Aging
http://www.youtube.com/watch?v=NXrON2QX0vc
http://www.ageme.com/
© 1990-Life Care Centers of America
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Normal Aging
“Old age is not an illness.
It is a continuation of life with decreasing capacities for adaptation"
Frederic Verzar (1973)- Swiss gerontologist
• Species-specific life-spans
– Human = 120 years
• Time-dependent process
– Begins gradually
– Decreased reserve capacity
– Associated with functional loss
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Suggested Age Categories
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MIDDLE AGE
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Beginning of noticeable physical aging
Physical exertion becomes more difficult
Minor chronic conditions
Vision/hearing loss may begin
40 is seen as the beginning of the aging process
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LATER MATURITY
•
OLD AGE
– Chronic illness is common
– Activity limitation
– Begins in 60's
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Physical frailty
Disabling chronic disease
Slowing of mental processes
Begins in 70's
Older Adults – A Diverse Population
Although age is sometimes called the great equalizer, today’s elderly represent
a wide range of characteristics.
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Heterogeneity vs. diversity
• Heterogeneity is individual level differences
– May reflect the interaction of genetics and lived experience
– Variations do not have an effect on social experience
• For example the biological difference in blood type has physical but not social
implications
• Diversity, however, has political and social implications,
usually reflected in the power structure of a society
– Systematic
– May result in disparity and inequities
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Literacy, Health, and Aging
•Reduced literacy can be due to many causes
•“Health literacy is the degree to which individuals have the capacity to obtain, process, and
understand basic health information and services needed to make appropriate health decisions.”
Healthy People 2010, Health Communication Terminology
•Patients’ health literacy may be affected
–if they have health care providers who use words that patients don’t understand
–Low educational skills
–Cultural barriers to health care
–Limited English Proficiency (LEP)
•Limited health literacy is more prevalent among
–Older adults
–Minority populations
–Those who are poor
–Medically underserved people
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Education and Literacy
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Health Literacy and Older Adults
AgingStats.gov site
Potential Sources of Diversity other
than Race/Ethnicity
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Cohort
Finances
– Income (amount &
sources)
Assets
– Accumulated resources,
particularly property,
wealth
Roles (Social) – parenthood,
widowhood, etc.
Gender
Sexual orientation
Religion/Value systems
Language
Community (size, location)
● Occupation
● Marital status
● Family composition
● Education
● Living arrangements
● Health & functional status
● Personality
● Personal interests
● Diet
● Historic time
● Life stage
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Health of Older Adults
“How old would be if you didn’t
know how old you was?”
Satchel Paige
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Expectations Regarding Aging
Assessment
• Ten scales
– General health
– Cognitive function
– Mental health
– Functional
Independence
– Sexual function
– Pain
– Urinary incontinence
– Sleep
– Fatigue
– Appearance
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Defining Health
• Distinction of aging and disease
• What is “uncompromised” health?
– Who is healthy?
• Is looking “young for one’s age” a reflection of health?
• WHO (World Health Organization) defines health in terms
of physical, mental, and social well-being
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Health As a Continuum
Excellent
Absence of
disease or
impairment
Poor
Has
Condition
Activity
Mild
Severe
Frailty
Restriction Disability Disability
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Diagnostic Measures vs Functional
Status
• 60-80% of older adults have at least one chronic
condition
• Chronic disease does not always affect function
– Many people who have chronic conditions lead
active, productive lives
• 60% of older adults are free of disability
• Chronic conditions may be accompanied by pain
and physical limitation
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Successful Aging
• Rowe and Kahn’s Model
Freedom from
and disability
• –Minimize
risk disease
of disease
and disability
High cognitive
functioning
• –Maintain
physical
and cognitive function
Social engagement
• –Continue
engagement with life
• Positive spirituality
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The 7 dimensions of wellness
are key to an active, healthy life
Physical
Intellectual
Social
Vocational
Spiritual
Emotional
Environmental
SOURCE: National Wellness Institute
http://www.icaa.cc/activeagingweek/resourcesaaw.htm
OLDER AMERCANS MONTH 2013
• http://www.olderamericansmonth.acl.gov/ind
ex.html
• Unleash the Power of Age
– Older Americans Month is a proud tradition that shows our commitment to honoring
the value that elders contribute to our communities. This year’s Older Americans Month
theme—“Unleash the Power of Age!”—highlights the significant contributions made by
thousands of older Americans across our nation.
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Older Americans Month
 2000 - In the New Century. . . . The Future is Aging
 2001 - The Many Faces of Aging
 2002 - America: "A Community for all Ages"
 2003 - “What We Do Makes A Difference.”
