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Does “Older” Mean “Sick and Frail”?

Denise Logeland April 30, 2018
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Age, disease and frailty are related but separate phenomena, and for some people, physical decline is slow to arrive.

Kathleen Cameron, senior director of the Center for Healthy Aging at the National Council on Aging, answered questions about aging and decline by telling about an evening out with a friend just a couple days earlier. The friend, who represents one end of the health spectrum, is 90, deeply engaged with her community and social circle, still driving her car, and just recently retired.

“Even within the old-old, there are major differences” in health and physical ability, Cameron said. More than any other stage of life, older adulthood is a time of divergence in health status. Genetics and environmental factors both play roles. So do personal choices and habits.

“A lot depends on health behaviors that we start early in life” around eating, activity levels, and tobacco and alcohol use, Cameron said. Research is also showing the importance of social connectedness as a protective factor in older people’s health.

Here’s data on what’s happening with older adults’ health and functioning.

1. It’s not unusual to have multiple chronic conditions. One national survey found that 56% of people 65 and older had two or more chronic conditions, and 23% had three or more conditions. Here are the 10 most common chronic health problems in adults 65 and older:

  • Hypertension, 58% of the population
  • High cholesterol, 47%
  • Arthritis, 31%
  • Ischemic Heart Disease (narrowing of the arteries), 29%
  • Diabetes, 27%
  • Chronic Kidney Disease, 18%
  • Heart Failure, 14%
  • Depression, 14%
  • Dementias, including Alzheimer’s Disease, 11%
  • Chronic Obstructive Pulmonary Disease, 11%

2. Still, most older adults are functioning well independently. About 7 million (or 15 percent) of people 65-and-older need long-term supports and services, such as adult day care, home-based care or nursing home care. Among the others in this age group—those who are not in residential care facilities—94 percent have no limitations in performing “activities of daily living” (walking, dressing, bathing, eating, using the toilet, and getting in and out of chairs and bed). And 88 percent have no limitations in a second tier of tasks called “instrumental activities of daily living” (cooking and household chores, shopping and errands, managing personal finances).

3. It’s possible to be disease free, independently functioning and still frail. Frailty is distinct from age, disease and disability, but is associated with them. In recent decades, frailty has been delineated by researchers as a clinical syndrome in its own right, characterized by physiological changes such as advanced loss of muscle mass. Both age and chronic disease are risk factors for frailty. Diet and exercise can be good interventions. Left untreated, frailty is predictive of falls, inability to preform activities of daily living and death.

4. A share of older adults are frail or developing frailty—but most are not. Among Americans 65 and older who live outside of residential care facilities, only 15 percent meet one widely used definition of frailty. Another 45 percent meet the criteria for pre-frailty. Even in the population of those 90 and older, where the percentage who are frail rises to 38 percent, nearly two-thirds of people are not frail.

5. To better prevent and treat frailty, a single definition and diagnosis is needed. So far, consensus around a definition doesn’t exist among clinicians. It’s needed in order to spread knowledge of frailty to family physicians and others outside the field of geriatrics. It’s also needed to unlock insurance reimbursement. Reimbursement, in turn, could encourage private sector investment in the development of new treatments, possibly from an emerging class of drugs called geroprotectors that are aimed at the most fundamental mechanisms of aging.

Whatever the current health of an individual, negative beliefs about aging pose a health risk in themselves. A growing body of research has shown that older adults are more able to recover from disabling health events, less likely to experience depression, and more likely to live longer if they have positive self-perceptions in connection with aging. Ageism and isolation can undermine positive feelings. Globally, the World Health Organization is making efforts to reduce ageism and its effects on older adults’ health. In the United States, the nonprofit Frameworks Institute, with support from a coalition of aging and health organizations, is working to change the way older adults are viewed through the Reframing Aging project.

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Denise Logeland

Denise Logeland is a writer on issues of aging, and a former editor for PBS Next Avenue and Twin Cities Business magazine.

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