Health
Status of Older Adults.
Dispelling Ageism
OBJECTIVES:
● Describe the global and national health status
of older adults.
● Identify and refute at least four common misconceptions
about older adults.
● Describe characteristics of healthy older
adults.
● Provide an example of primary, secondary, and
tertiary prevention practices among the older population.
Older Americans constitute a large and growing
population group. You will be part of it in the future.
Perhaps your parents and grandparents are in that
group now. In fact, people age 65 years and older make up the fastest-growing
segment of the American population (Eliopolous, 2001;
Pan American Health Organization, 2002). This trend is expected to continue,
with the most rapid increase expected between the years 2010 and 2030, when the
“baby boom” generation reaches 65 years of age. Older adults make up a group
whose health needs are not fully understood, and the nation has yet to offer
the full complement of services they require and deserve. For community health
nursing, this population group poses a special challenge. The increasing number
of seniors in the community increases the need for health-promoting and preventive
services. These services help maximize an older person’s ability to remain an
independent, contributing member of society and to maintain a high quality of
life. With this group’s potential for longevity come the myriad problems
brought on by these extended numbers of years, including dwindling finances
that may not be keeping up with inflation; increasing chronic disease and
disability; diminishing functional capacity; and ongoing losses regarding work,
home, family members, and other loved ones. Significant economic,
environmental, and social changes create a demand for greater protective and
preventive services for older adults in addition to requiring adjustments in
health care provision patterns. The challenge is clear. Nursing must study the needs
of this group and respond with appropriate, effective, and cost-effective
interventions.
There are four fundamental requirements for effective
nursing of any population:
1. Know the characteristics of the population.
2. Set aside stereotypes based on misconceptions about
the population.
3. Know the health needs of the population as a basis
for nursing intervention.
4. View the population from an aggregate, public
health perspective that emphasizes health protection, health promotion, and
disease prevention.
This chapter first examines the global challenge of an
aging society and the characteristics of the aging population in the
HEALTH
STATUS OF OLDER ADULTS
Never before has the population of older adults been
so large, and its numbers are on the increase. The progressive aging of
populations is hailed as a triumph for the human species. People are living
longer as a result of improved health care, eradication and control of many
communicable diseases, use of antibiotics and other medicines, healthier
dietary practices, safer global water supplies, regular exercise, and
accessibility to a better quality of life. This is especially true for people
in developed countries, and particularly for residents of the
Global Demographics
It is estimated that more than 420 million people
worldwide are older than 65 years of age. This is about 7% of the world’s
population. In the United States, more than 35 million people (12% of the
population) are older than 65, and by 2050 that number is expected to increase
to 20% of the population (National Center for Health Statistics, 2002). Between
1950 and 2000, the percentage of Americans younger than 18 years of age fell
from 31% to 26%, and the percentage of elderly rose from 8% to 12% (Fig. 30–1).
Death rates have fallen steadily over the past 100
years. Life expectancy at birth in the United States increased from 51 to 80
years for women and from 48 to 74 years for men between 1900 and 2000
(Population Reference Bureau, 2003). Although there have been significant
improvements in longevity, in 22 countries the percentage of the population
older than 65 years of age is greater than in the
Women outnumber men in the older population because
they have an advantage in life expectancy that averages 6 years. In fact, older
women outnumber older men in most countries, and more than half of the women in
the
National
Demographics
As already stated, in 2000, the average life
expectancy at birth for Americans was 80 years for women and 74 years for men.
However, there are disparities in life expectancy among various subgroups in
the population. Life expectancy is highest for white Americans and lowest for
black Americans, who have the highest death rates of any of
Nevertheless, older people are healthier than ever before.
Although statistics indicate that men in the United
States who are 65 years old have an average of 14.8 years of life remaining,
and women 19.5 years (National Institute on Aging, 2001). Increasing numbers of
capable elderly people are living independently, and the hearty elderly—people
older than 65 years of age who maintain a high level of wellness and activity,
well above present expectations for that age—are increasing in number. Most
people older than 65 years of age not only maintain independent living but
continue to contribute to society. Many continue to work, and most stay
involved in community programs and activities. Some have become valuable
volunteers, helping others in such community activities as foster grandparents
and literacy programs for adults, working in libraries and homeless shelters,
or providing services such as Meals on Wheels.
Not only are more people living into old age, but
also, once they get there, they are living longer. Specifically, the number of
people living into “older” old age (75 years and older) is increasing. Forty
percent of elderly people in the
Other statistics on older adults may also help
community health nurses anticipate the psychosocial needs of the older
population. Most older men (76%) live out their years
with their spouse and therefore have someone for companionship; in contrast,
almost 60% of older women are widowed, single, or divorced (Eliopolous,
2001). In fact, there are five times as many widows (8 million) as widowers
(1.5 million) in the
Only 6% of all older
adults live in institutions; the overwhelming majority live in family settings
(Ebersole & Hess, 2004). Two thirds (66%) of older adults live within 30
minutes of an adult child. Approximately 80% of older adults have seen one of
their children within the previous week. These figures contradict the popular
notion of abandoned elderly who have been forgotten or neglected by their
families.
