Health Status
Indicator 13 : Life Expectancy
Life expectancy is a summary measure of the overall health of a population.
It represents the average number of years of life remaining to a person at a given age
if death rates were to remain constant. In the United States, improvements in health have resulted
in increased life expectancy and contributed to the growth of the older
population over the past century.
-
Americans are living longer than ever before. Life expectancies
at both age 65 and age 85 have increased. Under current mortality conditions,
people who survive to age 65 can expect to live an average of nearly 18 more
years, more than 6 years longer than people age 65 in 1900. The life expectancy
of people who survive to age 85 today is about 7 years for women and 6 years
for men.
-
Life expectancy at age 65 in the United States is lower than that of many other industrialized nations.
In 1999 women age 65 in Japan could expect to live on average 2.8 years longer than women in the
United States. Among men, the difference was 0.9 years.18
-
Life expectancy varies by race, but the difference
decreases with age. In 2001, life expectancy at birth was 5.5 years higher for
white people than for black people. At age 65, white people can expect to live
an average of nearly 2 years longer than black people. Among those who survive
to age 85, however, the life expectancy among black people is slightly higher
than among white people. Differences in life expectancy at birth have been
declining over time.
Data for this indicator can be found in Tables 13a
and 13b.
Indicator 14 : Mortality
Overall, death rates in the U.S. population have declined during the past century. But for some diseases, death rates among older Americans have
increased in recent years.
- In 2001, the leading cause of death among people age 65 and over was diseases of heart
(1,632 deaths per 100,000 people), followed by malignant neoplasms (cancer) (1,100 per 100,000),
cerebrovascular diseases (stroke) (404 per 100,000), chronic lower respiratory diseases
(301 per 100,000), influenza and pneumonia
(155 per 100,000), and diabetes mellitus (151 per 100,000).
- Between 1981 and 2001,age-adjusted death rates for all causes of death among people age 65 and
over declined by 12 percent.19 Death rates for diseases of
heart and cerebrovascular diseases (stroke)
declined by approximately one-third. Age-adjusted death rates for diabetes
mellitus increased by 43 percent since 1981, and death rates for chronic
lower respiratory diseases increased by 62 percent.
- Diseases of heart and malignant neoplasms are the top two leading causes of death
among all people age 65 and over, irrespective of sex, race, or Hispanic
origin.
- The relative importance of
certain other causes of death varied among groups. For example, in 2001,
diabetes mellitus was the fifth leading
cause of death among black men, the fourth among Hispanic men, and the
sixth among white and Asian or Pacific Islander
men. Among women age 65 and over, diabetes mellitus was the fourth leading
cause of death among Hispanics and blacks and the seventh leading cause
among whites.
Data for this indicator can be found in
Tables 14a, 14b, and 14c.
Indicator 15 : Chronic Health Conditions
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.21 Chronic health conditions negatively affect
quality of life, contributing to declines in functioning and the inability to remain in
the community.22 Many chronic conditions can be prevented or
modified with behavioral interventions. Five of the six leading causes of death among older Americans are chronic diseases. (See
"Indicator 14: Mortality.")
-
The prevalence of chronic conditions differs by sex.
Women report higher levels of hypertension, asthma, chronic bronchitis, and
arthritic symptoms than men. Men report higher levels of heart disease, cancer,
diabetes, and emphysema.
-
There are differences by race and ethnicity in the
prevalence of certain chronic conditions. Among people age 65 and over,
non-Hispanic blacks report higher levels of hypertension and diabetes than
non-Hispanic whites (66 percent compared with 49 percent for hypertension and
23 percent compared with 14 percent for diabetes). Hispanics also report higher
levels of diabetes than non-Hispanic whites (24 percent compared with 14
percent) but similar levels of hypertension (48 percent).
-
The prevalence of some conditions is increasing over
time. In 1997-1998, 47 percent of people age 65 and over reported having
hypertension compared with 50 percent in 2001-2002. Diabetes is also increasing
among the older population, from 13 percent in 1997-1998 to 16 percent in
2001-2002.
Data
for this indicator can be found in Table 15a and 15b.
Indicator 16 : Sensory Impairments and Oral Health
Vision and hearing impairments
and oral health problems are often thought of as natural signs of aging. Often,
however, early detection and treatment can prevent, or at least postpone, some
of the debilitating physical, social, and emotional effects these impairments
can have on the lives of older people. Glasses, hearing aids, and regular
dental care are not covered services under Medicare.
-
In 2002, close to one-half of older men and nearly
one-third of older women reported trouble hearing. The percentage with trouble
hearing was higher for people age 85 and over (60 percent) than for people age
65-74 (30 percent). Ten percent of all older women and 19 percent of all older
men reported having ever worn a hearing aid.
-
Vision trouble affects 18 percent of the older
population, 16 percent of men and 19 percent of women. Among people age 85 and
over, 33 percent reported trouble seeing. In 2002, among people age 65 and over
who reported trouble seeing, 16 percent reported having ever had glaucoma, 16
percent reported ever having had macular degeneration, and 44 percent reported
having had cataracts in the past 12 months.
-
The prevalence of edentulism,
having no natural teeth, was higher for people age 85 and over (38 percent)
than for people age 65-74 (24 percent). Socioeconomic differences are large.
Forty-six percent of older people with family income below the poverty line
reported no natural teeth compared with 27 percent of people above the poverty
threshold.
Data
for this indicator can be found in Table 16a, 16b, and 16c.
