Older Adults

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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 racesWhiteBlack or African Americana
Specified age and yearBoth sexesMaleFemaleBoth sexesMaleFemaleBoth sexesMaleFemale
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 birthRemaining life expectancy in years
1900b,c47.346.348.347.646.648.733.032.533.5
1950c68.265.671.169.166.572.260.859.162.9
1960c69.766.673.170.667.474.163.661.166.3
197070.867.174.771.768.075.664.160.068.3
198073.770.077.474.470.778.168.163.872.5
199075.471.878.876.172.779.469.164.573.6
199575.872.578.976.573.479.669.665.273.9
199676.173.179.176.873.979.770.266.174.2
199776.573.679.477.174.379.971.167.274.7
199876.773.879.577.374.580.071.367.674.8
199976.773.979.477.374.679.971.467.874.7
200077.074.379.777.674.980.171.968.375.2
200177.274.479.877.775.080.272.268.675.5
200277.374.579.977.775.180.372.368.875.6
200377.574.880.178.075.380.572.769.076.1
200477.875.280.478.375.780.873.169.576.3
At 65 years
1950c13.912.815.012.815.113.912.914.9
1960c14.312.815.814.412.915.913.912.715.1
197015.213.117.015.213.117.114.212.515.7
198016.414.118.316.514.218.415.113.016.8
199017.215.118.917.315.219.115.413.217.2
199517.415.618.917.615.719.115.613.617.1
199617.515.719.017.615.819.115.813.917.2
199717.715.919.217.816.019.316.114.217.6
199817.816.019.217.816.119.316.114.317.4
199917.716.119.117.816.119.216.014.317.3
200018.016.219.318.016.319.416.214.217.7
200118.116.419.418.216.519.516.414.417.9
200218.216.619.518.216.619.516.614.618.0
200318.416.819.818.516.919.817.014.918.5
200418.717.120.018.717.220.017.115.218.6
At 75 years
198010.48.811.510.48.811.59.78.310.7
199010.99.412.011.09.412.010.28.611.2
199511.09.711.911.19.712.010.28.811.1
199611.19.812.011.19.812.010.39.011.2
199711.29.912.111.29.912.110.79.311.5
199811.310.012.211.310.012.210.59.211.3
199911.210.012.111.210.012.110.49.211.1
200011.410.112.311.410.112.310.79.211.6
200111.510.212.411.510.212.310.89.311.7
200211.510.312.411.510.312.310.99.511.7
200311.810.512.611.710.512.611.49.812.4
200411.910.712.811.910.712.811.49.912.2
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 age200020102020203020402050
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
Total282,125308,936335,805363,584391,946419,854
0419,21821,42622,93224,27226,29928,080
51961,33161,81065,95570,83275,32681,067
2044104,075104,444108,632114,747121,659130,897
456462,44081,01283,65382,28088,61193,104
658430,79434,12047,36361,85064,64065,844
85+4,2676,1237,2699,60315,40920,861
Male
Total138,411151,815165,093178,563192,405206,477
049,83110,94711,71612,39913,43714,348
51931,45431,62233,70436,19938,49641,435
204452,29452,73254,96658,00061,45066,152
456430,38139,50240,96640,62243,96146,214
658413,21215,06921,33728,00329,48830,579
85+1,2401,9422,4033,3405,5737,749
Female
Total143,713157,121170,711185,022199,540213,377
049,38710,47911,21611,87312,86313,732
51929,87730,18732,25134,63336,83139,632
204451,78151,71153,66656,74760,20964,745
456432,05941,51042,68741,65844,65046,891
658417,58219,05126,02633,84835,15235,265
85+3,0284,1824,8666,2639,83613,112
Percent of total
Total
Total100.0100.0100.0100.0100.0100.0
046.86.96.86.76.76.7
51921.720.019.619.519.219.3
204436.933.832.331.631.031.2
456422.126.224.922.622.622.2
658410.911.014.117.016.515.7
85+1.52.02.22.63.95.0
Male
Total100.0100.0100.0100.0100.0100.0
047.17.27.16.97.06.9
51922.720.820.420.320.020.1
204437.834.733.332.531.932.0
456421.926.024.822.722.822.4
65849.59.912.915.715.314.8
85+0.91.31.51.92.93.8
Female
Total100.0100.0100.0100.0100.0100.0
046.56.76.66.46.46.4
51920.819.218.918.718.518.6
204436.032.931.430.730.230.3
456422.326.425.022.522.422.0
658412.212.115.218.317.616.5
85+2.12.72.93.44.96.1

