Older Adults' Health and Age-Related Changes

As with many stereotypes, the stereotypes about aging are often inaccurate. Most older Americans live independently and maintain close relationships with family and friends. Most peoples' personalities remain relatively stable throughout their lives. Depression among noninstitutionalized older adults is less prevalent than depression in younger adults. However, most older adults do experience normal, age-related changes that may affect their lifestyle. Common age-related physical changes include hearing impairment, weakening vision, and the increasing probability of arthritis, hypertension, heart disease, diabetes, and osteoporosis. The speed with which information is encoded, stored, and received may decrease as we age, and older Americans may experience memory loss.

Cognitive changes, which are associated with mental processes such as sensation and perception, memory, intelligence, language, thought, and problem-solving, occur among aging adults.

• Because it may take older adults more time to encode, store, and retrieve information, the rate at which new information is learned can be slower among aging adults, and older adults often have a greater need for repetition of new information. Although it may take older adults longer to input and retrieve new information, daily occupational and social functioning among those over age 65 is not impaired.

• Long-term memory shows substantial changes with age, while short-term memory shows less age-related decline.

• Most aspects of language ability remain strong, yet word-finding ability declines with age. Three-dimensional drawing similarly declines with age.

• Wisdom and creativity often continue to the very end of life.

• Overall prevalence of mental disorders in older adults is less than in any other age group, and general life satisfaction among older Americans is as good as, if not better, than any other age group.

The population of older Americans is getting older, with the number of Americans over age 85 increasing faster than any other group. Since 1900, the proportion of Americans age 65 and older has more than tripled. Life expectancy for men is now 73 years; for women, it is 80 years.

• Our population of older Americans is increasingly more educated. While 34 percent of those over age 65 graduated from high school, that figure will rise to 83 percent by the year 2030.

• Thirteen percent of older adults live in poverty, as compared with 15 percent of Americans under age 65. However, the figure is 33 percent for African-Americans, 22 percent for Hispanics, and 20 percent for adults over age 85.

• Sixty-four percent of older Americans between the ages of 65 and 74 are married and live with a spouse; while of those over age 85, 24 percent are married and live with a spouse, and 48 percent live alone. Among women over age 65, one-half are widowers.

• The primary source of income for those over age 65 is social security benefits.

• Religious affiliation is the most common form of organizational participation among older adults, with 50 percent reporting attending services weekly.

• Two-thirds reported voting in the 1992 presidential election, compared to 50 percent of younger adults.

Today's older Americans are predominantly White, but the demographics of older America will undergo a dramatic transformation in the next few decades.

• The number of older Black Americans will triple by the middle of the next century, moving them from 8 to 10 percent of Americans over age 65.

• The older Hispanic population will increase 11 fold, going from representing fewer than 4 percent of today's older adults to representing nearly 16 percent of older adults.

• There are some major differences in the aging of the minority population as compared to the aging of White Americans. The onset of chronic illness in minorities is usually earlier than in Whites.

• Minorities have a higher incidence of obesity and late onset diabetes.

• Health problems among minorities are underreported to healthcare practitioners.

• Minorities frequently delay seeking health-related treatments.

• Minorities have often been excluded from drug research.

• Some of the factors contributing to poor mental health among minorities include poverty, segregated and disorganized communities, poor education, unemployment, stereotyping, discrimination, and poor healthcare.

A number of physical changes occur as adults reach age 65. The most common are listed below.

• Hearing impairment among older adults is often moderate or mild, yet it is widespread; 48 percent of men and 37 percent of women over age 75 experience hearing difficulties.

• Visual changes among aging adults include problems with reading speed, seeing in dim light, reading small print, and locating objects.

• The amount of time it takes to respond to features in the environment once they are detected is typically slower among older adults.

• The proportion of older adults needing assistance with everyday activities increases with age. Nine percent of those between ages 65 and 69 need personal assistance, while up to 50 percent of older Americans over 85 need assistance with everyday activities.

