More than 37 million “baby boomer” adults born between 1946 and 1964 (60 percent) will manage more than 1 chronic condition by 2030.
Older adults are at high risk for developing chronic illnesses and related disabilities. These chronic conditions include:
- Diabetes mellitus
- Congestive heart failure
Many experience hospitalizations, nursing home admissions, and low-quality care. They also may lose the ability to live independently at home. Chronic conditions are the leading cause of death among older adults.
Interview an older adult who has a chronic illness and related disability.
- what it is like to deal with the health care system in order to manage the illness
- quality of life and the impact the illness has on daily activities
Why Is the Health of Older Adults Important?
- Preventive health services are valuable for maintaining the quality of life and wellness of older adults. In fact, the Patient Protection and Affordable Care Act of 2010 includes provisions related to relevant Medicare services. However, preventive services are underused, especially among certain racial and ethnic groups.
- Ensuring quality health care for older adults is difficult, but the Centers for Medicare & Medicaid Services (CMS) has programs designed to improve physician, hospital, and nursing home care, among others.
- Older adults use many health care services, have complex conditions, and require professional expertise that meets their needs. Most providers receive some type of training on aging, but the percentage of those who actually specialize in this area is small. More certified specialists are needed to meet the needs of this group.
Quality of Life
- Through programs that address chronic illnesses, Federal Government agencies are improving the quality of life for older adults. To combat existing health disparities, many of these programs target minorities and underserved populations.
- The ability to complete basic daily activities may decrease if illness, chronic disease, or injury limit physical or mental abilities of older adults. These limitations make it hard for older adults to remain at home. Early prevention and physical activity can help prevent such declines. Unfortunately, less than 20 percent of older adults engage in enough physical activity, and fewer do strength training. Minority populations often have lower rates of physical activity.
- Most older adults want to remain in their communities as long as possible. Unfortunately, when they acquire disabilities, there is often not enough support available to help them. States that invest in such services show lower rates of growth in long-term care expenditures.
- Each year, 1 out of 3 older adults falls. Falls often cause severe disability among survivors. Injuries from falls lead to:
- Fear of falling
- Sedentary behavior
- Impaired function
- Lower quality of life
Falls are the leading cause of death due to unintentional injury among older adults; deaths and injuries can be prevented by addressing risk factors.
- Caregivers for older adults living at home are typically unpaid family members. Caregiver stress often results in unnecessary nursing home placement.
- One to 2 million older adults in the United States are injured or mistreated by a loved one or a caregiver. A measure of elder abuse has been added to encourage data collection on this issue.
Understanding the Health of Older Adults
The Healthy People 2020 objectives on older adults are designed to promote healthy outcomes for this population. Many factors affect the health, function, and quality of life of older adults.
Individual Behavioral Determinants of Health in Older Adults
Behaviors such as participation in physical activity, self-management of chronic diseases, or use of preventive health services can improve health outcomes.
Social Environment Determinants of Health in Older Adults
Housing and transportation services affect the ability of older adults to access care. People from minority populations tend to be in poorer health and use health care less often than people from nonminority populations.
Health Services-Related Determinants of Health in Older Adults
The quality of the health and social services available to older adults and their caregivers affects their ability to manage chronic conditions and long-term care needs effectively.
Emerging Issues in the Health of Older Adults
Emerging issues for improving the health of older adults include efforts to:
- Coordinate care.
- Help older adults manage their own care.
- Establish quality measures.
- Identify minimum levels of training for people who care for older adults.
- Research and analyze appropriate training to equip providers with the tools they need to meet the needs of older adults.
There is growing recognition that data sources are limited for certain subpopulations of older adults, including the aging lesbian, gay, bisexual, and transgender populations. Research for these groups will inform future health and policy initiatives.
Chronic Diseases among Older Adults
Chronic diseases are long-term illnesses that are rarely cured. Chronic diseases such as heart disease, stroke, cancer, and diabetes are among the most common and costly health conditions. Chronic health conditions negatively affect quality of life, contributing to declines in functioning and the inability to remain in the community. Many chronic conditions can be prevented or modified with behavioral interventions. Six of the seven leading causes of death among older Americans are chronic diseases.
As shown in the bar chart above, the prevalence of certain chronic conditions differs by sex. Women report higher levels of arthritis and hypertension than men. Men report higher levels of heart disease and cancer.