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]
TotalMaleFemale
Characteristic199020002005200619902000200520061990200020052006
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)29.632.635.235.512.313.915.115.217.218.720.020.3
Percent distribution
Marital status
Never married4.63.94.13.64.24.24.43.84.93.63.93.6
Married56.157.257.757.876.575.274.975.041.443.844.744.9
Spouse present54.154.654.854.774.272.671.771.939.741.342.041.9
Spouse absent2.02.62.93.02.32.63.23.11.72.52.73.0
Widowed34.232.130.329.914.214.413.713.148.645.342.942.4
Divorced5.06.77.98.75.06.17.08.15.17.28.59.1
Educational attainment
Less than ninth grade28.516.713.413.030.017.813.213.027.515.913.512.9
Completed 9th to 12th grade, but no
high school diploma16.1a13.812.711.915.7a12.711.911.016.4a14.713.312.5
High school graduate32.9b35.936.336.729.0b30.431.632.935.6b39.939.939.5
Some college or associate's degree10.9c18.018.719.010.8c17.818.417.411.0c18.219.020.2
Bachelor's or advanced degree11.6d15.618.919.514.5d21.424.925.69.5d11.414.314.9
Labor force participatione
Employed11.512.414.515.015.916.919.119.88.49.111.111.4
Unemployed0.40.40.50.40.50.60.70.60.30.30.40.3
Not in labor force88.187.284.984.683.682.580.279.791.390.688.588.3
Percent below poverty levelf11.49.79.810.17.86.97.07.313.911.811.912.3

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]
19802004
Age and rank orderCause of deathDeathsCause of deathDeaths
Under 1 year
All causes45,526All causes27,936
1Congenital anomalies9,220Congenital malformations, deformations and chromosomal abnormalities5,622
2Sudden infant death syndrome5,510Disorders related to short gestation and low birth weight, not elsewhere classified4,642
3Respiratory distress syndrome4,989Sudden infant death syndrome2,246
4Disorders relating to short gestation and unspecified low birthweight3,648Newborn affected by maternal complications of pregnancy1,715
5New born affected by maternal complications of pregnancy1,572Unintentional injuries1,052
6Intrauterine hypoxia and birth asphyxia1,497Newborn affected by complications of placenta, cord and membranes1,042
7Unintentional injuries1,166Respiratory distress of newborn875
8Birth trauma1,058Bacterial sepsis of newborn827
9Pneumonia and influenza1,012Neonatal hemorrhage616
10New born affected by complications of placenta, cord, and membranes985Diseases of circulatory system593
14 years
All causes8,187All causes4,785
1Unintentional injuries3,313Unintentional injuries1,641
2Congenital anomalies1,026Congenital malformations, deformations and chromosomal abnormalities569
3Malignant neoplasms573Malignant neoplasms399
4Diseases of heart338Homicide377
5Homicide319Diseases of heart187
6Pneumonia and influenza267Influenza and pneumonia119
7Meningitis223Septicemia84
8Meningococcal infection110Certain conditions originating in the perinatal period61
9Certain conditions originating in the perinatal period84In situ neoplasms, benign neoplasms and neoplasms of uncertain or unknown behavior53
10Septicemia71Chronic lower respiratory diseases48
514 years
All causes10,689All causes6,834
1Unintentional injuries5,224Unintentional injuries2,666
2Malignant neoplasms1,497Malignant neoplasms1,019
3Congenital anomalies561Congenital malformations, deformations and chromosomal abnormalities389
4Homicide415Homicide329
5Diseases of heart330Suicide285
6Pneumonia and influenza194Diseases of heart245
7Suicide142Chronic lower respiratory diseases120
8Benign neoplasms104In situ neoplasms, benign neoplasms and neoplasms of uncertain or unknown behavior84
9Cerebrovascular diseases95Influenza and pneumonia82
10Chronic obstructive pulmonary diseases85Cerebrovascular diseases77
1524 years
All causes49,027All causes33,421
1Unintentional injuries26,206Unintentional injuries15,449
2Homicide6,537Homicide5,085
3Suicide5,239Suicide4,316
4Malignant neoplasms2,683Malignant neoplasms1,709
5Diseases of heart1,223Diseases of heart1,038
6Congenital anomalies600Congenital malformations, deformations and chromosomal abnormalities483
7Cerebrovascular diseases418Cerebrovascular diseases211
8Pneumonia and influenza348Human immunodeficiency virus (HIV) disease191
9Chronic obstructive pulmonary diseases141Influenza and pneumonia185
10Anemias133Chronic lower respiratory diseases179