 2004 - “Aging Well, Living Well”
 2005 - Celebrate Long-term Living
 2006 - Choices For Independence
 2007 - Making Choices for a Healthier Future
 2008 - Working Together for Strong, Healthy and Supportive Communities
 2009 - Living Today for a Better Tomorrow
 2010 - Age Strong! Live Long!
 2011 – Older Americans: Connecting the Community
 2012 – Never Too Old to Play
The Geriatric I’s
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Immobility
Instability
Incontinence
Intellectual Impairment
Impairment of vision and
hearing
• Irritable colon
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•
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Inanition
Impecunity
Iatrogenesis
Insomnia
Immune deficiency
Impotence
Isolation
Acute vs. Chronic Disease
ACUTE
• Rapid onset
• Amenable to quick
diagnosis and
restorative measures
• Can be completely
removed from the body
CHRONIC
• Insidious onset
• Often easily diagnosed,
can be ameliorated but
effects cannot
necessarily be removed
• Usually a long term or
life long condition
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Acute Conditions in Older Adults
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•
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Resistance (immune response) is lower
More debilitating
Recuperative capacity is lower
Older adults have 3x more days of restricted
activities compared to younger (17-44 year olds)
• Older adults have more days spent “sick in bed” –
one study showed an average of 14 days
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Chronic Disease and Aging
http://www.silverbook.org/ The Cost of Chronic Disease
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The Impact of Stress, Chronic
Disease, and Pain
• Stress
– 43% of adults suffer adverse health effects from stress
– 75%-90% of all doctor’s visits are for stress-related ailments
– Costs businesses $300 billion a year (OSHA estimate)
• Chronic disease
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50%+ of U.S. health expenditures are related to 5 chronic conditions (mood disorders,
diabetes, heart disease, asthma, high blood pressure)
$1 trillion a year: cost to the economy
20% of Medicare recipients have 5 or more conditions, accounting for two-thirds of
Medicare expenditures
• Pain
– 40 million visits to health care providers are for pain
– $100 billion a year in health care expenditures and lost productivity
-- Shari Dwyer (Inside AARP)
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Chronic Conditions of Older Adults
Percent (%)
Percent of Persons Age 65 and Over (age-adjusted) Reporting Selected
Chronic Conditions by Sex, 2004-2005
Data Source: National Health Interview Survey
http://www.bandwidthonline.org/find-data.asp#tgm
Trends in Health and Aging
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Prevalence of Chronic Disease
• At least 80% of
Americans have at least
one chronic disease
• 50% have at least two
chronic diseases
http://www.cdc.gov/aging/pdf/saha_2007.pdf
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Multiple Chronic Conditions
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Multiple Chronic Conditions
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Chronic Disease and Mortality
http://www.cdc.gov/aging/pdf/saha_2007.pdf
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Alabama Has High Rates
of Chronic Disease
http://www.bandwidthonline.org/find-data.asp#tgm
Trends in Health and Aging
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Chronic Disease and
Activity Limitation
• 25% of individuals (all
ages) with chronic
illness also have
activity limitations
• Chronic conditions
limit the activities of
about 12 million
seniors who live at
home.
Partnership for Solutions 2004, Chronic Conditions:
Making the case for ongoing care
National Center for Chronic Disease Prevention and
Health Promotion 2005, Healthy Aging
http://www.silverbook.org/ The Cost of Chronic Disease
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Fair/Poor Health of 65+
Percent of Non-institutionalized Persons Age 65 and Over
(age-adjusted) Reporting Fair to Poor Health by Race/Ethnicity, 1982-2005
60
Percent (%)
50
40
30
20
10
0
1982
1985
1990
White non-Hispanic
1995
Hispanic
2000
2005
Black non-Hispanic
Data Source: National Health Interview Survey
http://www.bandwidthonline.org/find-data.asp#tgm
Trends in Health and Aging
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IADL and ADL Difficulty
Percent of Medicare Beneficiaries Reporting Difficulty with
IADLs or ADLs by Age, 2004
35
30
Percent (%)
25
IADL Only
1 to 2 ADLs
3 to 6 ADLs
20
15
10
5
0
65-74
75-84
85 years and over
Data Source: Medicare Current Beneficiary Survey
http://www.bandwidthonline.org/find-data.asp#tgm
Trends in Health and Aging
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Chronic Conditions and Age
• Cancer
• Cardiovascular Disease and
Stroke
• Diabetes
• Neurological Disease
– Alzheimer’s
– Parkinson’s
• Comorbidity
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Older Adults Report Good Health
Percent Reporting Good to Excellent Health
Age
White
Black
Hispanic
65-74
80
66
66
75-84
75
59
60
85+
68
54
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Older Americans: Key Indicators of Well-Being, 2010
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A Typical Older Adult
?
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