There are differences by race and ethnicity in the prevalence of certain chronic conditions. In 2007–2008, among people age 65 and over, non-Hispanic blacks report higher levels of hypertension and diabetes than non-Hispanic whites (71 percent compared with 54 percent for hypertension and 30 percent compared with 16 percent for diabetes). Hispanics also report higher levels of diabetes than non-Hispanic whites (27 percent compared with 16 percent), but lower levels of arthritis (42 percent compared with 51 percent).
Arthritis, Osteoporosis, and Chronic Back Conditions
Arthritis, osteoporosis, and chronic back conditions all have major effects on quality of life, the ability to work, and basic activities of daily living.
There are more than 100 types of arthritis. Arthritis commonly occurs with other chronic conditions, such as diabetes, heart disease, and obesity. Interventions to treat the pain and reduce the functional limitations from arthritis are important, and may also enable people with these other chronic conditions to be more physically active.
Osteoporosis is a disease marked by reduced bone strength leading to an increased risk of fractures (broken bones). Chronic back pain (CBP) is common, costly, and potentially disabling.
Arthritis affects 1 in 5 adults and continues to be the most common cause of disability. It costs more than $128 billion per year. All of the human and economic costs are projected to increase over time as the population ages.
There are interventions that can reduce arthritis pain and functional limitations, but they remain underused. These include:
- Increased physical activity
- Self-management education
- Weight loss among overweight/obese adults
In the United States, an estimated 5.3 million people aged 50 years and older have osteoporosis. Most of these people are women, but about 0.8 million are men. Just over 34 million more people, including 12 million men, have low bone mass, which puts them at increased risk for developing osteoporosis. Half of all women and as many as 1 in 4 men aged 50 years and older will have an osteoporosis-related fracture in their lifetime.
Chronic Back Conditions
About 80 percent of Americans experience low back pain (LBP) in their lifetime. It is estimated that each year:
- 15-20 percent of the population develop protracted back pain.
- 2-8 percent have chronic back pain (pain that lasts more than 3 months).
- 3-4 percent of the population is temporarily disabled due to back pain.
- 1 percent of the working-age population is disabled completely and permanently as a result of LBP.
Americans spend at least $50 billion each year on LBP. LBP is the:
- Second leading cause of lost work time (after the common cold)
- Third most common reason to undergo a surgical procedure
- Fifth most frequent cause of hospitalization
Understanding Arthritis, Osteoporosis, and Chronic Back Conditions
Many factors determine the pain, function, and quality of life of those with arthritis. Greater physical activity can reduce pain and improve function. However, physical activity remains an underused intervention, even though there are a variety of programs to help people with arthritis increase physical activity safely and with little pain. Self-management education can achieve similar positive outcomes by teaching people skills and techniques to deal with the day-to-day issues that result from arthritis. Weight loss among those who are overweight or obese also helps reduce symptoms of arthritis.
There are many factors that contribute to osteoporosis and fractures. Nutrition and physical activity are important modifiable (controllable) risk factors. Family history and personal history of fractures are also risk factors for osteoporosis.
Chronic Back Conditions
CBP is often progressive and its cause(s) can be difficult to determine. Most important, previous studies have shown that patients with CBP make up at least 90 percent of total spending on the treatment of lower back pain.
Emerging Issues in Arthritis, Osteoporosis, and Chronic Back Conditions
Several emerging issues may warrant future Healthy People objectives for arthritis, osteoporosis, and chronic back conditions.
- Fatigue is a clinically important symptom of many types of arthritis and other rheumatic conditions. It is often just as problematic as pain.
- Early diagnosis of inflammatory types of arthritis is of growing importance, because the early use of disease-modifying anti-rheumatic drugs has resulted in much more successful treatment of these conditions. There is a continuing effort to develop early biomarkers (both biochemical and imaging markers) of arthritis, osteoporosis, and chronic back conditions to allow adequate and early assessment and treatment of these conditions.
- Worksite accommodation will become a greater issue as the number of working-age people with arthritis and chronic back conditions increases.
- Social participation, an important part of the World Health Organization (WHO) International Classification of Functioning, Disability, and Health (ICF), should be measured for people with arthritis and other chronic conditions.
- Anxiety and depression re frequently observed outcomes associated with chronic conditions such as arthritis, osteoporosis, and chronic back conditions.
- Better measures of arthritis and chronic back pain self-management education will help focus intervention efforts.
- A greater availability of health-related quality-of-life measures will be important in order to monitor nonfatal, but chronic, disabling conditions such as arthritis, osteoporosis, and chronic back conditions.