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]
19802004
Age and rank orderCause of deathDeathsCause of deathDeaths
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 causes108,658All causes126,230
1Unintentional injuries26,722Unintentional injuries29,503
2Malignant neoplasms17,551Malignant neoplasms18,356
3Diseases of heart14,513Diseases of heart16,088
4Homicide10,983Suicide11,712
5Suicide9,855Homicide7,479
6Chronic liver disease and cirrhosis4,782Human immunodeficiency virus (HIV) disease6,294
7Cerebrovascular diseases3,154Chronic liver disease and cirrhosis3,108
8Diabetes mellitus1,472Cerebrovascular diseases2,928
9Pneumonia and influenza1,467Diabetes mellitus2,625
10Congenital anomalies817Influenza and pneumonia1,194
4564 years
All causes425,338All causes442,394
1Diseases of heart148,322Malignant neoplasms146,476
2Malignant neoplasms135,675Diseases of heart101,169
3Cerebrovascular diseases19,909Unintentional injuries26,593
4Unintentional injuries18,140Diabetes mellitus16,347
5Chronic liver disease and cirrhosis16,089Cerebrovascular diseases16,147
6Chronic obstructive pulmonary diseases11,514Chronic lower respiratory diseases15,265
7Diabetes mellitus7,977Chronic liver disease and cirrhosis14,065
8Suicide7,079Suicide10,917
9Pneumonia and influenza5,804Nephritis, nephrotic syndrome and nephrosis6,030
10Homicide4,019Septicemia5,996
65 years and over
All causes1,341,848All causes1,755,669
1Diseases of heart595,406Diseases of heart533,302
2Malignant neoplasms258,389Malignant neoplasms385,847
3Cerebrovascular diseases146,417Cerebrovascular diseases130,538
4Pneumonia and influenza45,512Chronic lower respiratory diseases105,197
5Chronic obstructive pulmonary diseases43,587Alzheimer's disease65,313
6Atherosclerosis28,081Diabetes mellitus53,956
7Diabetes mellitus25,216Influenza and pneumonia52,760
8Unintentional injuries24,844Nephritis, nephrotic syndrome and nephrosis35,105
9Nephritis, nephrotic syndrome, and nephrosis12,968Unintentional injuries35,020
10Chronic liver disease and cirrhosis9,519Septicemia25,644

