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Living Longer: An Aging America

Americans are living longer because of better heath care prevention and innovative medical technologies and new medications. By 2030, the number of older Americans (60 years and older) will have more than doubled to 70 million – one in every five.¹ This will place tremendous demands on the public healthcare system and medical and social services, as well as the VA health care system. VA’s elderly population (85 years and older) is expected to reach one million by 2006. ²

Americans are living longer than ever before, and many of the elderly are living active, healthy and productive lives. However, many older persons deal with significant issues. For example, 80% percent of those older than 65 years of age have at least one chronic health condition; about 31% of older persons live alone (7.9 million women and 2.6 million men); and the median income of older persons in 2002 was $19,436 for males and $11,406 for females – about 3.6 million older Americans lived below the poverty level. In the same year, more than 12.5 million people older than 65 were discharged from hospitals and spent more than 12% of their income on health care expenditures. ^3,4

While our population ages, with more than 80 million Americans currently older than 50, it is imperative that we focus on healthy aging. Medical research shows that a healthy diet and exercise can reduce the onset of chronic diseases and their risk factors such as high blood pressure, high cholesterol, and obesity. ⁵ Statistics from the Department of Health and Human Services (HHS) show that about 22% of persons 60 years and older are obese. This is important because obesity is linked to diabetes, heart disease, and dementia. ^5,6 In addition, scientists have found that obesity is tied to higher rates of many cancers.⁷

Certain behaviors, no matter one’s age, are risk factors for the nation’s leading causes of death. Important health-related behaviors include regular physical activity, good nutrition, and tobacco use. Nearly 40% of deaths in this country can be attributed to smoking, physical inactivity, poor diet, or alcohol abuse.³

By age 75, about one in three men and one in two women do not engage in any physical activity. Yet regular physical activity significantly decreases the risk of heart disease, colon cancer, diabetes, and high blood pressure. Being physical active also helps:

• Control weight,
• Contributes to healthy bones, muscles, and joints,
• Relieves the pain of arthritis,
• Reduces anxiety and depression symptoms, and
• Can decrease hospitalizations, physician visits, and medications.³

Good nutrition is vital to maintaining good health and can extend the productive life span of older Americans by reducing the rates of chronic diseases such as heart disease, stroke, some cancers, diabetes, and osteoporosis.

Tobacco use is the single most preventable cause of death and disease in the United States. Smoking cessation has major benefits for men and women, regardless of age or whether or not they have a smoking-related disease.

HSR&D has an array of ongoing studies and programs that focus on health care issues important to older veterans. In addition, HSR&D funds the Northwest Center for Outcomes Research in Older Adults in Seattle, WA, as well as the Interdisciplinary Research Program to Improve Care for Older Veterans in San Francisco, CA and the Patient Safety: Safe Mobility for Frail Elderly and Persons with Disabilities program in Tampa, FL. To find out more about any of these any of these programs, visit the HSR&D website at http://www.hsrd.research.va.gov/ . Please see below for a few specific studies.

Cardiovascular disease (CVD) is the leading cause of death and disability among older adults (65 and older). Dietary fiber has been associated with reduced incidence of ischemic heart disease (IHD) and stroke in middle-aged populations; however, the impact of dietary fiber intake on CVD risk has not been evaluated among older adults. To investigate this relationship, researchers prospectively examined the association between dietary fiber intake and the risk of incident CVD in the Cardiovascular Health Study – a population-based, longitudinal cohort study of the determinants of coronary heart disease and stroke among persons age 65 and older. Investigators in the prospective study hypothesized that cereal fiber, but not fruit or vegetable fiber, would lower the risk of incident CVD in their elderly subjects (n = 3588). Dietary intake was assessed using a 99-item food frequency questionnaire that included questions about cereal, fruit and vegetable fiber intake. Potential CVD events were identified during annual examinations and interim 6-month telephone interviews. For this analysis, CVD events included combined incident stroke, fatal and nonfatal myocardial infarction (MI), and coronary heart disease mortality. They also examined ischemic heart disease (IHD) mortality. Findings from this study, led by an HSR&D investigator, showed that during the 8.6 years of follow-up, there were 811 incident CVD events (159 IHD deaths, 308 nonfatal MIs, and 344 strokes). After adjusting for several variables (i.e., age, gender, and exercise), higher cereal intake was associated with lower risk of total stroke and ischemic stroke and with a trend toward lower risk of ischemic heart disease mortality. The main foods contributing to cereal fiber intake were dark breads and high fiber or bran cereals.⁸

