas. "To Be Old, Gifted and Employed is No Longer Rare." The New York Times, January 14, 2001.
AARP (American Association of Retired Persons). 601 E St., NW, Washington, D.C. 20049. (800) 424-3410. 〈http://www.aarp.org〉.
American Geriatrics Society. The Empire State Building, 350 Fifth Ave., Suite 801, New York, NY 10118. (212) 308-1414. 〈http://www.americangeriatrics.org〉.
Federal Interagency Forum on Aging-Related Statistics. 6525 Belcrest Road, Room 790, Hyattsville, MD 20782. (301) 458-4460. 〈http://www.agingstats.gov〉.
Global Action on Aging. P.O. Box 20022, New York, NY 10025. (212) 557-3163. 〈http://www.globalaging.org〉.
Gray Panthers. 733 15th Street, NW, Suite 437. Washington, D.C. 20005. (800) 280-5362. 〈http://www.graypanthers.org〉.
Novartis Foundation for Aging and Gerontology. Novartis Foundation for Gerontology, Lichtstrasse CH-4002, Basel, Switzerland. Tel: +41-61-324-7353. 〈http://www.healthandage.com〉.
U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201.(877) 696-6775. 〈http://www.hhs.gov〉.
Novartis Foundation. "Does Ageism Affect Health Care Rationing?" 〈http://www.healthandage.com/edu/2healthpolicy/content/page3.htm〉.
Pils, Katharina. GOMA: Growing Old in Metropolitan Areas. 〈http://www.healthandage.com/edu/2health_in_vi/content/page14.htm〉.