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 age1950a,b1960a,b1970b1980b19902000c20032004
All personsDeaths per 100,000 resident population
All ages, age-adjustedc586.8559.0492.7412.1321.8257.6232.3217.0
All ages, crude355.5369.0362.0336.0289.5252.6235.6222.2
Under 1 year3.56.613.122.820.113.011.010.3
14 years1.31.31.72.61.91.21.21.2
514 years2.11.30.80.90.90.70.60.6
1524 years6.84.03.02.92.52.62.72.5
2534 years19.415.611.48.37.67.48.27.9
3544 years86.474.666.744.631.429.230.729.3
4554 years308.6271.8238.4180.2120.594.292.590.2
5564 years808.1737.9652.3494.1367.3261.2233.2218.8
6574 years1,839.81,740.51,558.21,218.6894.3665.6585.0541.6
7584 years4,310.14,089.43,683.82,993.12,295.71,780.31,611.11,506.3
85 years and over9,150.69,317.87,891.37,777.16,739.95,926.15,278.44,895.9
Male
All ages, age-adjustedd697.0687.6634.0538.9412.4320.0286.6267.9
All ages, crude423.4439.5422.5368.6297.6249.8235.0222.8
Under 1 year4.07.815.125.521.913.312.110.9
14 years1.41.41.92.81.91.41.11.1
514 years2.01.40.91.00.90.80.70.6
1524 years6.84.23.73.73.13.23.43.2
2534 years22.920.115.211.410.39.610.510.5
3544 years118.4112.7103.268.748.141.442.840.9
4554 years440.5420.4376.4282.6183.0140.2136.2132.3
5564 years1,104.51,066.9987.2746.8537.3371.7331.7312.8
6574 years2,292.32,291.32,170.31,728.01,250.0898.3785.3723.8
7584 years4,825.04,742.44,534.83,834.32,968.22,248.12,030.31,893.6
85 years and over9,659.89,788.98,426.28,752.77,418.46,430.05,621.55,239.3
Female
All ages, age-adjustedd484.7447.0381.6320.8257.0210.9190.3177.3
All ages, crude288.4300.6304.5305.1281.8255.3236.2221.6
Under 1 year2.95.410.920.018.312.59.89.7
14 years1.21.11.62.51.91.01.31.2
514 years2.21.20.80.90.80.50.50.6
1524 years6.73.72.32.11.82.12.11.7
2534 years16.211.37.75.35.05.25.75.2
3544 years55.138.232.221.415.117.218.617.7
4554 years177.2127.5109.984.561.049.850.249.6
5564 years510.0429.4351.6272.1215.7159.3141.9131.5
6574 years1,419.31,261.31,082.7828.6616.8474.0417.5388.6
7584 years3,872.03,582.73,120.82,497.01,893.81,475.11,331.11,245.6
85 years and over8,796.19,016.87,591.87,350.56,478.15,720.95,126.74,741.5
White male e
All ages, age-adjustedd700.2694.5640.2539.6409.2316.7282.9264.6
All ages, crude433.0454.6438.3384.0312.7265.8249.5236.5
4554 years423.6413.2365.7269.8170.6130.7125.3122.2
5564 years1,081.71,056.0979.3730.6516.7351.8313.2294.4
6574 years2,308.32,297.92,177.21,729.71,230.5877.8761.1703.2
7584 years4,907.34,839.94,617.63,883.22,983.42,247.02,030.11,897.1
85 years and over9,950.510,135.88,818.08,958.07,558.76,560.85,747.25,348.4
Black or African American male e
All ages, age-adjustedd639.4615.2607.3561.4485.4392.5364.3342.1
All ages, crude346.2330.6330.3301.0256.8211.1206.0196.7
4554 years622.5514.0512.8433.4328.9247.2248.1240.0
5564 years1,433.11,236.81,135.4987.2824.0631.2580.9560.2
6574 years2,139.12,281.42,237.81,847.21,632.91,268.81,195.51,096.6
7584 yearsf4,106.13,533.63,783.43,578.83,107.12,597.62,426.62,235.5
85 years and over6,037.95,367.66,819.56,479.65,633.54,850.34,637.3

