WHO ARE THE ELDERLY?

The older adult population is typically defined in chrono­logic terms and includes individuals 65 years of age and older. This age was chosen somewhat arbitrarily, and his­torically it is linked to the Social Security Act of 1935. With this Act, the first national pension system in the United States, which designated 65 years as the pensionable age, was developed. Since then, the expression old age has been understood to apply to anyone older than 65 years. Be­cause there is considerable heterogeneity among this group, older adults often are subgrouped into young-old (65 to 74 years), middle-old (75 to 84 years), and old-old (85+ years) to reflect more accurately the changes in func­tion that occur. Age parameters, however, are somewhat irrelevant because chronologic age is a poor predictor of biologic function. However, chronologic age does help to quantify the number of individuals in a group and allows predictions to be made for the future.

In the year 2000, 12.4% of the total United States population (34.4 million) was 65 years of age or older. The proportion of older adults declined for the first time in the 1990s, due partly to the relatively low number of births in the late 1920s and early 1930s. This trend is not expected to continue, however, as the "baby boomers" (born from 1946 to 1964) reach age 65, beginning in the year 2011. During the 1990s, the most rapid growth of the elderly population occurred in the oldest age groups. Those 85 years and older increased by 38%, whereas the 75- to 84-year-olds increased by 23% and the 65- to 74-year-old group increased by less than 2%. The entire population of older adults is expected to grow to over a million by the year 2030 (Fig. 3-1). Average life ex­pectancy has increased as a result of overall advances in health care technology, improved nutrition, and improved sanitation. Women who are now 65 years of age can ex­pect to live an additional 19.2 years (84.2 years of age), and men an additional 16 years (81 years old).¹,²

Aging can be thought of somewhat as a women's issue because women tend to outlive men. In the year 2000, there was a sex ratio of 143 women for every 100 men older than 65 years in the United States. This ratio in­creases to as high as 243 women for every 100 men in the 85 years and older age group. Marital status also changes with advancing age. In 2000, almost half of all older women living in the community were widows, and there were four times as many widows as there were widowers.¹,²

Although about 4 million older adults were in the workforce in 2000 (i.e., working or actively seeking work),

most were retired.¹ Retirement represents a significant role change for older adults. Attitudes and adjustment to re­tirement are influenced by preretirement lifestyles and val­ues. Individuals with leisure pursuits during their work life seem to adjust better to retirement than those whose lives were dominated by work. For many of today's cohort of older adults, the work ethic of the Great Depression re­mains profoundly ingrained as the central purpose in life. When work is gone, a significant loss is felt, and something must be substituted in its place. Because leisure has not al­ways been a highly valued activity, older adults may have difficulty learning to engage in meaningful leisure pursuits.

Loss of productive work is just one of many losses that can accompany the aging process. Loss of a spouse is a highly significant life event that commonly has negative implications for the survivor. Experts cite an increased mortality among recently bereaved older adults (especially men), an increased incidence of depression, psychological distress, loneliness, and higher rates of chronic illness. Loss of physical health and loss of independence are other changes that can affect the psychosocial aspects of aging, as can relocation, loss of friends and relatives, and changes in the family structure.

Poverty is common among the elderly population. In 2001, 10% of those 65 years of age and older lived below the poverty line, and another 6.5% were classified as "near poor" (income between the poverty level and 125% of this level). Poverty rates vary among elderly subgroups, with 21.9% of elderly African Americans at poverty level in 1999, 20.4% of elderly Hispanics, and 8.9% of elderly Cau­casians. The main sources of income for older persons in 1998 were Social Security (90% of older persons), income from assets (59%), public and private pensions (41.6%), and earnings (22%).¹

Contrary to popular belief, most older adults live in community settings. Most live in some type of family set­ting, with a spouse, their children, or other relatives, and approximately 30% live alone. Only 4.5% of all individu­als 65 years of age and older reside in long-term care facilities or nursing homes. However, this number increases to 18.2% for persons 85 years of age or older.¹

Older adults are the largest consumers of health care. In 199 7, more than half of the population (54.5%) reported having one or more disabilities. One third had at least one severe disability, and approximately one sixth (14%) had difficulties with activities of daily living (ADL). Almost half of all adult hospital beds are filled with patients 65 years of age and older.²

THE ELDERLY

Number of Persons 65+: 1900 to 2030 (numbers in millions)

1900 1920 1940 1960 1980 1990 2000 2010 2020 2030 Year (as of July 1)

FIGURE 3-1 Number of people 65 years and older, 1990 to 2030 (number in millions). Note: increments in years are uneven. Based on U.S. Bureau of Census. (From: A profile ofolder Americans: 2002. U.S. De­partment of Health and Human Services: Administration on Aging).

>- The older population, which is subgrouped into the young-old (65 to 74 years), the middle-old (75 to 84 years), and the old-old (85+ years), has increased dramatically during the past century and is expected to continue to grow as the result of overall advances in health care technology, improved nutrition, and improved sanitation.

>■ As the result of increased years, many older adults are con­fronted with retirement, changes in lifestyle, loss of signifi­cant others, and a decline in physical functioning.

>■ Although aging brings with it a unique set of biophysiologic changes, it is not synonymous with disease and disability. Most older adults can perform most or all of the activities they performed in earlier years, although they often take longer and require greater motivation.