If you are in your 60s or 70s, think back to your childhood years. Chances are you did not know anyone who was 90 years old, and you probably knew very few people in their 80s. Today, on the other hand, you may have elderly parents in their 90s and friends with similarly elderly parents. You probably know many 80-year-olds, and it does not even occur to you that an 80-year-old is unusual. Recently, in a congregation with an attendance of about 110, the worship leader asked members who were 80 years old or older to stand. Nearly a dozen stood, and some of the active qualifying members were not in church that day. It's not uncommon for retirement centers to have a half dozen or more 100-year-olds. And if you are, indeed, in your 60s or 70s, chances are you don't think of yourself as "old," though when you were a child, you surely called people such as yourself "old people."
According to the U.S. Census Bureau, America's population of people 90 and older has tripled since 1980, reaching 1.9 million in 2010, and will be at an estimated 2.3 million by 2020. Between 1940 and 2010 the number of people 65 and older doubled. This is having all sorts of unintended and unexpected consequences, not the least of which is the effect on Social Security and Medicare. The fact that there are more people living longer is forcing us to rethink our understanding of the life cycle and how to live into an age that at one time didn't seem possible, let alone typical.
One of the places this new longevity is having a significant impact is on illness and disease. People have more years in which to develop maladies, and there are diseases to which the elderly are particularly susceptible.
Here is a survey of what might be called diseases of the elderly. Its purpose is to help you think about the medical implications of increased longevity and also as something to ponder as you think about your own health.
Adult onset diabetes (type 2)
More than 25 percent of people 65 or older have diabetes; the majority of cases are type 2 diabetes. The body either resists the effects of insulin or doesn't produce enough insulin to maintain a normal glucose level. Older adults with diabetes are further at risk for other conditions such as cardiovascular complications, visual impairment, urinary incontinence, renal disease, and depression.
In osteoarthritis, the cartilage between the bones degrades through wear and tear until it becomes very thin, allowing the bones to rub together. This causes pain, inflammation, and difficulty moving the joint. This is most commonly seen in the elderly. (Rheumatoid arthritis, on the other hand, is caused by an overactive auto-immune system and is not found primarily in the elderly.)
Kidney and bladder problems
Aging increases the risk of kidney and bladder problems, such as losing bladder control (urinary incontinence), not being able to completely empty your bladder, susceptibility to urinary tract infections, and suffering from chronic kidney disease.
Neurodegenerative disease is an umbrella term for a range of conditions that primarily affect the neurons in the human brain. Neurons normally don't reproduce, so when they become damaged or die they cannot be replaced. Neurodegenerative diseases are incurable, debilitating conditions. The progressive degeneration and/or death of nerve cells causes problems with movement (called ataxia), or mental functioning (called dementia).
Dementia is responsible for the greatest burden of neurodegenerative diseases, with Alzheimer's representing approximately 60-70 percent of dementia cases. Alzheimer's disease is a progressive, degenerative brain disease that slowly erodes memory and thinking skills, and eventually even the ability to carry out simple tasks. It accounts for approximately 50-70 percent of all cases of dementia. The incidence of Alzheimer's rises exponentially with advancing age. Estimates vary, but experts suggest that as many as 5.1 million Americans may have Alzheimer's.
Diseases of the eye
macular degeneration is a disease associated with aging that gradually destroys sharp, central vision, which is needed for seeing objects clearly and for common daily tasks such as reading and driving.
Cataracts cause a clouding of the lens in the eye. Vision can appear cloudy or blurry, colors may seem faded, and the person may notice a lot of glare.
Diabetic eye disease is a complication of diabetes and a leading cause of blindness. The most common form is
diabetic retinopathy that occurs when diabetes damages the tiny blood vessels inside the retina.
Glaucoma is a group of diseases that can damage the eye's optic nerve and result in vision loss and blindness. It is usually associated with high pressure in the eye and affects side or peripheral vision.
Asthma and COPD -- Nearly 15 percent, or about one in seven, middle-aged and older U.S. adults suffer from lung disorders such as asthma or chronic obstructive pulmonary disease. While 10 percent of those people experience mild breathing problems, more than one-third of them report moderate or severe respiratory symptoms.
Influenza -- Aging increases the risk of contracting influenza and pneumonia. Influenza, or flu, is an illness caused by the influenza virus of which there are many different strains. While flu strikes people of all ages, those aged 65 years and older are disproportionately affected in terms of both hospitalization and death, with the oldest at the greatest risk. About 90 percent of those people dying from flu are over age 65.