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 age1950a,b1960a,b1970b1980b19902000c20032004
Deaths per 100,000 resident population
American Indian or Alaska Native male e
All ages, age-adjustedd320.5264.1222.2203.2182.7
All ages, crude130.6108.090.198.591.4
4554 years238.1173.8108.5116.794.1
5564 years496.3411.0285.0293.5260.7
6574 years1,009.4839.1748.2655.6590.0
7584 years2,062.21,788.81,655.71,309.91,252.1
85 years and over4,413.73,860.33,318.33,266.52,812.6
Asian or Pacific Islander male e
All ages, age-adjustedd220.7286.9185.5158.3146.5
All ages, crude119.888.790.686.381.4
4554 years112.070.461.162.756.6
5564 years306.7226.1182.6152.9138.9
6574 years852.4623.5482.5398.3347.7
7584 years2,010.91,642.21,354.71,145.11,047.0
85 years and over5,923.04,617.84,154.23,524.63,416.7
Hispanic or Latino male e,g
All ages, age-adjustedd270.0238.2206.8193.9
All ages, crude91.074.772.270.2
4554 years116.484.379.677.6
5564 years363.0264.8235.6224.6
6574 years829.9684.8625.0572.2
7584 years1,971.31,733.21,543.51,489.0
85 years and over4,711.94,897.53,874.53,496.8
White, not Hispanic or Latino male g
All ages, age-adjustedd413.6319.9286.9268.7
All ages, crude336.5297.5282.9269.1
4554 years172.8134.3129.8126.9
5564 years521.3356.3317.7298.8
74 years1,243.4885.1767.3709.5
7584 years3,007.72,261.92,049.91,915.1
85 years and over7,663.46,606.65,821.05,430.9
White female e
All ages, age-adjustedd478.0441.7376.7315.9250.9205.6185.4172.9
All ages, crude289.4306.5313.8319.2298.4274.5253.8238.3
4554 years141.9103.491.471.250.240.941.140.7
5564 years460.2383.0317.7248.1192.4141.3125.2117.2
6574 years1,400.91,229.81,044.0796.7583.6445.2392.0365.4
7584 years3,925.23,629.73,143.52,493.61,874.31,452.41,315.21,229.1
85 years and over9,084.79,280.87,839.97,501.66,563.45,801.45,193.64,810.4
Black or African American female e
All ages, age-adjustedd536.9488.9435.6378.6327.5277.6253.8236.5
All ages, crude287.6268.5261.0249.7237.0212.6200.0188.3
4554 years525.3360.7290.9202.4155.3125.0124.1121.2
5564 years1,210.2952.3710.5530.1442.0332.8304.7276.0
6574 years1,659.41,680.51,553.21,210.31,017.5815.2712.0656.5
84 years63,499.32,926.92,964.12,707.22,250.91,913.11,699.61,622.9
85 years and over5,650.05,003.85,796.55,766.15,298.74,976.54,534.7
American Indian or Alaska Native female e
All ages, age-adjustedd175.4153.1143.6127.5119.9
All ages, crude80.377.571.975.973.6
4554 years65.262.040.245.449.5
5564 years193.5197.0149.4153.4116.9
6574 years577.2492.8391.8390.3317.4
7584 years1,364.31,050.31,044.1950.3894.1
85 years and over2,893.32,868.73,146.32,284.12,449.1

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 age1950a,b1960a,b1970b1980b19902000c20032004
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-adjustedd132.3149.2115.7104.296.1
All ages, crude57.062.065.068.265.1
4554 years28.617.515.914.813.7
5564 years92.999.068.860.350.7
6574 years313.3323.9229.6207.2205.6
7584 years1,053.21,130.9866.2769.7697.4
85 years and over3,211.04,161.23,367.23,020.02,817.1
Hispanic or Latino female e,g
All ages, age-adjustedd177.2163.7145.8130.0
All ages, crude79.471.569.664.1
4554 years43.528.227.027.0
5564 years153.2111.2102.193.1
6574 years460.4366.3330.6305.5
7584 years1,259.71,169.41,067.0962.7
85 years and over4,440.34,605.83,962.53,421.2
White, not Hispanic or Latino female g
All ages, age-adjustedd252.6206.8187.1175.1
All ages, crude320.0304.9285.1269.1
4554 years50.241.942.442.2
5564 years193.6142.9126.6118.9
6574 years584.7448.5394.8368.6
7584 years1,890.21,458.91,324.01,241.2
85 years and over6,615.25,822.75,232.24,862.4