• The top five causes of death among older adults are heart disease, cancer, cerebrovascular disease (relating to the blood vessels that supply the brain), pneumonia and flu, and chronic obstructive pulmonary disease. In spite of a decline in physical health, two-thirds of older adults who are not living in institutions (such as nursing homes) report their health to be good, very good, or excellent compared with others their age. What's important to remember about people over age 65 is that while many begin to experience some physical limitations, they learn to live with them and lead happy and productive lives.

There are a number of psychological problems associated with aging:

• Dementia, the irreversible deterioration of intellectual ability accompanied by emotional disturbance, afflicts between 5 and 7 percent of adults over age 65 and 30 percent of those over age 85. Unlike milder forms of mental decline with normal aging, dementia may lead to significant impairment in social functioning. People with dementia often suffer from depression, anxiety, and paranoia.

• Six percent of older adults suffer from anxiety disorders, and the most common anxiety diagnosis is generalized anxiety disorder, in which a person experiences dread, apprehension, and tension for a period of at least 6 months.

• The highest suicide rate of any age group is in older adults, primarily older Caucasian men who live alone.

• The incidence of sexual dysfunction increases with age for both men and women.
  Sleep problems increase with age, and about one-half of those over age 80 complain of sleep difficulty.

• Ten to 15 percent of older adults exhibit hypochondriasis, the persistent belief that one has a medical disorder despite the lack of medical findings.

• Prevalence of alcohol abuse and substance dependence among those age 65 and over is 2 to 5 percent for men and 1 percent for women.

• Drug abuse among older adults typically takes the form of prescription medication abuse, and older adults take 25 percent of the medication taken in the United States, which underscores that drug abuse among aging adults is often a result of having too many medications prescribed for them.

• Depression is a negative emotion frequently characterized by sadness, feelings of helplessness, and a sense of loss. Those with depression are likely to have an abrupt onset of symptoms, a history of psychiatric problems, decreased motivation, and a tendency to complain about their memory problems. However, depression among noninstitutionalized older adults is less prevalent than depression in younger adults.

• Behavior disorders in those over age 65 can take the form of physical aggression, motor overactivity (wandering), and disruptive verbal outbursts. Common causes of behavior disorders include delirium, depression, dementia, and psychosis.

• Alzheimer's Disease is a progressive disease that leaves a victim unable to form new memories and is marked by the loss of other mental functions. One of the primary symptoms of Alzheimer's Disease is the inability to recall newly learned information, such as a change of address, and disorientation. The onset of Alzheimer's is often gradual, occurring over a period of 8 to 20 years. At first, victims suffer memory loss and often get lost--even in their own homes. Eventually, they may fail to recognize other people, including family; show childish emotions; and lose the ability to dress and clean themselves.

The vast majority of older Americans remain healthy enough to drive, according to psychologist Karlene Ball, PhD, of the University of Alabama-Birmingham. However, Dr. Ball says there are some signs that an older adult should stop driving.

They include:

• Getting lost;

• Driving exceedingly slower than the flow of traffic;

• Not seeing approaching traffic;

• Being in an accident or noticing that other drivers are always honking at them.

MYTH:	FACT:
Most older people are pretty much alike.	They are a very diverse age group.
They are generally alone and lonely.	Most older adults maintain close contact with family.
They are sick, frail, and dependent on others.	Most older people live independently.
They are often cognitively impaired	For most older adults, if there is decline in some intellectual abilities, it is not severe enough to cause problems in daily living.
They are depressed.	Community dwelling older adults have lower rates of diagnosable depression than younger adults.
They become more difficult and rigid with advancing years.	Personality remains relatively consistent throughout the lifespan.
They barely cope with the inevitable declines associated with aging.	Most older people successfully adjust to the challenges of aging.

Armed with the facts about the myths and realities surrounding aging, society can better prepare itself to assist its older population, as can individual families. Regular mood and memory checkups should be encouraged for all older adults, just as we now encourage regular physicals. What's important to remember is that depression and social isolation are not normal for older Americans--living happily and productively is the norm for today's older adults.