In the total
The education level of the older population is
increasing. The percentage of older adults who have completed high school or a
higher level of education is 66.7% among whites, 37% among African-Americans,
and 30% among Hispanics (Miller, 1999). These figures are predicted to change
as the United States witnesses a trend toward a more educated senior population
because of the significant numbers of baby boomers who completed high school
and entered college during and since the 1960s (see Voices from the Community
I).
DISPELLING
AGEISM
Stereotyping older adults and perpetuating false
information and negative images and characteristics regarding older adults is
called ageism. These stereotypes often arise from negative personal experience,
myths shared throughout the ages, and a general lack of current information.
Ageism can interfere with effective practice and prevent the kind of
comprehensive and interdisciplinary service aging persons need and deserve.
Misconceptions
About Older Adults
Community health nurses must guard against ageism in
their practice by dispelling common misconceptions.
Misconception:
Most Older Adults Cannot Live Independently
Ninety-four percent of elderly individuals live in the
community, outside formal facilities or institutions. Some live alone or with
friends, and others live in the homes of non-relatives with room and board
provided. In some homes, assistance with ADLs is provided. There are also
alternative-housing arrangements—group-living situations for older adults in
which many types of housing and care possibilities are offered. This concept is
not new, but these centers are being built now in greater numbers to meet the
needs of a growing segment of the older adult population.
-
Most elders who are vigorous and functioning
independently live in their own homes. Only 6% live in institutions such as
skilled nursing facilities, extended care facilities, supervised living
facilities, and AD centers, and not all of these are permanent residents. Many
are recovering 
from illnesses or undergong
rehabilitation after an injury or surgery and will return to their living
situation in the community within weeks.
Misconception:
Chronologic Age Determines Oldness
Older people are quite distinct from one another in the
aging process, and they age at widely disparate rates. Some people at age 85
years still play golf, drive a car, and participate in social and community
activities; others are frail and cannot move about well. Physical, social, and
mental health parameters, life experiences, and genetic traits all combine to
make aging an individualized process (see Levels of Prevention Matrix).
Misconception:
Most Elderly Persons Have Diminished Intellectual Capacity or Are Senile
Studies show that intelligence, learning ability, and
other intellectual and cognitive skills do not decline with age. Cognitive
deficits are caused by certain risk factors. Nutritional status has been
singled out as a physical health variable that influences cognitive
functioning, particularly memory performance, regardless of a person’s age.
Anticholinergic ingredients that are present in many medications can interfere
with memory and cognitive functioning. In healthy, mentally stimulated older
adults, deficits are generally minimal and probably not even noticed. Speed of
reaction tends to decrease with age, but basic intelligence does not. In fact,
some abilities are viewed collectively as crystallized intelligence. Wisdom,
judgment, vocabulary, creativity, common sense, coordination of facts and
ideas, and breadth of knowledge and experience actually improve with age
(Miller, 1999). Most older people are largely capable
of making their own decisions; they want and need the freedom to make choices
and to be as independent as their limitations will allow.
Senility, although not a legitimate medical diagnosis,
is a term widely used by the lay public to denote deteriorating mental
faculties associated with old age. Yet fewer than 1%
of people aged 65 years, and only 18% of people older than 75 years, are
affected by cognitive impairment, dementia, or AD (discussed later). Although
most cases of cognitive impairment are not treatable, 10% to 20% of them are
reversible. These include problems caused by drug toxicity, metabolic
disorders, depression, or hyperthyroidism (Miller, 1999). Certainly, AD and
arteriosclerosis cause memory loss and altered behavior in the elderly, but
many older adults have similar symptoms as a result of anxiety, loss, or grief,
or simply from changes in their routine. These reactions need to be diagnosed
by health care providers and differentiated from disease processes.
Misconception:
All Older People Are Content and Serene
The picture of Grandma sitting serenely in her rocker
with her hands folded in her lap is misleading. It is true that many older
people have learned to accept rather than fight the hardships and vicissitudes
of life. Yet, for most people, advancing age brings increasing physical,
social, and financial problems to harass and worry them. Depression, which can
be a problem among the elderly, is sometimes confused with dementia because of
such symptoms as disorientation, failing memory, and eccentric behavior.
However, one must not forget that, to attain the status of senior citizen
(meaning one who has survived 65 years or more of living), one has had a great
deal of strength, tenacity, and capacity for adaptation, as well as a sense of
humor about many of the trials, tribulations, and absurdities in life. These
people are survivors, and survivors do not always sit contentedly in a rocking
chair on the sidelines of life.