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 age1950a,b1960a,b1970b1980b19902000c20032004
All personsDeaths per 100,000 resident population
All ages, age-adjustedd180.7177.9147.796.265.360.953.550.0
All ages, crude104.0108.0101.975.057.859.654.251.1
Under 1 year5.14.15.04.43.83.32.53.1
14 years0.90.81.00.50.30.30.30.3
514 years0.50.70.70.30.20.20.20.2
1524 years1.61.81.61.00.60.50.50.5
2534 years4.24.74.52.62.21.51.51.4
3544 years18.714.715.68.56.45.85.55.4
4554 years70.449.241.625.218.716.015.014.9
5564 years194.2147.3115.865.147.941.035.634.3
6574 years554.7469.2384.1219.0144.2128.6112.9107.8
7584 years1,499.61,491.31,254.2786.9498.0461.3410.7386.2
85 years and over2,990.13,680.53,014.32,283.71,628.91,589.21,370.11,245.9
Male
All ages, age-adjustedd186.4186.1157.4102.268.562.454.150.4
All ages, crude102.5104.594.563.446.746.942.940.7
Under 1 year6.45.05.85.04.43.82.83.4
14 years1.10.91.20.40.3*0.30.3
514 years0.50.70.80.30.20.20.20.2
1524 years1.81.91.81.10.70.50.50.5
2534 years4.24.54.42.62.11.51.61.4
3544 years17.514.615.78.76.85.85.85.6
4554 years67.952.244.427.220.517.516.716.7
5564 years205.2163.8138.774.654.347.240.839.5
6574 years589.6530.7449.5258.6166.6145.0127.8121.1
7584 years1,543.61,555.91,361.6866.3551.1490.8431.4402.9
85 years and over3,048.63,643.12,895.22,193.61,528.51,484.31,236.01,118.1
Female
All ages, age-adjustedd175.8170.7140.091.762.659.152.348.9
All ages, crude105.6111.4109.085.968.471.865.161.2
Under 1 year3.73.24.03.83.12.72.22.8
14 years0.70.70.70.50.30.40.3*
514 years0.40.60.60.30.20.20.10.2
1524 years1.51.61.40.80.60.50.50.5
2534 years4.34.94.72.62.21.51.41.4
3544 years19.914.815.68.46.15.75.35.1
4554 years72.946.339.023.317.014.513.413.1
5564 years183.1131.895.356.842.235.330.929.5
6574 years522.1415.7333.3188.7126.7115.1100.596.6
7584 years1,462.21,441.11,183.1740.1466.2442.1396.8374.9
85 years and over2,949.43,704.43,081.02,323.11,667.61,632.01,429.41,303.4
White male e
All ages, age-adjustedd182.1181.6153.798.765.559.851.748.1
All ages, crude100.5102.793.563.146.948.444.241.8
4554 years53.740.935.621.715.413.612.912.8
5564 years182.2139.0119.964.045.739.733.332.4
6574 years569.7501.0420.0239.8152.9133.8117.3110.8
7584 years1,556.31,564.81,361.6852.7539.2480.0422.4393.7
85 years and over3,127.13,734.83,018.12,230.81,545.41,490.71,247.01,129.3
Black or African American male e
All ages, age-adjustedd228.8238.5206.4142.0102.289.679.574.9
All ages, crude122.0122.9108.873.053.046.143.241.5
4554 years211.9166.1136.182.168.449.546.944.8
5564 years522.8439.9343.4189.7141.7115.4112.1107.4
6574 years783.6899.2780.1472.3326.9268.5237.4235.2
7584 yearsf1,504.91,475.21,445.71,066.3721.5659.2588.9551.0
85 years and over2,700.01,963.11,873.21,421.51,458.81,180.31,061.0

