Introduction

Achievements in medicine over the last few decades have increased the life expectancies of millions of Americans who earlier this century would have lost their lives to heart attacks, strokes, cancer and other diseases. The average length of life has increased, changing the demography of the nation. The number of older Americans have increased markedly as a proportion of the population. The old are also getting olderpeople over 75 years of age form the fastest growing segment of the population. In addition, life expectancy has increased more for women than for men, so that women over 65 outnumber men in the same age group. The rise in the age of Americans will have significant implications for the Nation's economy and health care systems.

Demographic Data

As of 1984, approximately 28 million Americans, 11.9% of the population, were 65 or older. A significant change in the age distribution of older Americans is occurring. The 75 plus group is now the fastest growing age segment of the American population.

Women outnumber men in the over 65 age group. In 1984, there were 16.7 million older women and 11.3 million older men, or a sex ratio of 148 women for every 100 men.

Between 1950 and 1983, life expectancy at birth increased for women by 7.0 years (from 71.1 to 78.1 years) and by 5.4 years for men (from 65.6 to 71.0 years).

The racial make-up of the older population in 1983 can be found in the table below.

Socioeconomic Data

In general, older people are less well educated than other adult population groups. However, the median years of school completed by older people has advanced from 8.7 in 1970 to 11.4 years in 1984. Data from 1984 indicate 9% of older people had four or more years of college.

While many people retire from the work force by age 65, 11.6% of men and 4.2% of women 65 and older are employed full-time and 4.3 and 4.0 respectively are employed part-time. (Approximately, 24% of all older people are employed).

In 1984, the median income of older persons was $10,450 for males and $6,020 for females. Compared to 1983, the incomes were 7.7% higher and represented a 3.3% increase in "real" income after adjusting for inflation.

Older people who live with nonrelatives or alone are likely to have less money than those who live with family members or as a member of multi-person households.

In 1984, 21% of people age 65 and over were poor or near poorbelow 125% of the poverty level.

A Louis Harris Associates poll indicated that there is a gap between the commonly held beliefs about old age and the real problems encountered by older people. For example, of people age 18-64, 68% believed older people did not have enough money to live on, and of people age 65 and over, 50% believed this to be the case.

About 5% of older people live in nursing homes. About 71% of elderly men live with their wives, and an additional 7% live with their children or relatives. 36% of elderly women live with their husbands, and 18% live with children or relatives.

While close to 30% of the older population lives alone, the majority of older people are not socially isolated or lonely. More than three-fourths of older people are members of a church or synagogue, and over half belong to voluntary organizations.

The majority of older people who live alone lived close to family with whom they had frequent contact, or talked with them frequently on the phone. Overall, 90% of the people surveyed living alone had gotten together with either family, friends or neighbors during the two weeks prior to the interview. Only 5% reported no contact with family or friends within the two-week period. The study shows that older people are not usually alienated and without social contacts.

Mortality

The leading causes of mortality among older people of different ages are shown in the table below. Diseases of the heart are the leading causes of death, accounting for 49% of the deaths of people age 60 to 64 and increasing to 64% among those age 80 to 84. The next leading causes of death are cancer, stroke, accidents, influenza and pneumonia.

Historical data suggest that improved health care and health practices can reduce the incidence and the rate of mortality from these diseases. Between 1950 and 1979, there was a 27% drop in the age-adjusted mortality rate for the population over 65, and the decline for women was twice as great as that for men. About half of this decrease in mortality was the result of the decline in death rates from heart disease, and another 25% was associated with a decrease in mortality caused by stroke.

Cancer is the only leading major cause of death to have increased, in part because of an increase in lung cancer among women associated with the increased prevalence of cigarette smoking among women.

Morbidity

44% of people age 65 or older suffer from arthritis, 28% have hearing impairments and 12% have visual impairments (NCHS, 1979).

Arthritis, while accounting for relatively few deaths and only 2% of hospital days, is associated with 16% of days spent confined to bed among the elderly.

Noninstitutionalized individuals age 65 and older reported an average of 9 days during 1980 when their activities were restricted because of health problems, and 14 days when they were confined to bed. By comparison, the number of restricted activity days was 26 among people age 45 to 64, and 15 among people age 17-44. The number of bed disability days was 8 among those age 45 to 64, and 5 days among those age 17 to 44.

Risk Factor Prevalence

When driving or riding in a car, only 29% of people age 65 and over wear a seat belt all or most of the time. Of all the age groups, this is the lowest percentage.

Scalds from hot water are a leading cause of burns among older people. Only 33% know the water temperature in their homes.

Exercise rates among older people are the lowest of any age group. 28% of them said they exercise or play sports regularly compared to 55% of those age 18-29.

Older people smoke less than other age groups, but 16% currently smoke. New data indicate that quitting smoking, even at a late age, can result in health benefits.

Alcohol use declines with age. Of people age 65 and over, 43% had at least one drink of beer, wine or liquor during the past year in contrast to 67% for all ages. According to the drinking index, 14% of older adults are light drinkers; 11% are moderate drinkers and 6% are heavy drinkers.

Significant Trends

The number of older Americans is growing. Only 4% of the population in 1900 was elderly whereas today 11.2% are age 65 or older. By 2030, projections indicate that 55 million people, or 18.3% of the population, will be age 65 or older. There will also be a significant change in the age distribution of older Americans. The number of people age 75 or older will probably increase by 71% by the year 2000.

Recent research now indicates that behavior change, even at a late age, may help maintain and improve health status and alleviate some of the chronic conditions experienced by older people. Health education activities have been initiated in this area, and research is continuing to distinguish age-related physiological changes from those associated with disease and behavior.