Pneumonia -- This is a chest infection that can be caused by a variety of viruses as well as bacteria or fungi. Pneumonia is the fourth leading cause of death among the elderly. Typically pneumonia occurs when a patient's immune system is weakened due to another illness, such as bronchitis or flu, and many people develop it in the hospital.
Osteoporosis is a chronic skeletal disease that causes reduced bone mass and deterioration of the bones' microarchitecture, resulting in an increased risk of fracture, which is the most serious consequence of this disorder. Seventy percent of all fractures are sustained by those aged 65 or older. Fractures have a serious negative impact on quality of life and are often the trigger for accelerated deterioration, ultimately ending in death. Despite the availability of effective preventive treatments, osteoporosis among the elderly is frequently underdiagnosed and/or undertreated.
Depression may sometimes be undiagnosed or misdiagnosed in older adults, because sadness is not the main symptom. They may have other less obvious symptoms, and they may not be willing to talk about their feelings. They may feel tired, helpless, or hopeless, and may have lost interest in many of the activities and interests they previously enjoyed. They may have trouble working, sleeping, eating, or just functioning, and this may go on day after day. If these symptoms apply, these older adults may be experiencing depression. As people get older, they go through a lot of changes - the death of loved ones, retirement, stressful life events, and medical problems. It's normal to feel uneasy, stressed, or sad about these changes. But after adjusting, most older adults feel well again. Depression is different. It is a condition that interferes with daily life and normal functioning.
Cardiovascular disease and coronary heart disease
The term Cardiovascular Disease refers to a group of diseases related to the heart and blood vessels, such as arteriosclerosis, stroke, heart failure, arrhythmia, or heart valve problems. Coronary heart disease is one of these diseases.
CHD is the leading cause of death of elderly men and women -- 81 percent of adults who die of CHD are aged 65 or older. The average age of a first heart attack is 64.7 years for men and 72.2 years for women. Because women have heart attacks at older ages than men, they're more likely to die from them within a few weeks.
An estimated 83.6 million American adults (more than 1 in 3) have one or more types of cardiovascular disease. Of these, 42.2 million are estimated to be 60 years of age or older. For the 60-through-79-year-old age group, the following have some form of CVD: 70.2 percent of men and 70.9 percent of women. For the 80-plus-year-old age group, the following have CVD: 83 percent of men and 87.1 percent of women.
Cancer in the elderly
As the population continues to expand during this period from 2000 to 2050, the number and percentage of Americans over 65 are expected to double. Since cancer incidence increases exponentially with advancing age, it is expected that there will be a surge in older cancer patients that will challenge both healthcare institutions and healthcare professionals. All cancers combined (except non-melanoma skin cancer) are almost seven times more frequent among elderly men (2,158 per 100,000 person-years), and around four times more frequent among elderly women (1.192 per 100,000 person-years) than among younger persons (30 to 64 years old).
The risk of having a stroke more than doubles each decade after the age of 55. Strokes can and do occur at any age, but nearly three-quarters of all strokes occur in people after the age of 65. Stroke is the third leading cause of death in the United States.
Obesity rates have increased in most age groups in the United States in recent years, but the biggest rise has been in older adults. The obesity rate among people 65 and older has increased by 4 percentage points - from 23.4 percent in 2008 to 27.4 percent in 2014.
Older persons are at risk of chronic diseases of the mouth, including dental infections such as tooth decay or cavities, periodontitis, tooth loss, benign mucosal lesions, and oral cancer. Other common oral conditions are dry mouth, thrush, denture sores, and inflammation at the corners of the mouth.
Changes to aging skin and its ability to heal and resist disease mean that skin infections get much more common as people get older. These include viral infections like herpes zoster (shingles), pressure ulcers, bacterial or fungal foot infections (which can be more common in those with diabetes), cellulitis, and even drug-resistant infections like Methicillin-resistant Staphylococcus aureus or MRSA.
Gastrointestinal diseases, such as gastroesophageal reflux and peptic ulcers, are prevalent in the elderly.
This is a daunting list, and it reminds us that the medical community will have its work cut out for it in the coming decades. But if we were to look more deeply into each of these diseases, we would find that important research is being conducted into their causes and treatment.
Thus, this longer life that most of us want to and probably will experience is presenting both challenges and opportunities, not the least of which are the advances in medicine it will push forward.
U.S. Census Bureau