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 age1950a,b1960a,b1970b1980b19902000c20032004
Deaths per 100,000 resident population
American Indian or Alaska Native male e
All ages, age-adjustedd66.444.346.134.935.0
All ages, crude23.116.016.815.615.6
4554 years* *13.315.514.0
5564 years72.039.848.630.729.9
6574 years170.5120.3144.7101.4109.4
7584 years523.9325.9373.3280.7312.0
85 years and over1,384.7949.8834.9596.9559.5
Asian or Pacific Islander male e
All ages, age-adjustedd71.459.158.048.544.2
All ages, crude28.723.327.226.024.3
4554 years17.015.615.014.719.2
5564 years59.951.849.342.236.8
6574 years197.9167.9135.6128.3102.6
7584 years619.5483.9438.7355.7350.8
85 years and over1,399.01,196.61,415.61,093.0969.0
Hispanic or Latino male e,g
All ages, age-adjustedd46.550.543.041.5
All ages, crude15.615.814.915.0
4554 years20.018.118.117.5
5564 years49.248.843.542.9
6574 years126.4136.1113.9114.4
7584 years356.6392.9337.1323.3
85 years and over866.31,029.9837.4778.9
White, not Hispanic or Latino male g
All ages, age-adjustedd66.359.951.948.2
All ages, crude50.653.949.747.0
4554 years14.913.012.112.1
5564 years45.138.732.131.1
6574 years154.5133.1116.9110.0
7584 years547.3482.3426.0396.9
85 years and over1,578.71,505.91,264.21,145.3
White female e
All ages, age-adjustedd169.7165.0135.589.060.357.350.547.2
All ages, crude103.3110.1109.888.671.676.969.565.3
4554 years55.033.830.518.613.511.210.010.1
5564 years156.9103.078.148.635.830.225.825.1
6574 years498.1383.3303.2172.5116.1107.392.189.0
7584 years1,471.31,444.71,176.8728.8456.5434.2389.9366.8
85 years and over3,017.93,795.73,167.62,362.71,685.91,646.71,442.11,315.7
Black or African American female e
All ages, age-adjustedd238.4232.5189.3119.684.076.269.865.5
All ages, crude128.3127.7112.277.860.758.354.851.9
4554 years248.9166.2119.461.844.138.136.033.9
5564 years567.7452.0272.4138.496.976.471.865.0
6574 years754.4830.5673.5361.7236.7190.9175.3166.8
7584 yearsf1,496.71,413.11,338.3917.5595.0549.2498.3489.5
85 years and over2,578.92,210.51,891.61,495.21,556.51,414.21,270.7
American Indian or Alaska Native female e
All ages, age-adjustedd51.238.443.734.235.1
All ages, crude22.019.321.519.921.3
4554 years**14.414.610.
5564 years*40.737.926.024.5
6574 years128.3100.579.594.8110.9
7584 years404.2282.0391.1304.7258.8
85 years and over1,095.5776.2931.5569.1710.1

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-adjustedd60.854.949.142.638.9
All ages, crude26.424.328.728.827.0
4554 years20.319.713.312.610.5
5564 years43.742.133.330.828.1
6574 years136.1124.0102.895.678.1
7584 years446.6396.6386.0330.2312.5
85 years and over1,545.21,395.01,246.61,042.4979.9
Hispanic or Latino female e,g
All ages, age-adjustedd43.743.038.135.4
All ages, crude20.119.418.617.9
4554 years15.212.411.711.8
5564 years38.531.927.827.7
6574 years102.695.286.083.0
7584 years308.5311.3302.8272.2
85 years and over1,055.31,108.9902.3830.4
White, not Hispanic or Latino female g
All ages, age-adjustedd61.057.650.847.7
All ages, crude77.285.578.273.7
4554 years13.210.99.79.8
5564 years35.729.925.524.7
6574 years116.9107.692.189.0
7584 years461.9438.3393.6371.6
85 years and over1,714.71,661.61,461.31,335.1
TABLE 10.9
Percentage of people age 65 and over with moderate or severe memory impairment, by age and sex, 2002
Both sexesMenWomen
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 over12.714.911.2
65695.17.83.1
70748.210.96.1
757913.617.211.2
808418.821.817.0
85 and over32.133.931.2

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
AgeAll dementiaAlzheimer'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 years712,000332,000
8089 years1,996,0001,493,000
90 years699,000556,000
Total3,407,0002,381,000

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 dementiaAlzheimer's diseaseVascular dementia
AgeCombinedMaleFemaleCombinedMaleFemaleCombinedMaleFemale
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 years4.975.254.762.322.302.330.981.270.76
8089 years24.1917.6827.8418.1012.3321.344.093.584.38
90 years37.3644.5934.6929.7033.8928.156.198.145.46
Total13.9311.1415.749.747.0511.482.432.342.48
TABLE 10.12
Sex ratio for population 25 years and over by age, 2000 and 2030
[Men per 100 women]
20002030
Country25 to 54 years55 to 64 years65 to 69 years70 to 74 years75 to 79 years80 years and over25 to 54 years55 to 64 years65 to 69 years70 to 74 years75 to 79 years80 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 States989185797252989289868164

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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