Misconception: Older Adults Cannot
Be Productive or Active
More than two thirds (between 65% and 68%) of the male
work force retire before age 65 years. In contrast, the participation rate for
women between 45 and 64 years of age is continually rising (Ginn,
Street, & Arber, 2001; Rix, 2001). Some reasons
for early retirement include health, availability of private pension benefits,
social expectations, and long-held plans to do something else with their time (Menzey, 2001). These additional years give older adults
time for travel, volunteering, and hobbies. This “third phase of life” is a
gift of the 20th century that allows people to pursue these and other
interests. Many older retired adults care for grandchildren,
great-grandchildren, or even a very old surviving parent. Twenty-five percent
of people aged 58 or 59 have at least one living parent; and 10% of older
adults have at least one offspring who is older than 65 (Miller, 1999).
More than 4 million Americans older than 65 years of
age work full- or part-time, and many others, who are not included in labor
statistics, work but do not report their earnings. An example is the
grandmother who chooses to give up full-time employment in an unsatisfying job
to baby-sit for three preschool grandchildren and is paid in cash by her two
children. The grandmother gets to spend time with growing grandchildren and not
lose all her income potential; the parents feel comfortable that their children
are being cared for by a loving family member; and the grandchildren are
experiencing the joy of being with their grandparent. In another situation,
active retired older adults assist with their two children’s businesses. The
mother types legal documents for the son’s law practice during busy times, and
the father helps out on Saturdays in the daughter’s pool supply store. Everyone
wins in these situations.
Healthy older people usually do not disengage or
withdraw and isolate themselves from society; rather, they are active and
involved. Remaining active—through a daily routine, purposeful behavior, and a
positive view of life—produces the best psychological climate.
Misconception:
All Older Adults Are Resistant to Change
People at any age can learn new information and
skills. Research indicates that older people can learn new skills and improve
old ones, including how to use a computer. Learning occurs best in a
self-paced, supportive environment (Morrell, Mayhorn,
& Bennett, 2000). The elderly have spent a lifetime adapting to change,
with varying measures of success. People older than 65 years grew up in an age
when having an automobile was a luxury and many did not have a television,
microwave oven, or VCR until they were in middle adulthood. Elders learned to
adapt to these changes, and they are becoming increasingly computer literate
today. The ability to change does not depend on age but rather on personality
traits acquired throughout life or, sometimes, on socioeconomic difficulties.
For example, elders living on fixed incomes may be faced with inflationary
costs. This may cause them to vote against a school levy that would increase
taxes, although they otherwise would support the schools.
Misconception:
Social Security Will Not Be There When I Retire
The Social Security fund is healthy! Although the
government has borrowed from it, the trust fund growth has been sufficient to
keep Social Security solvent until 2041—which is 3 years longer than was
projected in 2001 (American Association of Retired Persons, 2002). In addition,
Medicare will stay financially healthy until 2030, also a 1-year gain over the
2001 estimate. Money still pours into the Social Security fund from payrolls,
and not until 2019 will the administrators have to start tapping the trust fund
to meet obligations. If there were no changes to the dispursement
schedule of the fund for the next 35 years, the fund would become exhausted.
Even with that worst-case scenario, however, payroll tax revenues would be
enough to pay 75% of everyone’s benefits for the next 75 years.
Even though the Social Security system is secure, most
people who will reach retirement age in the next few decades have experienced a
lifestyle well beyond what could be supported by the Social Security benefits
they are scheduled to receive. This means that people must plan early and
contribute to a retirement plan at work (or establish their own retirement fund
if self-employed), invest, and save regularly. These multiple sources of income
at the time of retirement will provide the resources necessary so that
decisions about when to start or how to spend one’s retirement can be based on
personal preference rather than a restricted and fixed Social Security check.
Characteristics
of Healthy Older Adults
No one knows conclusively all of the variables that
influence healthy aging, but it is known that a lifetime of healthy habits and
circumstances, a strong social support system, and a positive emotional outlook
all significantly influence the resources people bring to their later years.
Most 
people recognize a healthy older person when they meet
one.
What is healthy old age? As was mentioned earlier, the
vast majority (94%) of elderly individuals, even those with chronic diseases or
other disabilities, are living outside institutions and are relatively
independent. Their ability to function is a key indicator of health and
wellness and is an important factor in understanding healthy aging. Good health
in the elderly means maintaining the maximum possible degree of physical,
mental, and social vigor. It means being able to adapt, to continue to handle
stress, and to be active and involved in life and living. In
short, healthy aging means being able to function, even when disabled, with a
minimum of ordinary help from others (USDHHS, 1991, 2000).
Wellness among the older population varies
considerably. It is influenced by many factors, including personality traits,
life experiences, current physical health, and current societal supports. Some
elderly people demonstrate maximum adaptability, resourcefulness, optimism, and
activity (Display 30–1). Others, often those from whom we tend to draw our
stereotypes, have disengaged and present a picture of dependence and
resignation. Most of the elderly population fall somewhere in
between those two extremes. Although the level of wellness varies among
the elderly, that level can be raised. The challenge in community health
nursing is to maximize the wellness potential of elderly clients. Nurses must
analyze and capitalize on an older person’s strengths rather than focus on the
difficulties. The goal is to enable older people to thrive, not merely survive
(Eliopoulos, 2001; Miller, 1999).