Dementias, Including Alzheimer’s Disease
Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—to such an extent that it interferes with a person’s daily life. Dementia is not a disease itself, but rather a set of symptoms. Memory loss is a common symptom of dementia, although memory loss by itself does not mean a person has dementia. Alzheimer’s disease is the most common cause of dementia, accounting for the majority of all diagnosed cases.
Diagnosis of dementia is key to effective treatment and care. It is important to distinguish dementia from temporary, reversible conditions that may cause loss of cognitive functioning. Temporary, reversible conditions include:
- Series of strokes
- Side effects from medication
- Chronic alcoholism
- Some tumors and infections in the brain
- Vitamin B12 deficiency
These conditions are not dementia, but they can be serious and should be treated by a doctor as soon as possible.
Why Are Dementias, Including Alzheimer’s Disease, Important?
Alzheimer’s disease is the 6th leading cause of death among adults aged 18 years and older. Estimates vary, but experts suggest that up to 5.1 million Americans aged 65 years and older have Alzheimer’s disease. These numbers are predicted to more than double by 2050 unless more effective ways to treat and prevent Alzheimer’s disease are found.
Dementia affects an individual’s health, quality of life, and ability to live independently. It can diminish a person’s ability to effectively:
- Manage medications and medical conditions.
- Maintain a bank account.
- Drive a car or use appliances safely.
- Avoid physical injury.
- Maintain social relationships.
- Carry out activities of daily living, such as bathing or dressing.
People living with dementia are at greater risk for general disability and experience frequent injury from falls. Older adults with dementia are 3 times more likely to have preventable hospitalizations. As their dementia worsens, people need more health services and, oftentimes, long-term care. Many individuals requiring long-term care experience major personal and financial challenges that affect their families, their caregivers, and society.
There are important steps to take to improve the identification of and care for people with dementia. These include:
- Increasing the availability of existing effective diagnostic tools.
- Decreasing the number of people with undiagnosed dementia.
- Reducing the severity of symptoms through better medical management.
- Supporting family caregivers with social, behavioral, and legal resources.
- Encouraging healthy behaviors to reduce the risk of co-occurring conditions.
Understanding Dementias, Including Alzheimer’s Disease
Several factors determine the risk of developing dementia, including age and family history. Other factors affect the management of dementia by families, communities, and the health care system.
Aging is a well-known risk factor for Alzheimer’s disease and other types of dementias. Among adults aged 65 years and older, the prevalence of Alzheimer’s disease doubles every 5 years.
People with a family history of Alzheimer’s disease are generally considered to be at greater risk of developing the disease. Researchers have identified 3 genes that are linked to early-onset Alzheimer’s disease. Until recently, only 1 gene had been identified that increases the risk of late-onset Alzheimer’s disease. However, during 2009 and 2010, international teams studying the genetics of Alzheimer’s disease have identified and confirmed 3 new genes that are associated with increased risk of late-onset Alzheimer’s disease.
Many individuals with Alzheimer’s disease or other dementias are undiagnosed. Primary care providers do not routinely test for Alzheimer’s disease. Alzheimer’s disease and other dementias are more often undiagnosed in rural and minority populations than in urban or white populations.
Some chronic conditions are common in people with Alzheimer’s disease and other dementias. Dementias can greatly complicate the medical management of these conditions; this increases the need for coordination of care among different specialists.
Lack of diagnosis seriously reduces a person’s access to available treatments and valuable information. Active medical management, information and support, and coordination of medical and community services have been shown to improve quality and outcomes of care for people with dementia.
Emerging Issues in Dementias, Including Alzheimer’s Disease
Over the past decade, there has been significant scientific progress in understanding and managing dementia, with most of the research focused on Alzheimer’s disease. During the next decade, it will be important that progress be made in:
- Improving the early diagnosis of Alzheimer’s disease and other dementias.
- Developing interventions to delay or prevent Alzheimer’s disease and other dementias.
- Finding better ways to manage dementia when other chronic conditions are present.
- Understanding the influence of lifestyle factors on a person’s risk of cognitive decline and dementia.
Think for Yourself
If you had the opportunity to decide how to spend some limited funding to improve the health of older adults, how would spend it? Why?
- Spend it all on a specific condition?
- Which condition?
- Spend it on prevention, treatment, or cure?
- Spend it on national, state, or local efforts?
Source: Healthy People, http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=31
Chronic Diseases among Older Adults: http://www.agingstats.gov/agingstatsdotnet/Main_Site/Data/2010_Documents/Docs/OA_2010.pdf
Arthritis, Osteoporosis, and Chronic Back Conditions: http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=3
Dementias, Including Alzheimer’s Disease: Healthy People, http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=7