Indicator 17 : Memory Impairment
Memory skills are important to
general cognitive functioning, and declining scores on memory tests are
indicators of general cognitive loss for older adults. Low cognitive
functioning (i.e., memory impairment) is a major risk factor for entering a
nursing home.23,24
-
Older men are more likely to experience moderate or
severe memory impairment than older women. In 2002, 15 percent of men age 65 and
over experienced moderate or severe memory impairment compared with 11 percent
of women. At age 85 and over, the difference narrowed, and approximately
one-third of both men and women experienced moderate or severe memory
impairment.
-
The prevalence of moderate or severe memory impairment is
six times as high for people age
-
85 and over as it is for people age 65-69. In 2002, the
proportion of people age 85 and over with moderate or severe memory impairment
was 32 percent compared with 5 percent for people age 65-69.
Data for this indicator can be found in Table
17.
Indicator 18 : Depressive Symptoms
Depressive symptoms are an
important indicator of general well-being and mental health among older adults.
People who report many depressive symptoms often experience higher rates of
physical illness, greater functional disability, and higher health care
resource utilization.23,25
-
Older women are more likely to report clinically-relevant
depressive symptoms than older men. In 2002, 16 percent of women age 65-69
reported depressive symptoms compared with 10 percent of men. At age 85 and
over, 22 percent of women reported depressive symptoms compared with 15 percent
of men.
-
The prevalence of clinically-relevant depressive symptoms
is related to age. In 2002, the proportion of people age 65 and over with
clinically-relevant depressive symptoms was higher for people age 85 and over
(20 percent) than for people age 65-69 (13 percent).
-
Serious mental illness is another measure of mental
health. It identifies people who have a
diagnosable mental disorder, such as schizophrenia, bipolar disorder, or severe
forms of depression, resulting in functional impairment in major life
activities.26 In 2000-2001, 3 percent of women and 2 percent of men
age 65 and over reported experiencing symptoms of serious mental illness.27
-
Psychotropic medications are commonly prescribed by
doctors to treat mental disorders in older patients. In 1996, more than 6
million noninstitutionalized people age 65 and over
used psychotropic medications (e.g., antidepressants, antianxiety
agents, and sedative/hypnotics).28
Data for this indicator can be found in Table 18.
Indicator 19 : Disability
Functioning in later years may
be diminished if illness, chronic disease, or injury limits physical and/ or
mental abilities. Changes in disability rates have important implications for
work and retirement policies, health and long-term care needs, and the social
well-being of the older population.
-
The age-adjusted proportion of Americans age 65 and over
with a chronic disability declined from 25 percent in 1984 to 20 percent in
1999. Some researchers have estimated that disability rates have declined more rapidly
during this period.29
-
This proportion declined for both sexes -- from 28
percent in 1984 to 23 percent in 1999 for older women and from 19 percent in
1984 to 15 percent in 1999 for older men.
-
Despite the decline in rates, the number of older
Americans with chronic disabilities increased from about 6.2 million in 1984 to
6.8 million in 1999. This is because the overall population of older people was
growing fast enough to outweigh the decline in disability rates from 1984 to
1999.
Different indicators can be used to monitor disability, including limitations in
activities of daily living (ADLs) and instrumental activities of daily living (IADLs) and measures of
physical, cognitive, and social functioning. Aspects of physical functioning such as the ability to
lift heavy objects, walk 23 blocks, or reach up over one's head are more closely linked to
physiological capabilities than are ADLs and IADLs,
which may be influenced by social and cultural
role expectations and by changes in technology.
-
Older women reported more problems with physical
functioning than older men. In 2002, 31 percent of women reported they were
unable to perform at least one of five activities,
compared with 18 percent of men.
-
Problems with physical functioning were more frequent at older ages. Thirteen percent of men age 65-74
reported they were unable to perform at least one of five activities, compared with 35 percent of men age 85
and over. Among women, 20 percent of those age 65-74 were unable to perform at least one activity,
compared with 58 percent of those age 85 and over.
-
Physical functioning was related to race, but not strongly. Among men, 17 percent of non-Hispanic
whites were unable to perform at least one activity, compared with 26 percent of non-Hispanic blacks and 22
percent of Hispanics. Among women, 30 percent of non-Hispanic whites were unable to perform at least
one activity, compared with 36 percent of non-Hispanic blacks and 29 percent of Hispanics.
Data for this indicator can be found in Tables
19a, 19b, and 19c.
Indicator 20 : Respondent-Assessed Health Status
Asking people to rate their
health as excellent, very good, good, fair, or poor provides a common indicator
of health easily measured in surveys. It represents physical, emotional, and
social aspects of health and well-being. Respondent-assessed health ratings of
good, very good, and excellent correlate with lower risks of mortality.30
-
During the period 2000-2002, 73 percent of people age 65
and over rated their health as good or better. This pattern was true for the
decade preceding 2002 as well; the majority of older people reported their
health to be good to excellent. In fact, the percentage of people age 65 and
over reporting fair or poor health declined from 29 percent in 1991 to 27
percent in 2001.31
-
The proportion of people reporting positive health
decreases among the older age groups. Among non-Hispanic white men, 79 percent
of those age 65-74 report good or better health. At age 85 and over, 65 percent
of non-Hispanic white men report good or better
ratings. While the difference is greatest among white males, this pattern is evident
for non-Hispanic black men, Hispanic men, and women of similar race and ethnic
categories.
-
Regardless of age, older non-Hispanic white men and women
are more likely to report good health than their non-Hispanic black and
Hispanic counterparts. The greatest differences in reporting good health
occurred between non-Hispanic whites and blacks. Non-Hispanic blacks and
Hispanics are similar to one another in their positive health evaluations.
Data for this indicator can be found in
Table 20.