Hearing loss is the third most common condition among older Americans: 25% to 40% of those age 65 and older are hearing impaired. Prevalence increases with age, and more than 80% of patients older than 85 suffer a hearing loss. The inability to hear and communicate is strongly associated with depression, functional decline, and dementia, in addition to impacting self-esteem. However, the majority of older patients are not assessed or treated for hearing loss. For example, only 9% of internists offer hearing tests to their patients age 65 and older. Further, only 25% of patients with aidable hearing loss receive hearing aids. Given this, it is important for primary care physicians to screen, recognize, treat, and appropriately refer patients with hearing impairments. Investigators in this study, led by an HSR&DS Career Development Awardee, reviewed more than 1600 articles about the screening and management of hearing loss for older patients in primary care clinics. Their findings show that prompt recognition of reversible hearing loss maximizes possible recovery. The investigators recommend that primary care physicians be vigilant in asking their older patients about possible hearing loss, and in recognizing the symptoms. When disease management lay beyond the scope of the primary care setting, it is important to refer patients to appropriate specialists.⁹

Colorectal cancer is the second leading cause of death from cancer in North America, and identifying important risk factors in people with no symptoms (asymptomatic) can help in the development of risk reduction strategies. A VA prospective, cross-sectional study of 3,121 asymptomatic patients from 13 VA medical centers was conducted to determine risk factors associated with advanced colorectal cancer. All study participants, aged 50 to 75, had undergone a colonoscopy between 1994 and 1997. Complete medical histories and dietary information were obtained for 299 participants with advanced polyps, 30 participants with colon cancer, and 1,441 participants who had no polyps or growths in the colon. Investigators then compared risk factors among the three groups, such as diet, physical activity, alcohol intake, and smoking. Analyses of the data showed significant reductions in relative risk of cancer with increased intake of vitamin D. Total calcium and total folate intake also showed significant risk reduction, but vitamin D dominated both. Participants who consumed more than 645 international units (IUs) of vitamin D daily were 40% less likely to have advanced polyps. Thus, consuming vitamin D plus calcium may be a low-risk preventive strategy for colon cancer. This study also showed that smoking and moderate to heavy alcohol use increased the risk of colon cancer.¹⁰

Influenza-associated deaths in the U.S. have increased significantly over the past two decades, with 90 percent occurring among the elderly; however, in 2001 the influenza vaccination rate for persons 65 years and older was only 63 percent. Serious complications of influenza among the elderly include pneumonia, as well as and cerebrovascular and cardiovascular hospitalizations, which increase during influenza epidemics. Further, upper respiratory illnesses have been associated with an increased risk for ischemic heart disease and stroke. Investigators assessed the impact of influenza vaccination on the risk of hospitalization for ischemic heart disease and stroke. They also studied the effect of vaccination on hospitalization for pneumonia, influenza, and on death from all causes. Investigators examined computerized data from three large managed health care organizations for two large cohorts of elderly persons for the 1998-99 and 1999-00 influenza seasons (n = 140,055 and 146,328, respectively). Findings from this study, led by a senior research scientist at HSR&D’s Center for Chronic Disease Outcomes Research, showed that influenza vaccination of the elderly was associated with lower rates of hospitalizations for cardiac disease, stroke, pneumonia, and influenza during the flu season, and was associated with fewer deaths from all causes. This highlights the substantial benefits of vaccination and supports efforts to increase vaccine delivery to the elderly.¹¹