Health Status of Older Persons
Prior to the 20th century, most people did not reach old age, but this has now changed with most of the population living into old age. Public heath and preventive medicine measures are likely to further enhance longevity. The risk of disease and disability increases with age but it does not imply that old age is synonymous with disease and poor health. The increase in longevity and the higher prevalence of morbidity raises moral and ethical issues of quantity vs quality of life. In older patients there is a much greater prevalence of co-morbidities and sub-clinical disease (50% of those >65 years have 2 or more chronic diseases).
In the USA, a self assessment study found that 28% of older persons in their own home rated their health as fair or poor – 72% rated it excellent or good . 52% reported having at least one disability that limited them carrying out activities of daily living (ADL). In an Australian study, four health problems have been identified in subjective health evaluations – restricted mobility, sensory impairment, urinary incontinence and polypharmacy .
A profile of over 10 000 people over the age of 65 in England showed that 11% of men and 19% of women were disabled, based on a scoring system of ability to carry out activities of daily living . 38% of them had some form of cognitive impairment.
A paradox is that while women live longer than men, women have greater morbidity (eg rheumatoid arthritis). This implies that when measures of mortality are used, women have a greater health status then men. If morbidity was used, men are found to have a better health status (Kaplan & Andrews, 2000).
Most common reasons for death over the age of 65 years are :
Heart disease 35.1%
Malignant neoplasms 22.0%
Cerebrovascular disease 8.1%
Chronic obstructive pulmonary disease 5.5%
Pneumonia and influenza 4.6%
Diabetes mellitus 2.7%
Lincoln Gerontology Institute (1995) survey of 1000 people over age of 65 living in their own homes in Melbourne, Australia:
problems with legs and feet 36%
3/4 rated vision as good to excellent – women worse than men – 96% wore glasses
15% used a hearing aid
10% were current smokers. 45% were ex smokers
71% used prescribed medications. 15% were taking 5 or more medications
60% drove own cars as most common means of transport
40% had pain once or twice a month. 75% limited activities because of pain
22% had been admitted to hospital
70% had never seen a Podiatrist/62% had never seen a physiotherapist
The 10 most common reasons for a person over the age of 75 to visit a physician was for a general medical examination, vision dysfunction, post-operative visit, glaucoma, blood pressure check, cough, cataract, vertigo or dizziness, hypertension, back symptoms .
Characteristics of the Centenarians (over 100yrs) :
• think they are healthy and practice good health habits
• generally optimistic about life
• eat a varied diet and drink coffee, tea, and alcohol in moderation
• have like-long habits of mental and physical activity, enthusiastically enjoy walking
• regardless of educational level, most have good memories and continue to learn
• over 90% say that religion was important to them, though they are tolerant and not dogmatic
• tend to see the positive aspect of situations, are respectful of others and content with own life situation
• continue to have work to do; highly value work and doing things for others
• have broad social contacts and interests
• show tolerance for others and forgiveness of self
• demonstrate integrity and independence
Illness results in different experiences and has different significance to those who experience it. Williams (1990) five broad assumptions about the different ways that the older individual can use to cope with illness:
1) Illness is managed through normal living – everyday life keeps you going, and if you stop your illness gets worse
2) Illness as a constant struggle – determination not to become impaired is the key ingredient of this coping mechanism
3) Illness as an alternative way of life (not a common mechanism) – allows individuals with, for example, poor vision or mobility, to develop new behaviours that circumvent their disabilities (eg sedentary hobbies)
4) Illness as a loss to be endured – individuals respond to their limitations by abandoning previous activities and interests, stoically and without bitterness and resentment, but with resignation
5) Illness as a relief from effort – illness releases the individual from a continuing struggle – but they may have ambivalent feelings about this escape
These assumptions can be used a part of a model to predict the motivation for action or inaction when an individual is faced with an illness or disability.